Federal Reports

The VA Office of Inspector General (OIG) conducted a focused evaluation of the quality of care delivered in the inpatient and outpatient settings of the VA Southern Nevada Healthcare System. The review covered key clinical and administrative processes associated with promoting quality care—Leadership and Organizational Risks; Quality, Safety, and Value; Credentialing and Privileging; Environment of Care; Medication Management: Controlled Substances Inspection Program; Mental Health: Posttraumatic Stress Disorder; Long-term Care: Geriatric Evaluations; Women’s Health: Mammography; and High-risk Processes: Central Line-Associated Bloodstream Infections. The Facility had generally stable executive leaders who appeared actively engaged with employees. However, opportunities exist to improve patient experiences in the outpatient setting. The OIG reviewed accreditation agency findings, adverse events, Patient Safety Indicator data, and Strategic Analytics for Improvement and Learning (SAIL) results and did not identify any substantial organizational risk factors. The leadership team was knowledgeable about selected SAIL metrics but should continue to take actions to improve performance of Quality of Care and Efficiency metrics likely contributing to the current “2-Star” rating. The OIG noted findings in four of the eight areas reviewed and issued eight recommendations attributable to the Director, Chief of Staff, and Associate Director. The identified areas with deficiencies are: (1) Credentialing and Privileging • Focused Professional Practice Evaluation process (2) Environment of Care • Panic alarm testing (3) Medication Management: Controlled Substances Inspection Program • Annual physical security survey • Monthly inspections • Reconciliation process (4) Long-term Care: Geriatric Evaluations • Program evaluation

We performed an evaluation to determine whether demolition and decontamination activities at Widows Creek Fossil Plant (WCF) (1) adhered to safety principles found in the TVA Decommissioning, Deactivation, Decontamination, and Demolition (D4) Program Guide and (2) complied with selected safety criteria established in Brandenburg’s Health and Safety Plan (HASP) for WCF. We determined TVA and Brandenburg met selected safety requirements established in TVA’s D4 Program Guide and Brandenburg’s HASP for WCF. However, during our site visit, we noted safety hazards related to an eyewash station and personal protective equipment that were immediately addressed.

We determined that U.S. Customs and Border Protection (CBP) failed to ensure the timely collection, write-off, and processing of delinquent debt from importers during fiscal years 2014–16. Instead, CBP settled for collecting funds from importer surety bonds, which yielded less than 1 percent of the more than $189 million owed from importers. CBP did not exhaust all administrative efforts in its collection duties. This included completing required research — currently known as viability analysis worksheets — to determine the importers’ ability to pay, and the availability of assets to ensure the timely collection or termination of a debt. Additionally, CBP’s inability to properly track debt prevented the processing of more than $84 million of the delinquent debt during fiscal years 2014–16. CBP concurred with our four report recommendations. When implemented, these recommendations should improve CBP’s revenue collection process.

The County received about $28.1 million in Public Assistance grant awards from Florida — a FEMA grantee — for damages from severe storms, tornadoes, straight-line winds, and flooding in April and May 2014. Jackson County was the first subgrantee in Florida to be approved for a grant award obligation under the Federal Emergency Management Agency’s (FEMA) Public Assistance Alternative Procedures (PAAP) pilot program. The Sandy Recovery Improvement Act of 20131 authorized PAAP and authorized FEMA to implement alternative procedures through the PAAP pilot program. Florida did not fulfill its grantee responsibility to ensure the County followed applicable Federal grant management requirements, and FEMA did not ensure the grantee carried out its responsibilities

We issued this alert because, during our audit, we identified serious performance issues with U.S. Customs and Border Protection's (CBP) contract with Accenture. Accenture has yet to demonstrate the efficient, innovative, and expertly run hiring process described in its initial Performance Work Statement. In addition, before awarding Accenture the contract, CBP did not ensure the proposed systems and processes, such as applicant tracking, complied with all applicable laws and regulations or could be integrated into its hiring process. CBP also did not establish metrics to assess the contractor’s performance and hold the contractor accountable. Further, CBP allowed Accenture to use EyeDetect technology (retinal scanning tool used to discern deception) at an August 2018 hiring expo without proper approval. Unless CBP uses EyeDetect in its hiring process in the same manner Accenture does, it could potentially constitute a prohibited hiring practice. This could, in turn, subject CBP to increased legal risk and oversight by other federal agencies and Congress into CBP’s hiring practices. As of October 1, 2018 CBP had paid Accenture about $13.6 million for startup costs, security requirements, recruiting, and applicant support. In return, Accenture processed two accepted job offers. We recommended CBP assess Accenture’s performance under this contract. CBP concurred with our four recommendations.

The National Institutes of Health (NIH) is one of several Federal agencies that ship and receive select agents. In 2015, another Federal agency found that one of its facilities had inadvertently shipped live Bacillus anthracis, a select agent which causes the deadly disease anthrax, to 194 laboratories in the United States and other countries. In response to these events, we initiated a review of the policies, procedures, and protocols NIH implemented to ensure the safe shipment of select agents to and from its laboratories.