Federal Reports

Irena Shut, a medical marketer based in Los Angeles, California, was sentenced in United States District Court, Central District of California, on October 5, 2020, to two years’ probation for conspiracy to commit health care fraud. Our investigation found that Shut was paid commissions for facilitating the referral of prescriptions for medically unnecessary compounded drugs and other items reimbursed by health care benefit programs. As a result of the scheme, Amtrak’s insurance providers were fraudulently charged approximately $22,000. Criminal judicial proceedings for other defendants in this case are pending.

The U.S. Department of Housing and Urban Development (HUD), Office of Inspector General (OIG), audited the Nampa Housing Authority’s public housing program in response to a local OIG, Office of Investigation, referral. Our objective was to determine whether the Authority followed U.S. Department of Housing and Urban Development (HUD) public housing requirements pertaining to (1) calculating contract rents, (2) maintaining its waiting lists, (3) providing its staff the credentials needed to access HUD systems, and (4) storing and securing tenant files.We found that the Nampa Housing Authority charged 11 tenants the incorrect rent for at least 1 month, improperly maintained its waiting lists by housing tenants out of order, could not show that all HUD system users had proper credentials and that only employees with credentials accessed the system, and generally stored and secured tenant files properly.We recommend that the director of the Seattle Office of Public and Indian Housing require the Nampa Housing Authority to (1) reimburse the six tenants who overpaid rent totaling $1,550 using non-Federal funds, (2) develop and implement internal control procedures that support its policy and ensure a proper tenant selection process when selecting tenants for housing, and (3) ensure that the Authority follows all applicable HUD requirements related to accessing, use, and safeguarding credentials of HUD systems.

While conducting a site visit for the Employee Safety – Postal Service COVID-19 Response audit, we identified building maintenance and safety issues at Philadelphia’s Spring Garden Station that were not directly related to the scope of the audit. Specifically, we identified 30 deficiencies ranging from minor to more serious violations. We believe these issues warrant management’s immediate attention and corrective action.

The audit objectives were to determine whether program funds were managed in accordance with the ARC and Federal grant requirements

The audit objectives were to determine whether program funds were managed in accordance with the ARC and Federal grant requirements

The objective for this report was to assess the extent to which the company has taken steps to determine employees’ current perspectives on safety. We issued this report to provide our findings on a potential issue the company could address in the near term.We found that the company has not established a baseline measure of its own safety culture which is necessary to track its progress in improving its safety culture as a result of its investment in the SMS. According to a joint U.S. Department of Transportation (DOT) and Federal Railroad Administration study, as well as industry research, a primary method of establishing such a baseline is surveying employees’ values, attitudes, and perceptions about safety and the organization’s actions to improve it. We recommended the company develop and deploy an employee survey based on the DOT’s ten elements of a strong safety culture. The survey should be conducted in conjunction with planned training, or as soon as practical without delaying training. We also recommended the company use the survey’s results to measure its progress in improving safety culture over time and take action to address additional issues the survey identifies.

In 2010, Congress passed the Patient Protection and Affordable Care Act (ACA). The ACA established enhanced Federal reimbursement rates for services provided to nondisabled, low-income adults without dependent children (new adult group). The enhanced reimbursement rates established under the ACA have raised concerns about the possibility that States could improperly enroll individuals for Medicaid coverage in the new adult group and, as a consequence, the potential for improper payments.Our objective was to determine whether Colorado properly claimed reimbursement for Medicaid services provided from January 1, 2014, through September 30, 2015, to beneficiaries who were enrolled in the new adult group but who later became ineligible for Medicaid coverage.

