Federal Reports

The OIG examined whether the Veterans Health Administration (VHA) provided effective oversight of its two third-party administrators (TPAs), Optum and TriWest, to make sure VHA made accurate and timely community care payments for outpatient healthcare and dental services. The OIG estimated that VHA accurately paid Optum for outpatient healthcare services 98.6 percent of the time, totaling $5.1 billion for 33.1 million transactions, and accurately paid TriWest 99.8 percent of the time, totaling $4.4 billion for 25 million transactions. Review periods varied, and although error rates were small, the combined estimated errors resulted in overpayments of about $178.5 million because VHA did not charge the correct Medicare rate or applicable VA fee rate, sometimes because these rates were not available. VHA has made some overpayment recoveries, but others still need to be completed.
Community providers, VHA, and the TPAs generally met contract requirements for payment timeliness. Review periods varied. For Optum, the on-time rates were the following: providers submitting claims to the TPA, 99.8 percent; the TPA paying the provider, 97.8 percent; and VHA reimbursing the TPA, 92.5 percent. For TriWest, these on-time rates were, respectively, 99.9 percent, 98.2 percent, and 97.4 percent.
The OIG estimated that VHA paid over $900 million more to both TPAs combined than the TPAs paid community providers for dental services. This occurred because the contracts for four of the five community care regions did not limit VHA’s reimbursement payments to TPAs to the amount the providers invoiced to the TPAs.
VHA officials concurred with six of the OIG’s seven recommendations; they concurred in principle with recommendation 3.

Our Objective(s)To evaluate single audit reports uploaded to the Federal Audit Clearinghouse between October 1, 2024 and December 31, 2024, and identify findings that affect directly awarded Department of Transportation (DOT) programs.
Why This AuditOIG performs oversight of independent, non-Federal auditors' single audit reports. Over the past 3 fiscal years, on average over 250 single audit reports were issued that included findings related to programs directly funded by DOT. We issue memoranda that summarize the single audit reports' significant findings and recommendations that require priority action by DOT. When warranted, we also recommend that DOT recover funds that were inappropriately expended by non-Federal entities.
What We FoundAuditors reported 29 incidents of significant noncompliance with Federal guidelines related to 14 grantees that require prompt actions from DOT's Operating Administrations.

Of 29 findings, 12 were repeat findings related to 4 grantees.

Auditors identified questioned costs totaling $6,873,168 for seven grantees.

Of this amount, $5,574,091 was related to The Navajo Nation, Window Rock, AZ and $419,296 was related to Toledo Area Regional Transit Authority, Toledo, OH.

We identified nonmonetary repeat findings that caused disclaimers of opinions for two entities.
RecommendationsWe made four recommendations to OST to resolve and close the findings and recover questioned costs, if applicable.

While the EPA Office of Water issued two memorandums on implementing the Build America, Buy America Act requirements, its guidance related to manufactured products, documenting compliance, the consequences for noncompliance, using current waivers, and applying for new waivers was not sufficient. Without additional guidance, state revolving fund program administrators and manufacturers had concerns about complying with the Act's requirements.