Federal Reports

Evaluation report on Treasury's effectiveness in shifting the Hardest Hit Fund to help homeowners suffering from unemployment a loss of income or other hardships related to the pandemic.

In response to the Coronavirus Aid, Relief, and Economic Security (CARES) Act, the VA Office of Inspector General (OIG) reviewed the Veterans Health Administration’s (VHA) tracking and reporting of COVID-19 supplemental funding from legislation for pandemic relief.VA met monthly reporting requirements to OMB and Congress on supplemental fund obligations and expenditures. VA also submitted required weekly obligations and expenditures from supplemental funding to OMB by program activity. Of approximately $17.3 billion in medical care supplemental funds, VA reported it had obligated about $7.11 billion and had spent about $5.67 billion by December 29, 2020.The OIG team noted three concerns where VA’s reporting was not complete and accurate:• Obligations were at risk of not being included in VA’s reports.• VA initially delayed the reporting of reimbursable obligated amounts for two months.• VA’s reports contained negative dollar amounts in data fields that should have only positive amounts, which misstated VA’s overall reported obligations.Those concerns indicate weaknesses in how VA and VHA internal controls are structured to meet reporting requirements. Despite the risks identified, VA performed only a limited review at the summary fund level of its COVID-19 obligations and expenditures before reporting. A review of summary funds is not detailed enough to identify potential anomalies and ensure reliability of externally reported information. OMB’s guidance required VA to report on obligations and expenditures classified by the type of items or services purchased.The OIG concluded that the three identified variances affected the quality of reporting. Given the inherent risks due to outdated financial information technology infrastructure, the OIG recommended developing a procedure to review and validate the data at the program activity level to ensure information accurately represents the underlying source transactions. This procedure would help ensure proper accounting for all COVID-19 obligations and expenditures.

The VA Office of Inspector General (OIG) reviewed how underlying human resources processes affect VA’s reporting of staffing and vacancy data on its public website. The VA MISSION Act of 2018 requires VA to release this information quarterly. The law also requires the OIG to review the website periodically and recommend improvements.In this third annual report, the OIG found VA has acted to address longstanding data integrity concerns with its system for reported staffing and vacancy information. However, VA continues to experience challenges reconciling its position data. For example, both the Veterans Health Administration (VHA) and the Veterans Benefits Administration reported discrepancies between the actual number of vacant positions and the corresponding inventory in the system.The OIG identified opportunities for VA to improve the transparency and governance of HR Smart’s data, and thus improve the quality of reported information. Standardized guidance for position management and a perpetual oversight mechanism would also ensure data were consistently created, properly maintained, and continually reviewed.The OIG also found VHA human resources practices affected the transparency of staffing and vacancy data. VHA delegated much of its data reconciliation to its local facilities, which introduced variability in the process and did not allow for consistent creation, maintenance, and verification of information. VHA also had inadequate business processes to ensure quality data were available to support effective medical facility staffing oversight.Without consistent methods and reliable source documents for managing information, VHA cannot be sure HR Smart data accurately reflect VA’s budget and workload requirements.The OIG recommended examining and validating HR Smart inventory data, establishing standards to ensure positions are consistently approved, created, and maintained, and regularly monitoring position management. The OIG also recommended implementing policy and procedures for staffing level approvals and publishing detailed guidance establishing authoritative position management documents.

This audit is one of a series of audits to determine whether States had recovered, and returned the correct Federal share of, improper Medicaid claims amounts and damages. For this audit, we focused on Nebraska’s Medicaid Fraud Control Unit (MFCU) actions related to Medicaid overpayments from legal judgments and settlements that the State had pursued under relevant Medicaid fraud statutes. Nebraska is required to report recoveries for these MFCU-determined Medicaid overpayments to the Centers for Medicare & Medicaid Services (CMS) and to refund the Federal share to the Federal Government.Our objective was to determine whether Nebraska reported and returned the correct Federal share of MFCU-determined Medicaid overpayments identified during the period October 1, 2011, through September 30, 2018.

Why OIG Did This AuditThe Medicare hospice benefit allows providers to claim Medicare reimbursement for hospice services provided to individuals with a life expectancy of 6 months or less who have elected hospice care. Previous OIG audits and evaluations found that Medicare inappropriately paid for hospice services that did not meet certain Medicare requirements.Our objective was to determine whether hospice services provided by Professional Healthcare at Home, LLC (Professional Healthcare), complied with Medicare requirements.How OIG Did This AuditOur audit covered 3,458 claims for which Professional Healthcare (located in Fairfield, California) received Medicare reimbursement of $20.3 million for hospice services provided from April 1, 2016, through March 31, 2018. We reviewed a random sample of 100 claims. We evaluated compliance with selected Medicare billing requirements and submitted these sampled claims and the associated medical records to an independent medical review contractor to determine whether the services met coverage, medical necessity, and coding requirements.

