Federal Reports

The audit objectives were to determine whether program funds were managed in accordance with the ARC and Federal grant requirements

In May and October 2017, the VA Office of Inspector General (OIG) received several complaints alleging mismanagement and misuse of the VA Executive Protection Division. The complainants alleged ineffective procedures, scheduling and overtime abuses, pay administration issues, time card fraud, and various policy violations. They also alleged the misuse of the Executive Protection Division by former VA Secretary David Shulkin. The OIG substantiated that VA mismanaged the Executive Protection Division from at least 2015. The OIG found that there were no published operational policies or procedures on critical executive protection functions and a lack of adequate threat assessments. The OIG also identified several potential security vulnerabilities caused by members of the Executive Protection Division, as well as abuses by agents who claimed to be performing official duties when they were not. Secretary Shulkin relied on advice from the Office of Operations, Security, and Preparedness on how and when to use protection services. The OIG concluded that it was within Secretary Shulkin’s discretion to use the Executive Protection Division as he did. However, the OIG also found that government resources (vehicle and official time) were used on a few occasions to provide transportation to the Secretary’s spouse and that Secretary Shulkin violated ethical regulations by permitting his VA employee driver to use a personal vehicle and personal time to provide transportation services to the Secretary’s wife. VA concurred with the OIG's 12 recommendations, including that VA publishes policies to regulate essential functions of the Executive Protection Division, develops adequate threat assessments, institutes procedures to report and address security lapses, holds agents accountable for contributing to security lapses, makes certain agents and supervisors are held accountable for any overtime and travel reimbursement abuses, and provides the principal under protection a thorough orientation to the appropriate uses of the division’s services.

From January 1, 2015, through March 31, 2017 (audit period), Kelley Medical Equipment and Supply, LLC (Kelley Medical), which is located in Durant, Oklahoma, did not always comply with Medicare requirements when billing for selected orthotic braces (i.e., back, knee, and ankle-foot braces). For 24 of the 100 sampled beneficiaries, Kelley Medical complied with the requirements. However, for the remaining 76 beneficiaries, it did not comply with the requirements. Specifically, Kelley Medical billed for orthotic braces that were not medically necessary for 67 beneficiaries and could not provide medical records for 9 beneficiaries.

In the Spring of 2018, the Department of Justice and Department of Homeland Security (DHS) implemented a "zero-tolerance policy" for certain immigration offenses. As a result, DHS separated large numbers of alien families, with adults being held in Federal detention while their children were transferred to the care of the Office of Refugee Resettlement (ORR) within the Department of Health and Human Services (HHS). On June 26, 2018, in a class action lawsuit, Ms. L v. U.S. Immigration and Customs Enforcement (ICE), a Federal District Court ordered the Federal Government to identify and reunify separated families who met certain criteria. Given the potential impact of these actions on vulnerable children and ORR operations, the Office of Inspector General (OIG) conducted this review to determine the number and status of separated children (i.e., children separated from their parent or legal guardian by DHS) who have entered ORR care, including but not limited to the subset of separated children covered by Ms. L v. ICE.

In the Spring of 2018, the Department of Justice and Department of Homeland Security (DHS) implemented a "zero-tolerance policy" for certain immigration offenses. As a result, DHS separated large numbers of alien families, with adults being held in Federal detention while their children were transferred to the care of the Office of Refugee Resettlement (ORR) within the Department of Health and Human Services (HHS). On June 26, 2018, in a class action lawsuit, Ms. L v. U.S. Immigration and Customs Enforcement (ICE), a Federal District Court ordered the Federal Government to identify and reunify separated families who met certain criteria. Given the potential impact of these actions on vulnerable children and ORR operations, the Office of Inspector General (OIG) conducted this review to determine the number and status of separated children (i.e., children separated from their parent or legal guardian by DHS) who have entered ORR care, including but not limited to the subset of separated children covered by Ms. L v. ICE.

This healthcare inspection assessed allegations that over a multi-year period, providers at three facilities ordered or continued to order a high dose of an antidepressant medication amitriptyline for a patient who was not told about the risks of the high dose, and was experiencing some side effects associated with the medication. Additionally, when asked about attempts to reduce the dose of the patient’s medication, the VA Illiana Health Care System (system) in Danville, Illinois, provided Senator Joe Donnelly inaccurate information. The Office of Inspector General (OIG) substantiated VA providers did not explain to the patient that the amitriptyline dosing was higher than the drug labeling for outpatients or the risks of the high dosage during the period of care from 2012 through mid-2018. In 2012, a provider at the Orlando VA Medical Center (VAMC) in Florida ordered an electrocardiogram but did not inform the patient about an abnormality or discuss the potential that the high dose of amitriptyline contributed to the abnormality. At another VAMC in Indianapolis, Indiana, the ordering provider did not notify the patient that 2016 test results indicated a subtherapeutic level of amitriptyline. At the system, there was no follow-up to the patient’s expressed cardiac concerns due to a failed collaboration between the system’s treating psychiatrist and a primary care provider. Due to other potential causes, the OIG was unable to substantiate the patient experienced tachycardia or short-term memory loss because of taking amitriptyline. The system’s response to Senator Donnelly was not timely and included inaccurate information. The OIG made eight recommendations related to evaluations of the patient’s cardiac care, patient notification of electrocardiograms and blood tests, the strengthening of system processes for effective clinical consultation between providers and congressional inquiry responses, and an evaluation of system staff actions in preparation of the letter to Senator Donnelly.