Federal Reports

The Office of the Inspector General conducted a review of Supply Chain’s Sourcing organization to identify operational and cultural strengths and risks that could impact Sourcing’s organizational effectiveness. Our report identified strengths within Sourcing related to (1) teamwork, (2) direct management support for 3 of 4 departments, (3) perceptions of an ethical culture, and (4) customer support. However, we also identified issues that, if left unresolved, could increase the risk that Sourcing will be unable to effectively meet its objective in the future. These risks related to (1) alignment, (2) the selection process, (3) management behaviors, and (4) work management.

For calendar years 2015 and 2016, Liberty Medical, LLC, (Liberty), which is located in Port St. Lucie, Florida, did not always comply with Medicare requirements when billing for inhalation drugs. Of the 100 claim lines in our sample, 94 complied with the requirements; however, the remaining 6 claim lines did not comply with the requirements. Specifically, Liberty did not provide us with medical records for four claim lines and did not have adequate proof-of-delivery documentation for two claim lines. As a result, Liberty received $2,408 in unallowable Medicare payments.

Audit of the NLRB's purchase card program.

Review of NLRB purchase card transactions using forensic testing.

We audited an agreement between the Aleutian Pribilof Island Association (APIA) and the Bureau of Indian Affairs (BIA) to provide clients with job training, work, and education-related opportunities that lead to employment and self-sufficiency.During our audit, we found that APIA claimed costs that were unsupported and unallowable in accordance with the contract terms, applicable Federal laws and regulations, and BIA guidelines. We questioned $18,246 in costs claimed under the contracts and found deficiencies in APIA’s management of the contract. We issued two Notices of Finding and Recommendation (NFRs) to APIA during our fieldwork.We offered two recommendations to help BIA oversee APIA management of contract funds. Though APIA did not concur with either of the recommendations, its responses to the NFRs and adjustments to its files since we issued them caused us to consider these two recommendations to be resolved and implemented.

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The VA Office of Inspector General (OIG) conducted a healthcare inspection at the request of Senator Joe Manchin to review the postoperative care of a patient (Patient) who had vascular surgery at the Martinsburg VA Medical Center (Facility), West Virginia. In general, the OIG found the Patient’s immediate postoperative care was proper. However, the OIG had concerns with the Patient’s management at the Community Based Outpatient Clinic (CBOC) 10 days after the procedure when the Patient presented with signs and symptoms of a known vascular procedure complication. After an endovascular aneurism repair (EVAR), the Patient’s clinical condition was consistent with cholesterol embolization syndrome which has no accepted specific therapy. On EVAR post-operative day (POD) 14, the Patient had amputations of three toes and was noted to have infection in the amputated bone. The OIG could not determine if earlier toe amputations would have prevented the bone infection. On POD 10, after determining the Patient was experiencing a medical emergency, CBOC patient aligned care team staff did not ensure coordination of the Patient’s subsequent care. Staff failed to facilitate a safe transition between the CBOC and a non-VA hospital equipped to treat the Patient. Staff did not communicate relevant information or provide health record information to providers at the non-VA hospital upon learning where the Patient planned to seek emergency treatment. The OIG found deficiencies in Veterans Health Administration policy compliance with the lack of policy or standard operating procedure on the management of health emergencies in the CBOC and inconsistent health record documentation for the Patient. The OIG made three recommendations related to coordination of care, health emergency management, and health record documentation.