An Amtrak coach cleaner based in Chicago, Illinois, was terminated from employment on June 10, 2021, following his administrative hearing. Our investigation found that the former employee violated company policy by failing to report his arrest and conviction for driving under the influence and failing to report two other criminal convictions while employed by the company.

The OIG assessed how effectively VA managed its emergency caches during the first wave of the COVID-19 pandemic in early 2020. These caches contain a standard supply of drugs and medical supplies, including some personal protective equipment, for use during a public health emergency.The review team found that use and oversight of the emergency caches were limited. Only nine of 144 medical facilities activated their emergency caches during the review period (February through June 2020). Among the reasons they were not used included medical facility directors reporting supplies were not needed or caches lacked sufficient quantity for meeting pandemic demands. The Veterans Health Administration (VHA) also changed the process for mobilizing caches during the pandemic, but without clearly communicating it to medical facility directors.The review team also identified problems with cache maintenance and monitoring. Most caches contained some expired or missing personal protective equipment, diminishing their ability to support pandemic preparedness. Expired or incomplete cache inventories can also compromise facilities’ ability to respond to other local emergencies, such as hurricanes or wildfires. Furthermore, VHA had incomplete documentation on cache activations, making it difficult to know which caches would need to be restocked. Finally, medical facility leaders were not always able to accurately report if their facility’s cache was activated during the pandemic.VHA concurred with the three OIG recommendations to (1) clarify the intended use of the emergency caches during national emergencies and develop communication and documentation requirements so that all relevant parties are aware of their responsibilities and any changes to standard activation protocols, (2) establish minimum timeframes for reordering processes to make certain the caches are stocked with unexpired inventory, and (3) implement procedures to ensure that activation records are accurate and complete.

For our evaluation of the National Oceanic and Atmospheric Administration’s (NOAA’s) National Marine Fisheries Service (NMFS, also known as NOAA Fisheries) plan for the implementation of Coronavirus Aid, Relief, and Economic Security Act (CARES Act) funding, our objective was to determine whether NOAA complied with the requirements of the CARES Act. Specifically, we determined (1) what steps NOAA took in implementing the requirements for awarding funds, (2) challenges NOAA faced during implementation, and (3) NOAA’s current status in processing applications and award funds under the CARES Act. We found that NOAA Fisheries followed the requirements for implementing the CARES Act. NOAA Fisheries has put in place measures to mitigate challenges resulting from the review and approval process during COVID-19, and is on track to obligate all CARES Act funds before September 30, 2021. However, NOAA Fisheries still faces challenges with the pace at which funds are being disbursed to fishery participants.

Inspection report on OIG's survey of FCA employees on the safety measures and other actions implemented by FCA in response to COVID-19

This audit report is one in a series of OIG reports addressing the identification, reporting, and investigation of incidents of potential abuse and neglect of our Nation’s most vulnerable populations, including Medicaid beneficiaries in nursing facilities. Nursing facility residents are at an increased risk of abuse or neglect when health care professionals and caregivers fail to report incidents of potential abuse or neglect or when allegations of abuse or neglect are not acted upon in a timely manner.Our objectives were to determine whether California: (1) ensured that nursing facilities reported incidents of potential abuse or neglect of Medicaid beneficiaries transferred from nursing facilities to hospital emergency departments and (2) complied with Federal requirements for recording, prioritizing, and investigating allegations of abuse or neglect.

The objective was to determine whether the Social Security Administration (SSA) resolved the delinquent status of overpayments for beneficiaries identified by the Delinquent Debt Trigger File (DDTF).

OIG reviewed FSA’s program delivery of ECP for the 2017 hurricane-related disasters.

A former Amtrak electrician in Chicago pleaded guilty in the Circuit Court of Cook County, Illinois, to Financial Institution Fraud on June 9, 2021. The former employee was sentenced on the same date to one year probation and paid $11,944.44 in restitution to US Bank. Our investigation found that the former employee established a business and used it to engage in fraudulent credit card schemes.

