Federal Reports

OIG PEER REVIEW

Medicare payments may not be made for items or services that “are not reasonable andnecessary for the diagnosis or treatment of illness or injury or to improve the functioning of amalformed body member” (Social Security Act (the Act) § 1862(a)(1)(A)). In addition, the Actprecludes payment to any provider of services or other person without information necessaryto determine the amount due the provider (§ 1815(a)).Federal regulations state that the provider must furnish to the Medicare contractor sufficientinformation to determine whether payment is due and the amount of the payment (42 CFR§ 424.5(a)(6)).Claims must be filed on forms prescribed by CMS in accordance with CMS instructions (42 CFR§ 424.32(a)(1)). The Medicare Claims Processing Manual (the Manual) requires providers tocomplete claims accurately so that Medicare contractors may process them correctly andpromptly (Pub. No. 100-04, chapter 1, § 80.3.2.2). The Manual states that providers must useHCPCS codes for most outpatient services (chapter 23, § 20.3).3The Office of Inspector General (OIG) believes that this audit report constitutes credibleinformation of potential overpayments. Upon receiving credible information of potentialoverpayments, providers must exercise reasonable diligence to identify overpayments (i.e.,determine receipt of and quantify any overpayments) during a 6-year lookback period.Providers must report and return any identified overpayments by the later of (1) 60 days afteridentifying those overpayments or (2) the date that any corresponding cost report is due (ifapplicable). This is known as the 60-day rule.4The 6-year lookback period is not limited by OIG’s audit period or restrictions on theGovernment’s ability to reopen claims or cost reports. To report and return overpaymentsunder the 60-day rule, providers can request the reopening of initial claims determinations,submit amended cost reports, or use any other appropriate reporting process.

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 complied with Federal and State requirements when claiming Federal Medicaid reimbursement for Medicaid services provided to beneficiar

At the request of the Tennessee Valley Authority's (TVA) Supply Chain, we examined a cost proposal for engineering, design, and construction support services. Our examination objective was to determine if the cost proposal was fairly stated for a planned 5-year, $300 million contract.In our opinion, the cost proposal was overstated. Specifically, we found the proposed labor markup rates, for recovery of indirect costs, were overstated compared to recent actual costs. We estimated TVA could save about $4 million over the planned $300 million contract spend by negotiating reduced labor markup rates to more accurately reflect recent actual costs.(Summary Only)

The objectives were to determine whether USPTO (1) achieved its small business utilization goals, (2) contracting officials provided small businesses with adequate contract award opportunities, and (3) took appropriate actions to ensure contracting officials met small business contracting goals. We contracted with Booth Management Consulting, LLC (BMC)—an independent firm—to perform this audit of USPTO. Our office oversaw the progress of this audit to ensure that BMC performed the audit in accordance with generally accepted government auditing standards and contract terms. However, BMC is solely responsible for the attached report and conclusions expressed in it. As discussed in the attached report, BMC concluded that USPTO did not (1) meet its small business utilization goals, (2) provide small businesses with adequate contract award opportunities, and (3) take appropriate actions to meet small business contracting goals. BMC recommended in the report that the Under Secretary of Commerce for Intellectual Property and Director of the U.S. Patent and Trademark Office direct the Director of the Office of Procurement to ensure that the following occur: (1) Contract specialists verify small business eligibility prior to awarding small business contracts. (2) Contract specialists perform and appropriately document small business set-aside reviews. (3) Historically Underutilized Business Zones small business consideration is included in its annual acquisition forecasting activities and marketing efforts to maximize contracting opportunities. (4) The Office of Procurement uses the Forecasting and Advanced Acquisition Planning System and establishes clear lines of communication between the Office of Procurement, small business specialists, and contracting specialists for all procurement requests.