BACKGROUNDThe Medicare ProgramTitle XVIII of the Social Security Act (the Act) established the Medicare program, which provideshealth insurance coverage to people aged 65 and over, people with disabilities, and people withend-stage renal disease. The Centers for Medicare & Medicaid Services (CMS) administers theMedicare program. Medicare Part B provides supplementary medical insurance for medicaland other health services, including critical care services performed by physicians. CMScontracts with Medicare administrative contractors (MACs) to process and pay Part B claims.Medicare Coverage of Critical Care ServicesCritical care is defined as medical care delivered directly by a physician or a qualified nonphysicianpractitioner for a critically ill or critically injured patient. A critical illness or injury isone that acutely impairs one or more vital organ systems such that there is a high probability of imminent or life-threatening deterioration in the patient’s condition. Critical care involves highcomplexity decision making to assess, manipulate, and support vital system functions to treatsingle or multiple vital organ system failure and prevent further life-threatening deteriorationof the patient's condition (HCPCS [Healthcare Common Procedure Coding System] and CPTCodebook 2016–2018, and CMS, Medicare Claims Processing Manual, Pub. No. 100-04,Chapter 12, § 30.6.12.A (the Manual)).The time that can be reported as critical care is the physician time spent engaged in workingdirectly related to the individual patient's care. That time must be spent either at the patient’simmediate bedside or elsewhere on the floor or unit as long as the physician is immediatelyavailable to the patient. When the physician is providing critical care services, he or she mustdevote his or her full attention to the patient and cannot provide services to any other patientduring the same period (HCPCS and CPT Codebook 2016–2018, and the Manual, Chapter 12,§ 30.6.12.C).Critical care is a time-based service. CPT code 99291 is used to bill for the first 30 to 74 minutesof critical care on a given date of service by a physician or physician group of the samespecialty. CPT code 99292 is used to bill for additional blocks of time of up to 30 minutes eachbeyond the first 74 minutes of critical care occurring on the same date. Critical care that is lessthan 30 minutes in total duration on a given date should be reported using another appropriateevaluation and management (E&M) code (HCPCS and CPT Codebook 2016–2018, and theManual, Chapter 12, § 30.6.12.F). See the Figure on the following page for an explanation ofhow to code critical care services according to the amount of time spent providing critical care.Medicare Requirements for Identifying and Returning OverpaymentsClinical Practices of the University of PennsylvaniaClinical Practices is the faculty practice group for the University of Pennsylvania PerelmanSchool of Medicine’s clinical departments. Clinical Practices has locations throughout thePhiladelphia, Pennsylvania, metropolitan area and includes physicians in 59 different medicalspecialties and sub-specialties. Clinical Practices operates as a University of Pennsylvaniadivision and is responsible for operating the Perelman School of Medicine faculty’s clinicalpractices, as well as other University of Pennsylvania Health System clinical practices. Duringour audit period, Novitas Solutions was the MAC that processed and paid Clinical Practices’claims.

On October 5, 2018, the President signed into law the GDA as part of the FAA Reauthorization Act of 2018 (P.L. No. 115-254, Subtitle F). The purpose of the GDA is to foster efficient administration of geospatial data, technologies, and infrastructure by improving the coordination and partnerships between the producers and consumers of geospatial information in Federal, State, Tribal, and local governments, the private sector, and academia. Additionally, the GDA is intended to reduce duplicative efforts to procure geospatial data, services, expertise, and technology within the Federal Government. To facilitate efficient geospatial activities in the Federal Government, the GDA formalizes geospatial-related committees and governance processes. Additionally, the GDA codifies portions of OMB Circular No. A-16, Coordination of Geographic Information, and Related Spatial Data Activities, and the tools used to develop, drive, and manage the National Spatial Data Infrastructure (NSDI).

What We Looked AtGeospatial data contain information on locations on Earth, such as location identifiers and boundary characteristics. Transportation related geospatial data include instrument-flight-rule navigation charts and maps of pipeline inspection boundaries. In October 2018, Congress passed the Geospatial Data Act (GDA) on the management of the National Spatial Data Infrastructure (NSDI). NSDI includes 17 geospatial data themes, including a transportation theme. The act requires inspectors general of covered agencies to report to Congress on their agencies’ geospatial data. Our audit objective was to assess DOT’s progress in fulfilling the act’s requirements. Specifically, we reviewed the Department’s status in implementing its responsibilities (1) as a lead covered agency under section 756 and (2) as a covered agency under sections 759(a) and 759(b). What We FoundDOT has implemented two of five responsibilities under section 756—communicating with theme users about data needs and designating a point of contact for the GeoPlatform. It has partially completed a third. DOT has not yet developed standards for the National Geospatial Data Asset (NGDA) in the transportation theme, and does not have complete information about financial resources needed for transportation theme maintenance.DOT is making progress implementing 11 responsibilities as a covered Agency under section 759(a), with 4 complete and 4 partially complete. For example, DOT is updating its Geospatial Information System Strategic Plan—its strategy for promoting use of geographic information. While it is addressing the act’s reporting requirements under section 759(b), DOT has not collected information needed for an annual report. DOT also does not have a complete inventory of geospatial data assets but is updating its data inventory guidelines, which will explain how Operating Administrations should inventory and verify the accuracy of their geospatial data. RecommendationsDOT concurred with all 13 recommendations to help it comply with the act’s requirements and provided documentation to close 1 recommendation.