VA’s Program of Comprehensive Assistance for Family Caregivers provides benefits such as monthly stipends to approved caregivers of eligible veterans. The VA MISSION Act of 2018 expanded eligibility for the program from veterans injured on or after 9/11 to include veterans injured in any conflict. The prerequisites to expansion include an information technology (IT) system that fully supports the program. The OIG assessed VA’s efforts to implement this IT system and compliance with schedule and system performance requirements, as well as the development costs.The OIG recognizes VA’s significant efforts and the challenges involved. Millions of veterans, if determined eligible, may be considered for participation in the program. However, the OIG found that VA did not meet the MISSION Act’s October 1, 2018, deadline for implementing an IT system, nor the October 1, 2019, reporting requirement. This was due in part to governance issues and lack of continuity in leadership when upgrading and replacing the legacy system.The new IT system, the Caregiver Record Management Application (CARMA), was implemented on October 1, 2020, two years after the MISSION Act’s requirement.VA informed the OIG on January 22, 2021, that CARMA now includes functionalities that meet MISSION Act requirements. However, the OIG found VA did not establish the appropriate security risk category and fully assess the system’s privacy vulnerabilities.The OIG made four recommendations: (1) establish policies and procedures for joint governance on all IT projects to ensure efforts provide an adequate return on investment and achieve program objectives; (2) enforce an existing process to help IT projects deliver and sustain the intended outcomes, ensuring the Program and Acquisition Review Council evaluates underperforming projects; (3) reevaluate elevating the system’s risk category to better protect health information and other sensitive data; and (4) establish agency-wide policies and responsibilities for managing IT projects.

In its 10-year plan, the Postal Service expressed an intent to enhance tools that drive greater value for the senders of mail, including Informed Delivery (ID) and Informed Visibility (IV). In this white paper, the OIG discusses marketers’ perceptions of ID and IV and their suggestions to improve these platforms.

At the request of then Secretary of the U.S. Department of the Interior David Bernhardt and Members of Congress, we reviewed the actions the U.S. Park Police (USPP) took to disperse protesters in and around Lafayette Park in Washington, DC, on June 1, 2020. Our review focused on events that occurred in and around the park from May 29 through June 3 amid the ongoing Black Lives Matter protests. We sought to describe what occurred primarily from an operational perspective, including how and when the USPP, in coordination with its law enforcement partners, developed and executed its plan to clear the park and the USPP’s reasons for dispersing protesters from the area. We also sought to determine whether the warnings the USPP provided to protesters before it executed the plan complied with applicable guidance. We did not review as part of this project individual uses of force by USPP officers; these actions are the subject of separate inquiries or ongoing lawsuits.Protests began in and around Lafayette Park on May 29, 2020. On May 30, the USPP and U.S. Secret Service established a unified command to coordinate the law enforcement response to the protests. From May 30 to 31, at least 49 USPP officers were injured while policing the protests, and Federal and private property was vandalized.On the morning of June 1, the Secret Service procured antiscale fencing to establish a more secure perimeter around Lafayette Park that was to be delivered and installed that same day. The USPP, in coordination with the Secret Service, determined that it was necessary to clear protesters from the area in and around the park to enable the contractor’s employees to safely install the fence. The USPP planned to implement the operation as soon as the fencing materials and sufficient law enforcement officers arrived at the park. Six other law enforcement agencies assisted the USPP and the Secret Service in the operation to clear and secure areas near the park.The operation began at 6:23 p.m. and was completed by 6:50 p.m. Shortly thereafter, at 7:01 p.m., President Trump walked from the White House through Lafayette Park to St. John’s Church. At 7:30 p.m., the contractor began assembling and installing the antiscale fence and completed the work by approximately 12:30 a.m. on June 2.We found that the USPP had the authority and discretion to clear Lafayette Park and the surrounding areas on June 1. The evidence we obtained did not support a finding that the USPP cleared the park to allow the President to survey the damage and walk to St. John’s Church. Instead, the evidence we reviewed showed that the USPP cleared the park to allow the contractor to safely install the antiscale fencing in response to destruction of property and injury to officers occurring on May 30 and 31. Further, the evidence showed that the USPP did not know about the President’s potential movement until mid- to late afternoon on June 1—hours after it had begun developing its operational plan and the fencing contractor had arrived in the park.We also found that although the USPP used a sound-amplifying long-range acoustic device to issue three dispersal warnings to the crowd on June 1, not everyone could hear the warnings. Furthermore, we found that the USPP does not have a detailed dispersal warning policy applicable to operations like the one that occurred on June 1 and that this may have led to the ineffective warnings issued to the crowd that day.Finally, we found that the USPP and the Secret Service did not use a shared radio channel to communicate, that the USPP primarily conveyed information orally to assisting law enforcement entities, that an assisting law enforcement entity arrived late and may not have received a full briefing on the rules of engagement, and that several law enforcement officers could not clearly hear the incident commander’s dispersal warnings. These weaknesses in communication and coordination may have contributed to confusion during the operation and the use of tactics that appeared inconsistent with the incident commander’s operational plan.Given the lack of a specific policy, we recommend that the USPP develop a detailed policy for protests and other events of the type that occurred on June 1 and improve its field communication procedures to better manage multiagency operations.Read a statement from Inspector General Mark Lee Greenblatt regarding this Special Review report.

