Federal Reports

Prior OIG audits found that hospitals in six Medicare Administrative Contractor (MAC) jurisdictions counted residents (including interns) as more than one full-time equivalent (FTE) and, as a result, received excess Medicare graduate medical education (GME) reimbursement. This report summarizes the findings of those audits, providing information that may assist the Centers for Medicare & Medicaid Services (CMS) and MACs to achieve greater efficiency in the operation of Medicare.

We investigated an anonymous complaint alleging that Superintendent Ed Clark of Gettysburg National Military Park (GETT) violated ethics rules by soliciting funds on behalf of the Gettysburg Foundation, a non-Government organization; accepting Foundation-funded travel to events sponsored by the Foundation and those sponsored by other non-Government entities; and hosting a Foundation-funded dinner for his employees.We found that from February 2014 to October 2016, Clark traveled 27 times to attend events organized by the Foundation. We found that Clark committed criminal violations by submitting false travel vouchers and by accepting more than $23,000 in meals, lodging, and other in-kind gifts from non-Government organizations as compensation for his official services. In addition, he violated laws and regulations by failing to obtain required supervisory and ethics approval prior to taking these trips and by failing to report expenses accurately following his trips.We also found that his subordinate staff approved his travel authorizations, that he sometimes traveled without first submitting a travel authorization request, and that he requested full per diem reimbursement even though the Foundation paid for some of his meals during those trips.We found that Clark functioned as GETT’s liaison to the Foundation without prior supervisory approval or consulting with ethics officials. We did not find evidence that Clark solicited funds on GETT’s behalf, but we did find that Clark twice gave statements of support to the Foundation and the Civil War Trust that were included in solicitation letters addressed to members and potential donors.We also found that in September 2015 Clark asked the Foundation to pay for a dinner costing more than $6,000 that Clark and other National Park Service employees and Foundation guests attended, violating the ethics regulation that prohibits soliciting gifts from prohibited sources.We coordinated this investigation with the U.S. Attorney’s Office for the Middle District of Pennsylvania and on October 17, 2018, we were informed that office had declined prosecution.

The OIG investigated an allegation that altered records were submitted to the Office of Natural Resources Revenue (ONRR). The records were submitted to ONRR by a third-party consultant on behalf of their client, a company operating Federal mineral leases, during an audit of royalty refund requests. We found no evidence that records were altered. The information in the client’s official files matched the record the consultant provided to ONRR.

NGA OIG Fall Semiannual Report to Congress, 1 April - 30 September 2018

The OIG conducted a healthcare inspection in response to allegations regarding Sterile Processing Services (SPS) at the New Mexico VA Health Care System. The OIG team did not substantiate tampering with equipment was occurring or that sterile sets were incorrectly stored or damaged. Thirty-eight of 356 sterile sets inspected were missing instruments; those sets were not consistently labeled as to which instruments were missing. Not all patient safety events were reported as required. Additionally, some surgical procedures were delayed or canceled due to unavailable sterile instruments and equipment. The OIG team determined that, while no patient experienced an adverse clinical outcome related to delays or cancellations, three patients were exposed to increased risks for adverse clinical outcomes. The contract for SPS technicians responsible for reusable medical equipment (RME) reprocessing lapsed in spring 2017. An increase in the number of surgical delays and cancellations occurred for the two months after the contract ended, but the OIG could not establish the surgical delays were related to SPS staffing. Deficiencies in the documentation of SPS staff training and competency records as well as in the maintenance of a comprehensive list of RME and standard operating procedures for some items were identified. The OIG determined the VISN did not provide effective oversight and the facility did not effectively implement proposed action plans, as evidenced by recurring findings reported in multiple inspections. The OIG made 12 recommendations related to missing instruments, verification of items in sterile sets, accurate patient safety event reporting, SPS training, maintenance of an accurate RME list, standard operating procedures, competencies, a review of the SPS contract, implementation of actions from previous reviews and this review, evaluation of the SPS risk assessment, and independent verification by VISN staff, if necessary, to implementation of action plans related to SPS recommendations.