The U.S. Department of Housing and Urban Development (HUD), Office of Inspector General, audited HUD’s Office of Multifamily Housing Programs upon receiving a hotline complaint. The hotline complaint contained allegations that (1) HUD routinely fails to perform Endangered Species Act analysis or consultations; (2) there are many projects that have deficiencies in noise analysis and environmental assessment site factors; (3) the environmental reviews for projects with fewer than 200 units are not performed properly; and (4) there is no oversight for projects with fewer than 200 units, and there are no safeguards for checking reviews for projects with fewer than 200 units. Our objective was to determine whether (1) the complainant’s allegations were substantiated for the 8 properties reviewed and (2) the Office of Multifamily Housing Programs properly followed mitigation requirements for the 17 properties reviewed.We partially substantiated allegation 3 and incorporated that issue into the finding. We were not able to substantiate the other allegations. HUD did not always properly follow mitigation requirements for its Federal Housing Administration-insured multifamily projects. Specifically, HUD did not always identify required mitigation measures or upload mitigation resolutions into the HUD Environmental Review Online System (HEROS) to document completion of its projects. Additionally, HUD did not conduct the required radon mitigation for one of its projects before final endorsement. This condition occurred because the multifamily HEROS users lacked training, HUD did not have procedures in place, and radon requirements were not updated on the closing documents. As a result, HUD was at risk of not conducting all required measures to mitigate conditions that would endanger the health and safety of its multifamily residents and lacked assurance that the new radon requirements were properly followed before the checklist update for the final endorsement closing documents.We recommended that the Deputy Assistant Secretary for Multifamily Housing (1) conduct and make available internal HEROS training for all multifamily HEROS users on how to document the environmental review mitigation measures, (2) establish and implement written procedures specifying which multifamily employees are required to upload mitigation resolutions after construction completion and at final endorsement, (3) upload the 17 missing mitigation resolutions and the 1 missing radon testing document into HEROS for the projects in this finding, (4) Strengthen HEROS or internal procedures to add an additional requirement confirming that the mitigation resolutions have been uploaded at final endorsement, and (5) strengthen HEROS by adding a column on the dashboard to show the progress of the overall mitigation status.

Our objective was to determine if the Postal Service’s Automated Delivery Unit Sorter (ADUS) achieved projected cost savings. The Postal Service has deployed a wide range of automated sorting equipment to achieve cost savings associated with reducing less-efficient manual processing and enhancing productivity. The ADUS is one of its most recent efforts, automating the sorting of smaller packages (up to 30 pounds) in delivery units and small processing and distribution centers (P&DC). Postal Service management issued two Decision Analysis Reports (DAR) in fiscal years (FY) 2017 and 2018 for the purchase and deployment of 20 ADUS machines for a combined [redacted]. These machines were installed at 10 delivery units and 10 small P&DCs across the country and were projected to capture cost savings of $8.8 million in FYs 2018 and 2019.

This document discusses EAC OIG’s planned oversight activities for fiscal year 2021.

For our audit of the U.S. Department of Commerce's (the Department’s) collection, production, acquisition, maintenance, distribution, use, and preservation of geospatial data, our objective was to assess the Department’s progress toward compliance with the 13 covered agency responsibilities under section 759(a) of the Geospatial Data Act (Pub. L. No. 115-254, H.R. 302).We found the following: I. The Department should ensure its new geospatial data strategic plan aligns with the mission and design controls for adequate implementation. II. The Department should develop procedures to ensure compliance with its Policy on Planned Geospatial Acquisitions. III. Data harvesting issues are causing inconsistencies in Department metadata. IV. The U.S. Census Bureau should document compliance with metadata standards as part of its system of internal control for geospatial data.