Patients in active treatment for substance use disorder may also be treated for a variety of medical conditions. Medicare Part B covers these patients’ drug testing services when reasonable and necessary. For 2019, Medicare paid $180 million for such services provided to 274,000 beneficiaries with substance use disorders nationwide. Although the 2019 Medicare fee-for-service improper payment rate was 7.3 percent, the improper payment rate was 58.9 percent for the drug test with the highest Medicare fee schedule amount. We conducted this audit to evaluate how the Centers for Medicare & Medicaid Services (CMS) and its Medicare contractors addressed the risk for improper payments for drug testing services. Our objective was to assess the Medicare contractors’ program safeguards for ensuring that Medicare claims for drug testing services for beneficiaries with substance use disorders comply with Medicare requirements.Our audit covered Medicare Part B claims for drug testing services provided in 2019 for beneficiaries with substance use disorders. We interviewed CMS officials and reviewed requirements for drug testing services in all seven Medicare contractors’ Local Coverage Determinations (LCDs). We also interviewed staff from seven selected laboratories and analyzed claims data to determine the potential impact of weaknesses we identified.

DHS OIG's 37th Semiannual Report to Congress summarizes the work and accomplishments of the Department of Homeland Security Office of InspectorGeneral from October 1, 2020 to March 31, 2021.

This report examines the EPA’s activities to oversee mobile source compliance with clean air laws and regulations during the coronavirus pandemic. It highlights National Vehicle and Fuel Emissions Laboratory’s efforts to minimize the potential for noncompliance during the pandemic and the importance of returning to full testing capacity to provide the most effective oversight.

OIG reviewed USDA’s compliance with improper payment requirements and the Department’s high-dollar overpayments reports for FY 2020.

La EPA debe realizar nuevas RTR de las categorías de fuentes que emiten cloropreno y óxido de etileno para abordar los riesgos elevados de cáncer para una persona de por vida que afectan a más de 464,000 personas, como se observó en una herramienta de modelización, y lograr justicia ambiental.

To determine whether the Social Security Administration (SSA) overpaid widows when it applied the Social Security Act’s Retirement Insurance Benefits (RIB) limitation provision and the reduced widow(er)’s benefit policy.

Our objective was to assess the effectiveness of Terminal Handling Services (THS) operations in Denver, CO. We conducted site visits at the Denver THS facility and the Denver Processing and Distribution Center (P&DC). We selected the Denver P&DC because it accounted for about 76 percent of the total mail volume delivered to the Denver THS. Our fieldwork occurred after the President of the U.S. issued the national coronavirus emergency declaration on March 13, 2020. Our results may not reflect process and/or operational changes that occurred as a result of the pandemic.

U.S. Immigration and Customs Enforcement (ICE) did not adequately identify and track human trafficking crimes. Specifically, ICE Homeland Security Investigations (HSI) did not accurately track dissemination and receipt of human trafficking tips, did not consistently take follow-up actions on tips, and did not maintain accurate data on human trafficking. These issues occurred because HSI did not have a cohesive approach for carrying out its responsibilities to combat human trafficking. We made one recommendation to improve ICE’s coordination and human trafficking efforts to assist victims. ICE concurred with our recommendation.

Due to concerns identified during Evaluation 2020-15743, Sequoyah Nuclear Plant Radiation Protection’s Organizational Effectiveness (report issued December 10, 2020), we performed an evaluation of TVA Nuclear’s handling of potentially contaminated liquids at its nuclear sites. The scope of our evaluation was limited to TVA Nuclear’s process for releasing liquids from Radiologically Controlled Areas (RCA) for unrestricted use. We determined potentially contaminated liquids were released from RCAs at each nuclear site. This occurred because all applicable analyses were not performed on some liquids prior to release. In addition, we identified opportunities for improvement related to (1) TVA Nuclear’s processes for tritium analysis prior to the release of liquids for unrestricted use and (2) documentation issues at each nuclear site, including the incomplete submittal of records, incomplete maintenance processes, and inaccurate logs.

The objective was to determine whether the Social Security Administration (1) transferred overpayments from terminated Supplemental Security Income records to current records for recovery and (2) took corrective action to recover the Supplemental Security Income overpayments we identified in our 2009 audit.

