Federal Reports

In response to the Coronavirus Aid, Relief, and Economic Security (CARES) Act, the VA Office of Inspector General (OIG) reviewed the Veterans Health Administration’s (VHA) tracking and reporting of COVID-19 supplemental funding from legislation for pandemic relief.VA met monthly reporting requirements to OMB and Congress on supplemental fund obligations and expenditures. VA also submitted required weekly obligations and expenditures from supplemental funding to OMB by program activity. Of approximately $17.3 billion in medical care supplemental funds, VA reported it had obligated about $7.11 billion and had spent about $5.67 billion by December 29, 2020.The OIG team noted three concerns where VA’s reporting was not complete and accurate:• Obligations were at risk of not being included in VA’s reports.• VA initially delayed the reporting of reimbursable obligated amounts for two months.• VA’s reports contained negative dollar amounts in data fields that should have only positive amounts, which misstated VA’s overall reported obligations.Those concerns indicate weaknesses in how VA and VHA internal controls are structured to meet reporting requirements. Despite the risks identified, VA performed only a limited review at the summary fund level of its COVID-19 obligations and expenditures before reporting. A review of summary funds is not detailed enough to identify potential anomalies and ensure reliability of externally reported information. OMB’s guidance required VA to report on obligations and expenditures classified by the type of items or services purchased.The OIG concluded that the three identified variances affected the quality of reporting. Given the inherent risks due to outdated financial information technology infrastructure, the OIG recommended developing a procedure to review and validate the data at the program activity level to ensure information accurately represents the underlying source transactions. This procedure would help ensure proper accounting for all COVID-19 obligations and expenditures.

The VA Office of Inspector General (OIG) reviewed how underlying human resources processes affect VA’s reporting of staffing and vacancy data on its public website. The VA MISSION Act of 2018 requires VA to release this information quarterly. The law also requires the OIG to review the website periodically and recommend improvements.In this third annual report, the OIG found VA has acted to address longstanding data integrity concerns with its system for reported staffing and vacancy information. However, VA continues to experience challenges reconciling its position data. For example, both the Veterans Health Administration (VHA) and the Veterans Benefits Administration reported discrepancies between the actual number of vacant positions and the corresponding inventory in the system.The OIG identified opportunities for VA to improve the transparency and governance of HR Smart’s data, and thus improve the quality of reported information. Standardized guidance for position management and a perpetual oversight mechanism would also ensure data were consistently created, properly maintained, and continually reviewed.The OIG also found VHA human resources practices affected the transparency of staffing and vacancy data. VHA delegated much of its data reconciliation to its local facilities, which introduced variability in the process and did not allow for consistent creation, maintenance, and verification of information. VHA also had inadequate business processes to ensure quality data were available to support effective medical facility staffing oversight.Without consistent methods and reliable source documents for managing information, VHA cannot be sure HR Smart data accurately reflect VA’s budget and workload requirements.The OIG recommended examining and validating HR Smart inventory data, establishing standards to ensure positions are consistently approved, created, and maintained, and regularly monitoring position management. The OIG also recommended implementing policy and procedures for staffing level approvals and publishing detailed guidance establishing authoritative position management documents.

This audit is one of a series of audits to determine whether States had recovered, and returned the correct Federal share of, improper Medicaid claims amounts and damages. For this audit, we focused on Nebraska’s Medicaid Fraud Control Unit (MFCU) actions related to Medicaid overpayments from legal judgments and settlements that the State had pursued under relevant Medicaid fraud statutes. Nebraska is required to report recoveries for these MFCU-determined Medicaid overpayments to the Centers for Medicare & Medicaid Services (CMS) and to refund the Federal share to the Federal Government.Our objective was to determine whether Nebraska reported and returned the correct Federal share of MFCU-determined Medicaid overpayments identified during the period October 1, 2011, through September 30, 2018.

Why OIG Did This AuditThe Medicare hospice benefit allows providers to claim Medicare reimbursement for hospice services provided to individuals with a life expectancy of 6 months or less who have elected hospice care. Previous OIG audits and evaluations found that Medicare inappropriately paid for hospice services that did not meet certain Medicare requirements.Our objective was to determine whether hospice services provided by Professional Healthcare at Home, LLC (Professional Healthcare), complied with Medicare requirements.How OIG Did This AuditOur audit covered 3,458 claims for which Professional Healthcare (located in Fairfield, California) received Medicare reimbursement of $20.3 million for hospice services provided from April 1, 2016, through March 31, 2018. We reviewed a random sample of 100 claims. We evaluated compliance with selected Medicare billing requirements and submitted these sampled claims and the associated medical records to an independent medical review contractor to determine whether the services met coverage, medical necessity, and coding requirements.

An Amtrak coach cleaner based in Chicago, Illinois, was terminated from employment on June 10, 2021, following his administrative hearing. Our investigation found that the former employee violated company policy by failing to report his arrest and conviction for driving under the influence and failing to report two other criminal convictions while employed by the company.