In FY 2019, CIGIE continued to meet its mandated missions, and through this report, we present CIGIE’s accomplishments in FY 2019 reflecting our efforts in meeting our mandate. Together, the work of the OIG community resulted in significant improvements to the economy and efficiency of programs government-wide, with potential savings totaling approximately $40.8 billion. With the OIG community’s aggregate FY 2019 budget of approximately $2.5 billion, these potential savings represent an approximate $16 return on every dollar invested in the OIGs. In Background, we summarize the Council’s history and the Inspector General Empowerment Act of 2016, the most recent enhancement to the Inspector General Act of 1978. We also highlight some of the accomplishments of CIGIE’s standing committees in FY 2019. Then, in Strategic Plan Business Goal Accomplishments, we describe CIGIE’s accomplishments under FY 2019’s four major strategic business goals. Next, we summarize current issues of concern to CIGIE members in Key Legislation Affecting the IG Community and Shared Management and Performance Challenges. We then offer perspective on IG Community Accomplishments and provide Contact Information for CIGIE Members. Finally, we recognize the recipients of the most noteworthy 2019 Annual CIGIE Awards.

As required by the Inspector General Act of 1978 (as amended), this Semiannual Report summarizes the activities of the Department of Transportation Office of Inspector General for the preceding 6-month period.

The audit of a CNCS Social Innovation Fund award to Youthprise and four of its six subgrantees (Amherst H. Wilder Foundation, MIGIZI Communications, Sauk-Rapids Rice, and Guadalupe Alternative Programs) identified questioned Federal costs of $626,099, questioned match costs of $990,137, and compliance findings. These costs tested were incurred between August 1, 2016 and June 30, 2018. Most of the questioned costs identified were associated with (1) Youthprise improperly awarding sole-source contracts; and (2) subgrantees’ timekeeping deficiencies. Overall, CNCS’s proposed actions addressed our recommendations. CNCS disagreed with five of 14 recommendations due to the grant period ending and the absence of future funding. CNCS has committed to monitoring Youthprise’s compliance with Federal regulations for future grants – which satisfies the intent of these recommendations.Also, Youthprise and its subgrantees took corrective actions to improve controls over monitoring contractors; implemented a new timekeeping system and engaged CNCS preferred vendors to enhance its compliance with National Service Criminal History Checks.

The U.S. Department of Housing and Urban Development (HUD), Office of Inspector General (OIG) conducted this study to follow up on information we shared previously regarding what information servicers of mortgage loans insured by Federal Housing Administration (FHA) are providing to borrowers regarding forbearance options available under the Coronavirus Aid, Relief, and Economic Security Act (CARES Act).We reported on April 27, 2020, that our review of 30 FHA servicers who service approximately 90 percent of FHA loans, revealed that FHA servicer websites provided incomplete, inconsistent, dated, and unclear guidance to borrowers related to their forbearance options under the CARES Act. We cautioned that lack of clear and consistent guidance from FHA servicers and enforcement by FHA of that guidance allows servicers to leave struggling homeowners unable to make informed decisions about paying their mortgages and relief that may be available to them during this pandemicWe found that despite virtually all of the top 30 servicers updating information on their websites on options available to borrowers during this COVID-19 emergency, some servicer websites continue to provide information that could mislead or confuse borrowers or provide little or no information to borrowers related to their forbearance options under the CARES Act.

OIG Survey on FTC Metrics and Challenges

Audit of Federal Trade Commission Interagency Agreement Processes

The Postal Service outsources all relocation services to a relocation management firm (RMF). The RMF provides guidance to relocating employees on Postal Service policies and processes, ensures prompt payment of authorized expenses, and assists with arrangements for moving and storing household goods. On September 19, 2018, the Postal Service entered into a contract with the current RMF to manage its relocation program beginning February 1, 2019. Based on data from February 1, 2019, through May 12, 2020, this program authorized over 800 employee relocations and paid over $21 million in relocation benefits. Our objectives were to determine whether relocation benefits were reasonable and properly paid, the current RMF complied with contractual requirements, and the Postal Service effectively managed the relocation benefits program.

Advance Electronic Data (AED) refers to electronic messages with information about the shipper, the recipient, and the contents of a cross-border postal package. AED helps U.S. Customs and Border Protection (CBP) identify packages from foreign posts that may contain opioids and other illicit goods. Under the STOP Act of 2018, all incoming postal packages must have AED by January 1, 2021. To provide AED, USPS relies on foreign posts’ capability to digitize and transmit data from shippers’ customs declaration forms. The OIG found that the Postal Service will not be able to fully meet the STOP Act requirement to provide Advance Electronic Data (AED) on all incoming packages as from January 1, 2021. The absence of AED regulations, including a definition of compliance, limits the Postal Service’s ability to prepare for STOP Act implementation. Collaboration among posts, compliance incentives, and penalties could be key success factors.