Semiannual Report to Congress

The OIG assessed allegations that a patient’s care was delayed and mismanaged in the facility’s Emergency Department resulting in the patient’s death, and facility leaders ignored complaints of inadequate Emergency Department nurse staffing levels. Initially, the OIG had concerns regarding the impact of the pandemic on the scheduling and quality of the patient’s hemicolectomy surgery completed 15 days prior to the patient’s death; however, no deficiencies were identified.Between postoperative days 10 and 15, facility surgical staff instructed the patient several times, via phone, to seek urgent medical attention to address not eating, abdominal distension, and vomiting. The patient presented to non-VA hospitals twice and to the facility’s Emergency Department on the third occasion, where the patient was triaged as an Emergency Severity Index (ESI) 3, evaluated by a nurse practitioner, and returned to the waiting room. A short time later, the patient, yelled “I cannot breathe,” fell out of a chair, became unresponsive, and died later that day.The OIG substantiated that the patient’s Emergency Department care was deficient and mismanaged, which may have resulted in a delay in care. The OIG found the clinicians who triaged the patient failed to consider all reasonable causes of the patient’s shortness of breath, communicate with the patient’s surgeon, and assign an ESI 2.The facility did not have a policy that prohibited ESI 2 patients from remaining in the waiting room, which conflicted with guidance from the Emergency Nurses Association.The OIG did not substantiate inadequate levels of nursing staff in the Emergency Department during the week of the patient’s death or that facility leaders received complaints.The OIG made two recommendations to the Facility Director related to ESI 2 patients not remaining in the waiting room and review of identified concerns related to the patient’s pre-code Emergency Department care.

Medicare administrative contractors nationwide paid approximately $885 million for selected polysomnography (a type of sleep study) services provided to Medicare beneficiaries during January 1, 2017, through December 31, 2018 (audit period). Previous OIG audits of polysomnography services found that Medicare paid for some services that did not meet Medicare requirements. These audits identified payments for services with inappropriate diagnosis codes, without the required supporting documentation, and to providers that exhibited questionable billing patterns. After analyzing Medicare claim data, we selected for audit University of Michigan Health System (University of Michigan), a hospital provider located in Ann Arbor, Michigan.Our objective was to determine whether Medicare claims that University of Michigan submitted for polysomnography services complied with Medicare requirements.

Joshua Pearson, a marketer from St. George, Utah, was sentenced on June 3, 2021, in U.S. District Court, Central District of California, to three years probation, six months home confinement, and was ordered to forfeit $1,250,000. Pearson previously pleaded guilty to receipt of illegal kickbacks related to a health care fraud scheme after our joint investigation found that he received kickbacks from Sheridan Medical for patient referrals for compounded drugs—drugs that were medically unnecessary. A marketer from Sheridan Medical and the owner of Fusion Rx Compounding Pharmacy, both in Los Angeles, were also charged for their role in the scheme. Amtrak’s health insurance plan was fraudulently billed $17,000 as a result of the scheme. Criminal judicial proceedings for the other defendants are pending.

This product presents the results of the Office of Inspector General’s (OIG) February – March 2021 pulse survey of Food Safety and Inspection Service (FSIS) inspectors to obtain information about how FSIS frontline inspectors perceive coronavirus disease 2019 (COVID-19) safety in their work environments.

The Office of Inspector General (OIG) performed an inspection of the Office of the Chief Information Officer (OCIO) within the U.S. Department of Agriculture (USDA) to determine whether USDA followed Federal and Departmental incident response guidance.

The VA Office of Inspector General (OIG) initiated a healthcare inspection in spring 2018 after receiving allegations that former Pathology and Laboratory Medicine Service Chief Dr. Robert Levy misdiagnosed pathological specimens and altered quality management documents to conceal errors at the Veterans Health Care System of the Ozarks in Fayetteville, Arkansas. The inspection was completed after the OIG Office of Investigations conducted a criminal investigation. In January 2021, Dr. Levy was sentenced to 20 years in prison for manslaughter and mail fraud.The OIG substantiated the allegations. After a comprehensive, retrospective review of cases Dr. Levy interpreted over his 12-year tenure (almost 34,000 cases), clinical reviewers identified more than 3,000 diagnostic errors. The need for disclosures of errors causing serious injury was identified for 34 patients.As service chief of a specialty care department with only one other pathologist and chairperson of three pathology quality management committees, Dr. Levy had the opportunity to subvert the quality process. Facility leaders failed to recognize his manipulation of quality data. Dr. Levy admitted to long-term alcohol use. The OIG found that facility leaders missed opportunities to address signs of an impairment. The failure of facility leaders to promote a culture of accountability likely led to minimal reporting of Dr. Levy’s signs of impaired behaviors.The OIG made 10 recommendations to the Under Secretary for Health related to competency and pathology quality management processes, pathology reports, and the consulting process with external pathologists. The OIG also recommended the Office of General Counsel and the Office of Human Resources and Administration/Operations, Security & Preparedness be consulted about administrative actions for VHA leaders, as appropriate. Two recommendations focused on alcohol testing and management of impaired healthcare workers.Two recommendations to the Facility Director addressed peer references during reappraisal and evaluation of the facility’s psychological safety climate.

