Federal Reports

This audit responds to concerns raised about mail service in selected post offices in the Richmond District. Customers complained their mail was not delivered, tampered with, damaged, and mis-delivered. The Richmond District has 74 delivery units, 1,415 city routes in the Delivery Operations Information System, and 1,064,670 city delivery points. Our analysis of key city delivery performance indicators including carriers returning after 7 p.m., overtime hours used, and customer complaints identified 16 delivery units with poor performance.

A review of advances provided to approved grantees for the Partnership for Opportunity and Workforce and Economic Revitalization (POWER) program identified grantees that did not utilize the advances on a timely basis.

Every Postal Service-owned vehicle is assigned a Voyager credit card that is used to pay for its commercially purchased fuel, oil, and routine maintenance. OIG data analytics identified offices with potentially fraudulent Voyager card activity. The objective of this audit was to determine whether high-risk Voyager card transactions were properly reconciled, and Voyager card PINs were properly managed at the Roseburg, OR, Post Office.

The U.S. Department of Housing and Urban Development (HUD), Office of Inspector General audited Columbia Housing Authority in Columbia, MO because it was the only public housing agency in the State of Missouri that had converted units under the U.S. Department of Housing and Urban Development’s RAD program at the time. Our objective was to determine whether the Authority maintained auditable written records of resident relocation incentive payment consultations and properly paid business relocation incentive payments.We found that the Authority did not maintain the required written records of resident relocation incentive payment consultations. As a result, the Authority was unable to demonstrate that $126,824 in incentive payments were fair and consistent. In addition, the Authority risked an appearance of favoritism. We also found that the Authority paid $9,608 for a business owner’s relocation costs and financial losses without calculating the previous 2 years of average annual net earnings. As a result, HUD lacked assurance that the Authority properly paid a displaced business in lieu of payment for actual moving and related expenses. We recommend that the Director of HUD’s St. Louis, MO, Office of Public Housing require the Authority to require CHA to support $126,824 in incentive payments and develop and implement controls over its incentives program, including record-keeping requirements; defined processes, such as detailed checklist of available incentives, including monetary limits; and supervisory review requirements. Additionally, we recommend that HUD take appropriate administrative action and require the Authority to support the $9,608 payment with the required 2 years of annual net earnings.

Overdose deaths are at epidemic levels and the opioid crisis is now considered a public health emergency. In 2016, there were more than 42,000 opioid-related overdose deaths in the United States-115 deaths per day. Nearly 7,000 of these deaths occurred in five States in the Appalachian region-Alabama, Kentucky, Ohio, Tennessee, and West Virginia. All five of these States had high opioid prescribing rates and four reported opioid-related overdose death rates that far exceeded that of the Nation. Identifying beneficiaries who are at risk of overdose or abuse is key to addressing this crisis. This data brief provides data on opioid use in Medicare Part D in these five States in 2017, including the number of beneficiaries who were at serious risk of opioid misuse or overdose.

The OIG investigated allegations that a Bureau of Safety and Environmental Enforcement (BSEE) official might have improperly communicated with contractors. The complaint also alleged that the official may have improperly influenced modifications to contracts, and that he might have arranged for an organization to receive a subcontract.We found that the official met with contractors, but that the discussions in these meetings focused only on operations related to the offshore oil and gas industry. We did not find any laws or policies that prohibit these types of meetings. In addition, we found no evidence that the official discussed contracts with the organizations involved or that he influenced the award of any contract modifications or subcontracts.

The VA Office of Inspector General (OIG) conducted a healthcare inspection in response to a complaint that staff at the VA Boston Healthcare System in Massachusetts inappropriately discontinued consults (healthcare providers use consults to request an opinion, advice, or expertise regarding patients’ specific problems). The OIG reviewed a sample of discontinued consults and determined that none of these consults were processed inappropriately. The OIG verified that facility leaders and managers monitored and analyzed consult data, communicated with service leaders about identified concerns, implemented clinical and administrative processes for performance improvement, and monitored the results. The Veterans Integrated Service Network (VISN) provided oversight for tracking patients’ access to care, managing consults, and other facility performance measures. VISN leaders conducted monthly management meetings to review patients’ access to care and consult processing concerns, as well as performance data with facility leaders. Facility managers provided monthly reports on access to care and consult processing to a VISN manager, who tracked facility action plans related to access to care. Based on interviews and review of facility committee minutes and action plans, the OIG concluded that facility leaders were actively engaged and had effective performance improvement and consult management processes in place. Therefore, the OIG made no recommendations.

The VA Office of Inspector General (OIG) reviewed a complainant’s allegations and substantiated that the facility’s providers, at the time of a patient’s most recent hospital admission, failed to complete thorough evaluations including reconciliation of medications. The incomplete evaluation may have contributed to the patient’s declining health and likely hindered the provision of additional needed treatment. Providers failed to appropriately treat the patient’s underlying condition or recognize potential signs of illness such as an elevated white blood cell count. The OIG would have expected the providers to identify and remove the source of infection. The OIG was unable to determine whether the providers’ failures contributed to the patient’s death. The OIG was unable to determine whether system providers discharged the patient without a discussion with the family of the patient’s medical condition. However, the patient was competent and was included in care discussions; including family members in the discussions was not required. The OIG substantiated that providers did not communicate care options to mitigate the patient’s suffering. In addition, podiatry clinic staff did not consistently follow system policy for scheduling appointments and wound care clinic consults were not performed as required. Coordination of care expected for a geriatric patient with chronic illnesses, multiple wounds, and who was “at risk” for foot ulcers was lacking and care was fragmented. Deficiencies in the patient’s care coordination likely contributed to the patient’s worsening wounds. The podiatry attending physician did not document resident supervision in accordance with system policy. The OIG made eight recommendations related to medication reconciliation, provider education, infection source, care transitions, discharge planning, podiatry clinic scheduling, wound care clinic consults and practices, and resident supervision.