The Office of the Inspector General contracted with Williams Adley to conduct this audit. The audit objective was to evaluate the effectiveness of the Smithsonian’s information security program in fiscal year 2019.

Our objective was to assess contractual compliance and oversight of the Postal Service’s air transportation agreement with [redacted] (aviation supplier or supplier). We did not review the operational aspects of these provisions, such as mail transportation efficiency. Beginning in [redacted], the Postal Service entered into a contract with the aviation supplier to provide air transportation and ancillary services for moving mail to and from destinations within the contiguous 48 states and non-contiguous areas including Alaska, Hawaii, and Puerto Rico. The original agreement was effective beginning [redacted] and was extended through [redacted], for a total estimated value over this time period of $17.6 billion.

The objective of our ongoing audit is to evaluate FSA’s administration of MFP—this report provides interim results related to FSA’s demographic data collection policies.

Inspector General (OIG) performed an audit of four mission areas within the U.S. Department of Agriculture (USDA) to provide an assessment of the management and security of the Department’s information technology (IT) resources as they pertain to access management and logging controls. We reviewed relevant laws, regulations, and industry best practices in order to gain sufficient knowledge to evaluate USDA’s IT security posture.

On May 28, 2020, we initiated a non-audit service to identify U.S. Department of Agriculture’s (USDA) coronavirus disease 2019 (COVID-19) funding. Our objective was to identify the funding streams USDA used to respond to the COVID-19 pandemic as of May 31, 2020.

U.S. Customs and Border Protection (CBP) cannot ensure its Entry Reconciliation Program reporting is accurate or complies with requirements. Specifically, CBP did not always validate importers’ self-reported final values of imports when it assessed duties and fees because it did not require importers to substantiate self-reported merchandise values with source documentation. In addition, CBP did not always follow its policies when conducting reviews of reconciliation entries because its Standard Operating Procedures had been implemented differently across all ports of entry. Finally, CBP missed opportunities to collect additional revenue when it did not assess monetary liquidated damages for importers that filed reconciliation entries late or not at all. This occurred because CBP’s controls were insufficient to ensure the ports properly assess liquidated damages for importers who file reconciliations late or not at all. CBP’s actions compromised the integrity of the Entry Reconciliation Program and, as such, may have put approximately $751 million of revenue, in the form of reconciliation refunds, at risk. We made four recommendations to improve the overall effectiveness of the program. CBP concurred with three of our four recommendations.

We evaluated the Bureau of Land Management Montana/Dakotas State Office's use of oil and gas funds and found that it did not comply with oil and gas fund expenditure requirements from FYs 2015 through 2018.

The Inspector General for Tax Administration has reviewed the system of quality control for the audit organization of the EPA OIG in effect for the year ended September 30, 2020.

The Hospital complied with Medicare billing requirements for 54 of the 100 inpatient and outpatient claims we reviewed. However, the Hospital did not fully comply with Medicare billing requirements for the remaining 46 claims, resulting in overpayments of $1.6 million for the audit period. Specifically, 45 inpatient claims and 1 outpatient claim had billing errors.

The Department designed its review and approval processes to provide reasonable assurance that it would identify and resolve potential instances of State plans’ noncompliance with the ESEA and McKinney-Vento Act requirements subjected to peer review. The Department also designed the review and approval processes to provide reasonable assurance that it complied with selected ESEA and McKinney-Vento Actrequirements and Department policy. Although the Department implemented its plans for providing guidance to peer reviewers and States and implemented its peer review process in a manner that provided reasonable assurance of State plans’ compliance with ESEA and McKinney Vento Act requirements, we found that the Department did not implement all aspects of the review and approval processes as designed. The The Department did not (1) always retain records that ensured adequate and proper documentation of its peer reviewer selection decisions or its analysis of peer reviewer comments on the McKinney-Vento Act requirements of State plans, (2) publish all versions of States’ plans on its website, or (3) always show that it considered conflict of interest information collected from peer reviewers before assigning them to panels. We did not identify any evidence that would suggest that the Department acted outside its authority to disapprove a State plan as set forth in section 1111(a)(4)(A)(vi) of the ESEA. However, because of the issues noted above, we could not determine why the Department selected certain peer reviewers. We also could not always determine whether the Department considered the results of the peer review process whenproviding feedback on the McKinney-Vento Act section of State plans. Finally, we could not ensure that the Department considered conflict of interest information it collected from peer reviewers before assigning them to panels, which could affect the integrity of the peer review processes.

