Federal Reports

Under the home health prospective payment system (PPS), the Centers for Medicare & Medicaid Services pays home health agencies (HHAs) a standardized payment for each 60-day episode of care that a beneficiary receives. The PPS payment covers intermittent skilled nursing and home health aide visits, therapy (physical, occupational, and speech-language pathology), medical social services, and medical supplies.

Semiannual Report to Congress: Covering October 1, 2018 - March 31, 2019

We determined that DHS did not comply with Improper Payments Elimination and Recovery Act of 2010 (IPERA) because it did not meet two of the six requirements. Specifically, the Department omitted the percent of recaptured amounts from the Other Information section in its Agency Financial Report and did not meet its annual reduction target established for one of eight programs deemed susceptible to significant improper payments. DHS also did not comply with Executive Order 13520, Reducing Improper Payments, because it did not make available to the public DHS’ Quarterly High-Dollar Overpayment report for the second quarter of FY 2018. In addition, the third-quarter report DHS posted on its website erroneously excluded information on actions the agency has taken to recover high-dollar overpayments. Additionally, we reviewed DHS’ processes and procedures for estimating its annual improper payment rates. Based on our review, we determined that DHS did not provide adequate oversight of the components’ improper payment testing and reporting. We made seven recommendations to DHS’ Risk Management and Assurance Division to follow the Office of Management and Budget’s requirements to comply with IPERA, and to strengthen its oversight and review procedures for IPERA risk assessments.

The Tennessee Valley Authority’s (TVA) drawing program is designed and maintained to document the configuration of TVA’s systems, structures, and components. Drawings are utilized for a variety of reasons, including plant operation, maintenance activities, troubleshooting, and to establish clearance boundaries for isolating equipment so that work can be performed safely. Modifications to configuration should be captured through TVA’s Design Change Notice (DCN) process to ensure configuration control is maintained and drawings are updated to reflect the changes. Due to the importance of accurate drawings to plant personnel safety, we initiated an evaluation of Coal Operations’ DCN process. Our objective was to determine if the DCN process was being followed for modifications made to coal plant drawings. We determined that when the DCN process was utilized, DCNs were generally in compliance with procedural requirements and drawings appeared to have been updated accordingly. However, we determined the DCN process was not always followed for modifications made to coal plant drawings. Specifically, we found (1) modified drawings onsite that had not been updated through DCNs; (2) hand-illustrated drawings utilized in lieu of approved, computer-generated drawings; (3) outdated drawings potentially referenced in the course of work; and (4) reluctance at the sites to initiate the DCN process. Additionally, we identified opportunities for improvement related to (1) training, (2) drawing descriptions, (3) communication of DCN status and drawing availability, and (4) outdated standard programs and processes and intergroup agreements.

We recommend that the DHS Office of the Chief Security Officer address planning, policy, and acquisition deficiencies prior to further implementation of the expanded scope of the Insider Threat Program. Specifically, the alert highlighted deficiencies we identified in planning and implementing of the expanded Insider Threat Program, including issues with acquisition management, and revision and completion of required documentation. These issues required immediate attention and corrective action to ensure efficiency and effectiveness of the program. We issued four recommendations and the Department concurred with all of them.