Federal Reports

The Office of the Inspector General (OIG) conducted an inspection of GPO’s Suspension and Debarment Program to understand its overall process, associated timelines, and evaluate the effectiveness of the dissemination of debarments inside and outside of GPO.

The VA Office of Inspector General (OIG) examined whether Veterans Health Administration (VHA) medical facilities managed time and attendance for part-time physicians on adjustable work schedules to ensure salary payments were accurate.Part-time physicians on adjustable work schedules sign agreements estimating the number of hours they will work. They are paid according to that figure, up to a maximum of 1,820 hours a year, even if they work more or fewer hours. The physicians track the number of hours actually worked in the time and attendance system. At the end of the agreement period, payroll personnel reconcile the physicians’ salary payments against the hours worked, reimbursing for underpayments and billing for overpayments.Based on a review of 134 such agreements ending in 2019, the OIG found VHA medical facilities did not adequately manage time and attendance to ensure physicians were paid correctly for an estimated 44 percent of agreements. This occurred because key management controls were missing or not working. Officials did not make certain that medical facilities complied with policies and procedures.Consequently, the OIG estimated VHA medical facilities had about $8.3 million in questioned costs that year, and an additional $8.3 million in 2020. VHA medical facilities also may have violated the prohibition against voluntary services, and potentially the Antideficiency Act, by not correcting underpayments or by having physicians working above the 1,820-hour cap because their agreements were not properly reconciled.The OIG made nine recommendations to strengthen management controls, including completing overdue reconciliations, correcting inaccurate payments, and determining whether Antideficiency Act violations occurred. Recommendations also included ensuring time and attendance records are validated and certified, physicians do not significantly deviate from their agreements or work more than 1,820 hours in a service year, and reconciliations and associated payment corrections are promptly completed.

The VA Office of Inspector General (OIG) conducted a healthcare inspection to evaluate a primary care provider’s completion of electronic health record (EHR) documentation within the facility’s required time frame and accumulation of over 4,000 view alerts (EHR notifications) that may have resulted in patients’ adverse clinical outcomes. Also reviewed were actions taken by facility leaders to address the provider’s EHR documentation deficiencies.The OIG’s review of 220 identified patients’ care did not find adverse clinical outcomes related to the provider’s delinquent documentation. The OIG was unable to determine if patients experienced adverse clinical outcomes from the provider accumulating 4,000 view alerts, because the view alerts were addressed prior to the OIG inspection. Once addressed, view alerts are no longer active or viewable. Facility leaders reported finding no adverse clinical outcomes resulting from these view alerts.Facility leaders implemented actions to address the provider’s documentation deficiencies and monitored the provider for sustainable compliance with documentation requirements. The provider no longer treats patients at the facility.High numbers of accumulated view alerts were not isolated to the provider. However, facility leaders implemented strategies to reduce the number, and facility data showed a reduction of accumulated view alerts. Facility leaders need to continue to develop and implement strategies to manage and evaluate the effectiveness of view alerts and assess the need for retrospective reviews of patient care related to accumulated view alerts.During the inspection, the OIG also found that Health Information Management staff were not monitoring EHRs for patient care episodes without associated progress notes and facility policy did not define the time frame for providers to respond to view alerts as required by the Veterans Health Administration.The OIG made three recommendations related to providers’ view alert time frames and monitoring EHRs and view alerts.