The Department designed policies and procedures for awarding and monitoring discretionary grants through its Discretionary Grant Handbook. Additionally, the Department designed risk mitigation strategies specific to the Defraying Costs and Emergency Assistance programs through the Internal Control Plan. Together, these policies and procedures, as designed, should have provided reasonable assurance that the Department awarded and monitored grantees’ uses of Defraying Costs and Emergency Assistance grants in accordance with the Bipartisan Budget Act, Uniform Guidance, and Department policy. We concluded that OPE did not implement all the relevant Discretionary GrantHandbook processes and Internal Control Plan risk mitigation strategies as designed. Specifically, OPE did not (1) scrutinize costs in all applications and eliminate those costs that were unallowable; (2)validate grantees’ self-reported data; (3) prepare appropriate terms, such as a high-risk designation and associated conditions, for any awards made to grantees it designated as high risk; (4) apply its Emergency Assistance program allocation formula as designed; (5)conduct post-award conferences; (6) complete post-award monitoring; (7) support changes made through administrative action grant award notifications; and(8) retain all relevant records in official Emergency Assistance grant files.

The VA Office of Inspector General (OIG) conducted a healthcare inspection to evaluate allegations related to the care provided to a patient who died at the Charlie Norwood VA Medical Center (facility) and an allegation that the facility director failed to ensure adequate psychiatric provider coverage. The OIG did not substantiate that the patient died due to overmedication, because the cause of death was bilateral pulmonary thromboemboli with prolonged restraint and “noncontributory” toxicology findings. However, the OIG identified deficiencies during the patient’s care that likely contributed to the patient’s death. Staff improperly ordered and initiated medical-surgical restraint for the patient. Given that the patient was restrained for approximately 71 hours, the staff’s failure to effectively address the patient’s deep vein thrombosis prophylaxis needs contributed to the patient’s death. Staff’s failure to address the patient’s nicotine dependence may have contributed to the worsening of the patient’s agitation that led to restraint usage. Facility leaders and staff failed to comply with Georgia State law involuntary commitment process requirements. The OIG substantiated that the lack of mental health provider involvement likely contributed to the patient’s death, and the patient endured an unnecessary four-hour ambulance trip in restraints that likely contributed to the development of pulmonary thromboemboli.The OIG substantiated that the facility’s Downtown Division lacked adequate psychiatric providers to manage mental health emergencies and that leaders failed to ensure a psychiatrist was included on their code gray team. Also, nurse practitioners had been cancelling outpatient appointments so they could respond to Downtown Division mental health consult requests. The OIG concluded that the Disruptive Behavior Committee failed to provide input that may have reduced the patient’s risk of violence throughout the patient’s care and may have contributed to the mismanagement of the patient’s mental health treatment needs. The OIG made 18 recommendations.

VA spends millions of taxpayer dollars annually on healthcare resources procured without competition from affiliated educational institutions. This review focused on determining the extent of VA’s compliance with the requirement to obtain an Office of Inspector General (OIG) preaward review of healthcare resource proposals from affiliated institutions and the potential monetary impact for any noncompliance. Preaward reviews generally provide VA with pricing recommendations based on the affiliate’s actual expenses of providing the services and are used by VA contracting officers to negotiate fair and reasonable prices for the government and taxpayers. The OIG found VA awarded 227 contracts with a total value of $278.5 million without the required OIG preaward review for contracts above $500,000, which represents 63 percent of the contracts during the 5-year review period. A review of contract files and other sources revealed that contracting officers awarded contracts just below the review threshold and used a series or extended interim contracts to circumvent the review requirements. VA did not consider the monetary value of extending the contract periods when determining the value of the proposals and repeatedly used interim contracts to procure healthcare services without the required OIG preaward review. Additionally, contracting officers did not consistently document that the negotiated price was fair and reasonable, as required. The OIG recommended the Veterans Health Administration executive director for procurement ensure that contracting officers request preaward reviews for all sole-source healthcare resource contracts that exceed $500,000, require an OIG preaward review for all interim contracts that exceed the threshold, and mandate an immediate postaward review for any sole-source contract awarded on an interim basis as an emergency contract.