During our unannounced inspections of five U.S. Customs and Border Protection (CBP) facilities in the Laredo and San Antonio areas of Texas in February 2020, three Border Patrol stations and two Office of Field Operation ports of entry we visited appeared to be operating in compliance with the Transport, Escort, Detention, and Search (TEDS) standards we evaluated. We verified accessibility to water, food, toilets, sinks, basic hygiene supplies, and bedding. We observed clean facilities and verified that temperatures and ventilation in holding rooms were appropriate. Of the five facilities we visited, only one could provide on-site showers to detainees, but during our visits, no detainees were approaching the detention time threshold where a shower would be required. Because Border Patrol leadership directed all Border Patrol stations to implement Phase 2 of the enhanced medical screening ahead of the prescribed schedule outlined in CBP Directive 2100-004, the Border Patrol stations we visited were conducting alien intake health assessments using CBP Form 2500. These Ports of Entry had implemented Phase 1, but were not yet required to conduct Phase 2 assessments at the time of our inspection. We did not make any recommendations in this report.

We are issuing this management alert to advise the Department of Homeland Security and CBP of the urgency and short timeframe to award a new medical services contract. During two ongoing projects, we learned that CBP’s current contract for medical services will expire on September 29, 2020. As of September 3, 2020, CBP had not issued a solicitation for a new contract, leaving fewer than 30 days for necessary funding, reviews, and approvals before CBP can award the contract. A lapse in this contract could jeopardize the health and safety of migrants in CBP custody, as well as that of U.S. Border Patrol agents, CBP officers, and staff, during the current pandemic. We recommended that CBP dedicate all available resources necessary to its planning and communication to ensure continuity of CBP’s onsite medical services and that CBP conduct future contract planning and communication in a timely manner. CBP concurred with this recommendation.

The National Credit Union Administration (NCUA) Office of Inspector General (OIG) conducted this self-initiated audit to assess the NCUA’s examination and oversight authority of credit union service organizations (CUSOs) and third party vendors. The objectives of our audit were to determine whether: 1) the NCUA complied with applicable laws, regulations, policies, and procedures for CUSO and other (non-CUSO) third-party vendor reviews; and 2) the NCUA’s vendor review process effectively helps to assess the adequacy of credit union management’s due diligence reviews, and identify and reduce the risks vendor relationships pose to credit unions. The scope of our audit covered the period of January 1, 2013, through December 31, 2019.

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Tuesday, September 1, 2020We investigated allegations that a building management employee working in the Office of the Assistant Secretary – Indian Affairs misused their official position and engaged in unethical or illegal behavior.We found that the building management employee misused their Government charge card, participated in bid rigging, took a Government laptop for personal use, and failed to properly follow the DOI parking pass process policy, in violation of U.S. Department of the Interior policy and Federal regulations.The U.S. Department of Justice declined prosecution. The building management employee was removed from Federal service. We provided this final report to the Assistant Secretary for Indian Affairs.

The Veterans Health Administration (VHA) took measures to protect patients and employees from COVID-19 by canceling face-to-face appointments that were not urgent and converting some of them to virtual appointments. The VA Office of Inspector General (OIG) assessed VHA’s appointment management strategies and the status of canceled appointments. The review team found that about five million appointments (68 percent) canceled from March 15 through May 1, 2020, had evidence of follow up or other tracking. Patients completed appointments predominantly by telephone and some by video. Other appointments were tracked for future follow-up in VA’s scheduling system. However, about 2.3 million cancellations (32 percent) had no indication of follow up or tracking at the time of review. The review team also examined whether medical facilities followed VHA’s guidance on annotating the appointment cancellations. Doing so consistently would have allowed facilities to better determine which appointments needed to be rescheduled. However, VHA’s guidance changed over time, and facilities applied it inconsistently. Facilities also did not consistently follow guidance on leaving consults open so that medical providers could reschedule them. In addition, the team noted that canceling appointments in batches could mask the instances where patients were not contacted about the cancellations. The OIG’s ongoing surveillance of VHA data shows that overall, from March 15 through June 15, 2020, VHA has canceled nearly 11.2 million appointments and needs to follow up on about 3.3 million of those cancellations. The OIG recommended that VHA coordinate a well defined rescheduling strategy with all facilities and provide oversight to facilities that have a significant rate of appointments with no evidence of follow up or tracking. The OIG also recommended VHA ensure facilities do not solely rely on appointment annotations when rescheduling. Finally, the OIG recommended that facilities take appropriate action on canceled or discontinued consults.