For a covered outpatient drug to be eligible for Federal reimbursement under the program, the drug’s manufacturer must enter into a rebate agreement that is administered by the CMS and pay quarterly rebates to the States. Manufacturers are required to submit a list to CMS of all covered outpatient drugs and to report each drug’s average manufacturer price and, where applicable, best price. On the basis of this information, CMS calculates a unit rebate amount for each drug and provides the information to the States each quarter. Section 1903(i)(10) of the Act prohibits Federal reimbursement for States that do not capture the information necessary for billing manufacturers for rebates as described in section 1927 of the Act. To bill for rebates, States capture drug utilization data that identifies, by NDC, the number of units of each drug for which the States reimbursed Medicaid providers and report the information to the manufacturers. The number of units is multiplied by the unit rebate amount to determine the actual rebate amount due from each manufacturer. States use two primary models to pay for Medicaid services: fee-for-service and managed care. In the managed-care model, States contract with MCOs to provide specific services to enrolled Medicaid beneficiaries, usually in return for a predetermined periodic payment known as a capitation payment. States pay MCOs for each covered individual regardless of whether the enrollee received services during the relevant time period. MCOs use the capitation payments to pay provider claims for these services. Capitation payments may cover outpatient drugs, which include both pharmacy and physician-administered drugs. To claim Federal reimbursement, States report capitation payments made to MCOs as MCO expenditures on the Form CMS-64. These expenditures are not identified by specific type of service (such as pharmacy or physician-administered drugs). When States receive drug rebates from manufacturers, the States must report the rebates as decreasing adjustments on the CMS-64 report. States report drug rebate accounts receivable data on the Medicaid Drug Rebate Schedule, which is part of the CMS-64 report. CMS reimburses States for the Federal share of Medicaid expenditures reported on the CMS-64 report.To collect rebates for drugs, States submit to the manufacturers the drug utilization data containing NDCs for the drugs. NDCs enable States to identify the drugs and their manufacturers and to facilitate the collection of rebates for the drugs. The DRA amended section 1927 of the Act to specifically address the collection of rebates on physician-administered drugs for all single-source and top-20 multiple-source drugs. Effective March 23, 2010, the Affordable Care Act (ACA) required manufacturers to pay rebates on covered outpatient drugs dispensed to MCO enrollees if the MCOs are responsible for coverage of such drugs. Before the enactment of the ACA, drugs dispensed by Medicaid MCOs were excluded from the rebate requirements. States typically require MCOs to submit to the State agency NDCs for covered outpatient drugs dispensed to eligible individuals. MCOs submit to the State agency provider claim information, including claim lines for covered outpatient drugs. This information includes drug utilization data, which States must include when billing manufacturers for rebates. The State agency, which is responsible for billing and collecting Medicaid drug rebates for both pharmacy and physician-administered drugs, contracted with Conduent State Healthcare, LLC (the contractor), during our audit period to manage its drug rebate program. However, during most of our audit period, the State agency conducted most of those duties. The State agency did not start billing manufacturers for rebates related to physician-administered drugs until 2013, at which time they began retroactively billing for claims back to 2010.

Lamont Brown, of Brooklyn, New York, was sentenced in U.S. District Court, Eastern District of New York, on June 2, 2021, to a prison term of time served, probation for 36-months and was ordered to pay restitution of $97,210 to Amtrak. Brown previously pleaded guilty to conspiracy to commit wire fraud for his involvement in an Amtrak eVoucher scheme. Our investigation found that Brown and his co-conspirators used stolen credit card information to make unauthorized purchases of Amtrak tickets, canceled or exchanged those tickets for eVouchers, and then sold the fraudulently obtained eVouchers on the internet.

To determine whether the Social Security Administration’s (SSA) responses to the end of Fiscal Year (FY) 2019 Chief Information Officer (CIO) Federal Information Security Modernization Act of 2014 (FISMA) metrics were reliable.