See the additional details link below for the full report, report summary, multimedia or any agency follow-up.

See the additional details link below for the full report, report summary, multimedia or any agency follow-up.

The OIG examined whether the VA Office of Community Care accurately reimbursed third-party administrators under the Veterans Choice Program for payments made to community healthcare providers for services to veterans during the audit period. This is the third OIG report on healthcare claims payments under the Choice program. It focuses on claims processed through the Plexis Claims Manager system that were paid from February 21, 2017, through December 31, 2018. The audit team found that the Office of Community Care reimbursed third-party administrators at rates higher than what was typical for the same or similar medical services in a given geographic area. The office could have saved approximately $132.1 million during the period audited if it reimbursed third-party administrators at verifiable usual and customary rates, as required by the governing contract. Additionally, the Office of Community Care did not fully implement prior OIG recommendations to develop effective payment and internal control processes for the Choice program. As a result, the office made about $73 million in overpayments to Choice third-party administrators for medical services provided under the program. These errors were made because the appropriate payment rate was not used. The OIG will continue to monitor all recommendations. The OIG made eight recommendations to the Office of Community Care in this report to prevent and address payment errors under current and future contracts (as the Choice program has ended and other community care programs continue).

The Postal Service processes international election and political mail for eligible U.S. citizens throughout the world. Military and diplomatic members and their families or other U.S. citizens located in foreign countries can use or receive these types of mail. Election mail is any item mailed to, or from, authorized election officials that enables citizens to participate in the voting process. For example, local election offices in the U.S. send ballots or other election materials to international recipients and the international voters mail their completed election ballots back. Political mail is related campaign or messaging mail, and generally entails only outbound operations. Our objective was to evaluate the Postal Service’s preparedness for processing international election mail, including military and diplomatic mail.

Our objective was to determine whether the Postal Service is properly paying its injured employees.

o DHS has not effectively managed and coordinated Department resources for its Joint Task Forces (JTFs). Specifically, DHS has not maintained oversight authority through changes in leadership, implemented and updated policies and procedures, identified optimal JTF staffing levels and resources, and established a process to capture total allocated costs associated with JTFs. In addition, DHS has not fully complied with public law requirements to report to Congress on JTFs’ cost and impact, establish outcome-based performance metrics, and establish and maintain a joint duty training program. We recommended the DHS Secretary designate a department-level office to manage and oversee JTFs and address public law requirements. We made seven recommendations to improve DHS’ management and oversight of its JTFs and ensure compliance with legislative requirements. DHS provided a management response, but declined to comment, since the Acting Secretary is currently reviewing the status and future of the JTFs.

This report summarizes work that we initiated and completed during this semiannual period on a number of critical Departmental activities. Over the past 6 months, our office issued 30 products related to our audit, evaluation, and inspection work. These products addressed programs and personnel associated with the U.S. Census Bureau, International Trade Administration (ITA), National Oceanic and Atmospheric Administration (NOAA), United States Patent and Trademark Office (USPTO), and the Department itself. This report also describes our investigative activities addressing programs and personnel associated with the Bureau of Industry and Security (BIS), Census Bureau, NOAA, USPTO, and the Department itself.

Semiannual Report to Congress: April 1, 2020 - September 30, 2020

OIG reviewed USDA’s compliance with the covered agency responsibilities outlined in the Geospatial Data Act.

Report on Audit of Federal Trade Commission Personnel Security and Suitability Program Processes

