Federal Reports

OIG investigated allegations that the United Mine Workers of America Health and Retirement Funds (UMWAF) was not adhering to Federal law and regulations concerning three federally supported health benefit plans. According to the allegations, the UMWAF enrolled beneficiaries in the combined benefit fund (CBF) after the enrollment cutoff date and inflated the beneficiary numbers by retaining deceased beneficiaries in its records. The UMWAF reportedly also provided legal advice to a coal company during bankruptcy proceedings and failed to pursue recovery of other coal companies’ delinquent benefit plan premiums. Lastly, the UMWAF allegedly falsified enrollment documents so that beneficiaries would qualify for Federal support.We found that the UMWAF enrolled 1,909 beneficiaries into the CBF after the enrollment cutoff date and paid this population an estimated $96 million in benefits. After we initiated our investigation, however, the DOI Office of the Solicitor concluded that there was conflicting authority on this issue. The Office of Surface Mining Reclamation and Enforcement (OSMRE) will review beneficiary lists with this in mind before completing the fiscal year 2018 transfer requests. We could not determine if the UMWAF inflated beneficiary numbers by retaining deceased beneficiaries, because it did not provide detailed lists to the Government during funding requests.We also found no evidence that the UMWAF provided legal advice to a coal company during its bankruptcy proceedings, that the UMWAF failed to pursue delinquent coal operator premiums, and that the UMWAF falsified enrollment documents. We presented our findings to the U.S. Attorney’s Office for the District of Columbia, which declined prosecution.

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 Central Alabama Veterans Health Care System (facility). The review covered key clinical and administrative processes associated with promoting quality care—Leadership and Organizational Risks; Quality, Safety, and Value; Environment of Care; Medication Management: Anticoagulation Therapy; Coordination of Care: Inter-Facility Transfers; Mental Health Residential Rehabilitation Treatment Program; and Post-Traumatic Stress Disorder Care. OIG also provided crime awareness briefings to 194 employees.The facility has generally stable executive leadership and ongoing processes to improve employee and patient satisfaction. OIG’s review of accreditation organization findings, sentinel events, disclosures, Patient Safety Indicator data, and Strategic Analytics for Improvement and Learning (SAIL) results did not identify any substantial organizational risk factors. The senior leadership team was knowledgeable about selected SAIL metrics but should continue to take actions to improve care and performance of selected SAIL metrics, particularly Quality of Care and Efficiency metrics likely contributing to the current 3-star rating.OIG noted findings in four of the six areas of clinical operations reviewed and issued seven recommendations that are attributable to the Chief of Staff and Associate Director. The identified areas with deficiencies are:(1) Quality, Safety, and Value • Ongoing Professional Practice Evaluation data review(2) Coordination of Care: Inter-Facility Transfers• Informed consent and required transfer documentation(3) Environment of Care• Attendance of Environment of Care rounds• Locked mental health unit Interdisciplinary Safety Inspection Team training(4) Post-Traumatic Stress Disorder Care• Completion of suicide risk assessments• Referral for and completion of diagnostic evaluations

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 Robert J. Dole VA Medical Center (facility). The review covered key clinical and administrative processes associated with promoting quality care—Leadership and Organizational Risks; Quality, Safety, and Value; Medication Management: Anticoagulation Therapy; Coordination of Care: Inter-Facility Transfers; Environment of Care; High-Risk Processes: Moderate Sedation; and Long-Term Care: Community Nursing Home Oversight. OIG also provided crime awareness briefings to 96 employees.The facility has generally stable executive leadership to support patient safety and quality care. OIG’s review of accreditation organization findings, sentinel events, disclosures, Patient Safety Indicator data, and SAIL results did not identify any substantial organizational risk factors. The senior leadership team was knowledgeable about selected SAIL metrics but should continue to take actions to improve care, overall employee satisfaction, and performance, particularly Quality of Care and Efficiency metrics likely contributing to the current 3-star ranking.OIG noted findings in the six areas of clinical operations reviewed and issued 14 recommendations. The identified areas with deficiencies are:(1) Quality, Safety, and Value • Senior-level committee for quality, safety, and value functions• Physician Utilization Management Advisors’ documentation of decisions(2) Medication Management: Anticoagulation Therapy• Collecting, analyzing, and reporting quality assurance data• Employee competency assessments(3) Coordination of Care: Inter-Facility Transfers• Transfer data collection and reporting• Resident supervision and staff/attending physician countersignatures(4) Environment of Care• Environment of care rounds attendance• Panic alarm testing(5) High Risk Processes: Moderate Sedation• Pre-sedation airway and post-procedure pain level assessments(6) Long-Term Care: Community Nursing Home Oversight• Oversight committee meeting requirements• Integration into the facility quality improvement program• Annual reviews• Cyclical clinical visits

To watch a short video regarding the findings of this report, please click the link below.