What We Looked AtTo support its mission to provide the safest, most efficient airspace system in the world, the Federal Aviation Administration (FAA) seeks to procure state-of-the-art systems, high-quality goods, and first-rate services. In 2017, for example, the Agency made over $4 billion worth of purchases—of which a range of $87 million to an estimated $1.7 billion could be subject to the Buy American Act (BAA) and the FAA-specific Buy American Preference provisions (BAP). In response to a congressional request, we initiated this audit to assess FAA’s policies and procedures for awarding and administering contracts in accordance with domestic content laws. Specifically, we evaluated FAA’s policies and procedures for (1) implementing Buy American requirements and (2) overseeing Buy American compliance. What We FoundFAA’s Acquisition Management System requires Buy American–applicable contracts to include specific clauses that direct vendors to certify the origins of goods or products and contracting officers (CO) to fully understand BAA and BAP requirements. However, we found Buy American–applicable contracts where COs had omitted or improperly applied the required clauses, lacked vendor certifications, or did not fulfill contract filing requirements—due to a lack of BAA- and BAP-specific guidance and training. As a result, we estimate that FAA may have put up to $127 million in Federal funds at risk due to contracts missing required vendor certifications. In addition, while Federal policy directed agencies to monitor, enforce, and comply with the Buy American Laws, FAA does not require its staff to assess and report on compliance, although it has tools available for this purpose. The Agency also lacks effective processes for recording “place of manufacture data” or for tracking usage of BAP waivers. As a result, FAA cannot be certain that it is meeting the intent of the Buy American Laws—to purchase American-made materials and goods to strengthen our economic and national security. Our RecommendationsWe made eight recommendations to improve FAA’s compliance and oversight for contracts subject to domestic content laws. FAA concurred with all eight recommendations, which we consider resolved but open pending completion of the planned actions.

We audited the Harris County Hurricane Harvey Community Development Block Grant Disaster Recovery (CDBG-DR) program. We initiated this audit as part of our commitment to helping the U.S. Department of Housing and Urban Development (HUD) address its top management challenges and to support HUD’s strategic objective to support effectiveness and accountability in long-term disaster recovery. Further, Congress has expressed strong interest in HUD’s disaster programs.Our objective was to assess the efficiency and effectiveness of Harris County’s Hurricane Harvey CDBG-DR program and whether the program was assisting disaster participants in a timely manner; specifically, to examine the status of its HUD-approved activities and challenges, if any, in implementing the activities.We found that Harris County had not efficiently or effectively operated its Hurricane Harvey CDBG-DR program. Specifically, 3 years after Hurricane Harvey, Harris County had assisted only 112 of 4,513 planned program participants and had spent less than 1 percent of its grant funds. Harris County’s challenges included an inability to effectively assist applicants and inefficiencies in its reimbursement program. These conditions occurred because Harris County was overwhelmed by the number of programs it intended to operate and its staff did not respond effectively to Texas General Land Office (Texas GLO) guidance and training. As a result, the Texas GLO reduced the number of Harris County’s programs and assumed control of $338.7 million (27 percent) of its $1.2 billion Hurricane Harvey grant suballocation.We recommend that the Director of the Office of Block Grant Assistance require the Texas GLO to (1) provide its plan to continuously monitor Harris County’s pace and performance in its remaining program and take appropriate action to ensure that program goals are met; (2) set performance and financial milestones for all programs and activities funded under Harris County’s subrecipient agreement; (3) monitor Harris County’s capacity to manage its funds and address duplicative, inefficient, and cost-prohibitive processes or positions; and, (4) review Harris County’s priorities for providing assistance to program participants. Implementation of these recommendations would include determining whether additional activities need to be combined or eliminated and repurposing additional grant funds if necessary.

DHS had not yet strengthened its cybersecurity posture by implementing a Continuous Diagnostics and Mitigation (CDM) Program. DHS spent more than $180 million between 2013 and 2020 to design and deploy a department-wide continuous monitoring solution but faced setbacks. DHS initially planned to deploy its internal CDM solution by 2017 using a “One DHS” approach that restricted components to a standard set of common tools. We attributed DHS’ limited progress to an unsuccessful initial implementation strategy, significant changes to its deployment approach, and continuing issues with component data collection and integration. As of March 2020, DHS had developed a key element of the program, its internal CDM dashboard. However, the dashboard contained less than half of the required asset management data. As a result, the Department cannot leverage intended benefits of the dashboard to manage, prioritize, and respond to cyber risks in real time. Finally, we identified vulnerabilities on CDM servers and databases. This occurred because DHS did not clearly define patch management responsibilities and had not yet implemented required configuration settings. Consequently, databases and servers could be vulnerable to cybersecurity attack, and the integrity, confidentiality, and availability of the data could be at risk. We made three recommendations for DHS to update its program plan, address vulnerabilities, and define patch management responsibilities.

The Transportation Security Administration (TSA) did not manage the Recruitment and Hiring (R&H) contract in a fiscally responsible manner. Specifically, TSA did not properly plan contract requirements prior to awarding the contract and did not develop accurate cost estimates for all contract modifications. We recommended TSA establish a cross-functional requirements working group for planning and awarding the R&H re-compete efforts as well as other Personnel Futures Program contract requirements. The working group should develop a holistic and forward-thinking acquisition strategy, as well as implement a comprehensive process for reviewing and determining requirements. We also recommended TSA ensure Human Capital improves contract management activities including, but not limited to, requirements planning and realistic cost estimate development by obtaining additional expert resources or leveraging existing expertise. We made two recommendations to improve TSA’s contract management. TSA concurred with both recommendations.