Management Challenges and Performance Challenges

The VA Office of Inspector General (OIG) evaluated allegations that facility leaders failed to address nurse staffing shortages yet continued to accept resident admissions and that the shortages contributed to adverse events, environment of care concerns, and infection control issues. The OIG further assessed allegations that the Community Living Center (CLC) did not have 24-hour housekeeping aides available, was dirty and infested with flying insects, CLC staff did not wash their hands, the CLC was quarantined more than two times during a 12-month period, a contracted staffing company (registry agency) was not meeting the requested number of nursing assistants (registry staff), and registry staff did not have access to residents’ electronic health records (EHRs). The OIG substantiated that facility leaders failed to address CLC nurse staffing shortages yet continued to accept admissions. The OIG was unable to determine if insufficient CLC staffing levels led to adverse events. However, the OIG identified a higher potential for an adverse clinical outcome related to a missing resident. The facility missed an opportunity to further analyze the event. Facility leaders reduced the number of operating beds without VHA authorization. Managers increasingly relied on registry staff, but the registry agency inconsistently supplied the requested number of staff. The Staffing Methodology Coordinator had insufficient knowledge and used inaccurate staffing targets. The OIG substantiated that 24-hour Environmental Management Service was not available; CLC staff were not consistently meeting the facility hand-hygiene compliance goal; one or both CLC floors closed to admissions and visitors between 2018 and 2019, but CLC staff followed identified processes to minimize additional exposures; and registry staff did not have access to EHRs and could not document care. The OIG did not substantiate that the CLC was dirty but substantiated the presence of flying insects. The OIG made ten recommendations to the facility director.

The VA Office of Inspector General (OIG) conducted a healthcare inspection to evaluate concerns that the failure to follow pharmacy and nursing policies and procedures may have contributed to a patient’s death at the Southeast Louisiana Veterans Health Care System in New Orleans (facility). Following a code blue on the medical-surgical unit, a patient with multiple medical conditions was transferred to the intensive care unit (ICU). The patient’s provider ordered intravenous (IV) fentanyl (a controlled substance) and IV norepinephrine. Due to the patient transferring to the ICU, new medication orders entered previously were discontinued. As a result, an ICU nurse was unable to scan the IV fentanyl label. Another ICU nurse called the pharmacy for a new IV fentanyl label. A pharmacy staff member failed to follow the intent of the facility policy and sent an unattached IV norepinephrine label to the ICU. Subsequently, another ICU nurse incorrectly affixed the IV norepinephrine label to the IV fentanyl bag. The ICU nurse failed to follow facility policy by not verifying the patient and medication information prior to affixing the incorrect label. The patient received the IV fentanyl, mislabeled as IV norepinephrine, at rates not prescribed. ICU nursing staff also failed to follow the infusion rate orders and did not assess the effectiveness of the medication or complete documentation to ensure an accurate record of medications administered. Additional concerns identified during the OIG inspection included an unsecured IV controlled substance and the facility did not conduct a thorough review of the medication error. The OIG made eight recommendations related to unaffixed medication labels; medication administration, medication orders, and compliance with Veterans Health Administration and facility policies regarding high-alert and high-risk medications; security of controlled substances; submitting Joint Patient Safety Reports; peer review; and institutional disclosure.

The Unaccompanied Alien Children ProgramThe UAC program funds temporary shelter care and other related services for unaccompanied children in ORR custody. For project periods with services beginning during FYs 2014 and 2015, ORR awarded grants totaling $2.1 billion to providers for the care and placement of children. The UAC program is separate from State-run child welfare and traditional foster care systems.By law, HHS must provide for the custody and care of a UAC, defined as a child who has no lawful immigration status in the United States, who has not attained 18 years of age, and with respect to whom there is no parent or legal guardian in the United States available to provide care and physical custody (6 U.S.C. § 279(g)(2)). The Flores Settlement Agreement established a nationwide policy for the detention, treatment, and release of UAC and recognized the particular vulnerability of UAC while detained without a parent or legal guardian present (Flores v. Meese—Stipulated Settlement Agreement (U.S. District Court, Central District of California, 1997)).Under the Homeland Security Act of 2002, Congress transferred the care and custody of UAC to HHS from the former Immigration and Naturalization Service to move toward a child welfare-based model of care and away from the adult detention model. In the Trafficking Victims Protection Reauthorization Act of 2008, which expanded and redefined HHS’s statutory responsibilities, Congress directed that each child must “be promptly placed in the least restrictive setting that is in the best interest of the child” (8 U.S.C. § 1232(c)(2)).Care ProcessYFT, a nonprofit entity, is an ORR funded, faith-based shelter care provider in Bristow, Virginia. YFT also serves other adolescents in a separate residential program at its main campus and provides behavioral health services to the general public at various locations throughout the region. Since 2012, YFT has participated in ORR’s UAC program and served approximately 1,000 children. During our audit period, YFT’s ORR funded program received $9.2 million in Federal funds for the care and placement of 266 children.

See the additional details link below for the full report, report summary, multimedia or any agency follow-up.