This report contains information about recommendations from the OIG's audits, evaluations, reviews, and other reports that the OIG had not closed as of the specified date because it had not determined that the Department of Justice had fully implemented them. The list omits information that the Department of Justice determined to be limited official use or classified, and therefore unsuitable for public release.The status of each recommendation was accurate as of the specified date and is subject to change. Specifically, a recommendation identified as not closed as of the specified date may subsequently have been closed.

This Office of Inspector General (OIG) Comprehensive Healthcare Inspection Program report provides a focused evaluation of the quality of care delivered in the inpatient and outpatient settings of the Battle Creek VA Medical Center and multiple outpatient clinics in Michigan. The inspection covers key clinical and administrative processes that are associated with promoting quality care. This inspection focused on Leadership and Organizational Risks; COVID-19 Pandemic Readiness and Response; Quality, Safety, and Value; Medical Staff Privileging; Medication Management: Long-Term Opioid Therapy for Pain; Mental Health: Suicide Prevention Program; Care Coordination: Life-Sustaining Treatment Decisions; Women’s Health: Comprehensive Care; and High-Risk Processes: Reusable Medical Equipment.Three of four executive team members were serving in an acting capacity at the time of the OIG’s review. Employee survey results revealed opportunities for the Associate Director for Patient Care Services to improve staff satisfaction. Patient experience survey data highlighted various opportunities to improve satisfaction. The OIG’s review of accreditation findings, sentinel events, and disclosures did not identify any substantial organizational risk factors. Leaders were knowledgeable about selected data used in Strategic Analytics for Improvement and Learning models and should continue to take actions to sustain and improve performance.The OIG issued 11 recommendations for improvement in six areas:(1) Quality, Safety, and Value• Recommendation, implementation, and monitoring of action items• Interdisciplinary review of utilization management data(2) Medical Staff Privileging• Provider exit review forms(3) Medication Management• Pain management committee processes(4) Mental Health• Patient follow-up visits(5) Women’s Health• Women veterans health committee membership and attendance• Women veterans program manager duties• Designated maternity care coordinator(6) High-Risk Processes• Standard operating procedures• Staff training• Competency assessments

The portion of Americans who vote by mail had been growing steadily even before the novel coronavirus disease (COVID-19) pandemic led to millions of voters casting mail ballots for the first time. In the 2020 general election, the Postal Service delivered more than 135 million ballots to or from voters. In this white paper, the OIG provides an overview of vote-by-mail processes, the variability of those processes, and challenges for the Postal Service and others.

NGA OIG Spring Semiannual Report to Congress, 1 October 2020 - 31 March 2021

This semiannual report informs Congress of the Peace Corps Office of Inspector General's work from October 1, 2020, through March 31, 2021.

The Inspector General Act of 1978 requires the Inspector General to prepare semiannual reports summarizing the activities of the Office of Inspector General for the preceding six-month periods. The semiannual reports are intended to keep the Secretary and the Congress fully informed of significant findings, progress the Agency has made and recommendations for improvement.

Pursuant to the Inspector General Act of 1978, as amended, the Federal Election Commission submits the Office of Inspector General’s Semiannual Report to Congress. The report summarizes the activity of the FEC Office of Inspector General (“OIG”) from October 1, 2020, through March 31, 2021.

This report summarizes the oversight work performed by EAC OIG during the 6-month period ended March 31, 2021.

This Semiannual Report to Congress reflects how the EPA OIG is achieving its mission of preventing and detecting fraud, waste, abuse, mismanagement, and misconduct related to the programs and operations of the U.S. Environmental Protection Agency and the U.S. Chemical Safety and Hazard Investigation Board. During the reporting period, October 1, 2020, through March 31, 2020, among other accomplishments, the OIG evaluated how the EPA and the CSB adapted during the coronavirus pandemic, introduced an Oversight Plan addressing EPA’s top challenges, and provided oversight of scientific integrity at the EPA.

To summarize prior work on the Social Security Administration’s (SSA) administrative finality policy and evaluate the Agency’s actions to update it.

Under the home health prospective payment system (PPS), the Centers for Medicare & Medicaid Services pays home health agencies (HHAs) a standardized payment for each 60-day episode of care that a beneficiary receives. The PPS payment covers intermittent skilled nursing and home health aide visits, therapy (physical, occupational, and speech-language pathology), medical social services, and medical supplies.Our prior audits of home health services identified significant overpayments to HHAs. These overpayments were largely the result of HHAs improperly billing for services to beneficiaries who either were not confined to home (homebound) or were not in need of skilled services.Our objective was to determine whether Caretenders of Jacksonville, LLC (Caretenders), complied with Medicare requirements for billing home health services on selected types of claims.