In accordance with our Annual Performance Plan Fiscal Year 2020, the Office of Inspector General (OIG) conducted a performance audit of the United States Capitol Police's (USCP or the Department) Transit Incentive Program (TIP). OIG objectives were to determine whether the Department (1) established adequate internal controls and processes for ensuring compliance with Department policies, and (2) complied with applicable policies and procedures, as well as applicable laws, regulations, and best practices. Our scope included controls, processes, and operations during FY 2019.

We audited Vineville Christian Towers’ (project) Rental Assistance Demonstration Program (RAD) conversion in accordance with our annual audit plan. Our audit objective was to determine whether the project’s RAD conversion to the Section 8 Project-Based Voucher Program was completed in accordance with the U.S. Department of Housing and Urban Development’s (HUD) requirements; specifically, whether the Macon-Bibb County Housing Authority properly executed the housing assistance payments contract for the project’s RAD conversion. The Authority improperly executed a Section 8 Project-Based Voucher Program housing assistance payments (HAP) contract for 90 units. Specifically, the Authority did not ensure that (1) the tenant protection assistance was in place for all 90 tenants, and (2) only the units occupied at the time of contract execution were included on the contract. In addition, the Authority did not obtain information from HUD for properly issuing tenant protection assistance. This condition occurred because the Authority (1) lacked an understanding of retroactive RAD conversion type and was not familiar with the requirements for tenant protection assistance and (2) did not establish written procedures related to the RAD conversion and tenant protection assistance. As a result, the Authority improperly received more than $138,000 in administrative fees. Unless the Authority cancels the contract, we estimate that it will improperly provide nearly $257,000 over the next year for units improperly converted under RAD.We recommend that the Acting Director of HUD’s Atlanta, GA, Office of Public and Indian Housing require the Authority to (1) cancel the contract resulting from the RAD conversion, thereby putting nearly $257,000 to better use; (2) reimburse its Section 8 program more than $138,000 in associated administrative fees from non-Federal funds; (3) develop and implement procedures; and (4) provide training to its staff to help ensure compliance with program requirements.

The Postal Service uses a universal key, known as an arrow key, to access collection boxes, outdoor parcel lockers, cluster box units, and apartment panels. Supervisors assign these keys – generally one per route – to letter carriers for use on over 300,000 delivery and collection routes each day. Carriers and collectors must always keep arrow keys secured and attached to their belts or clothing by a chain while on duty and return them at the end of each day. Our objective was to assess the effectiveness of the Postal Service’s management controls for arrow keys.

Babar Iqbal, a California-based doctor and owner of Riverside Regional Surgery Center, was sentenced in the Superior Court of California, County of Riverside, on August 31, 2020, to 27 months in prison and was ordered to pay restitution of $2,799,550 for health care insurance fraud. Iqbal targeted patients whose insurance paid higher reimbursement amounts to providers who were considered out of network, and he performed services that were medically unnecessary. Iqbal also conspired with marketers to obtain fraudulent insurance policies for individuals who did not have health insurance. The marketers then referred these individuals to Iqbal at the Riverside Regional Surgery Center. In return, the marketers received a commission based on the reimbursement amount the insurance companies paid Iqbal. Amtrak’s health insurance plan was fraudulently billed approximately $1,653,210 as a result of the scheme. Iqbal previously pleaded guilty to several charges related to health care insurance fraud in June 2020.

To view a set of interactive dashboards with up-to-date data on COVID-19 cases in this facility, click the link below.

To view a set of interactive dashboards with up-to-date data on COVID-19 cases in this facility, click the link below.

To view a set of interactive dashboards with up-to-date data on COVID-19 cases in this facility, click the link below.

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

The Postal Service plays a vital role in the American democratic process and this role continues to grow as the volume of Election and Political Mail increases. In addition to the next general election, which will be held November 3, 2020, there will be federal elections for all 435 seats in the U.S. House of Representatives and 35 of the 100 seats in the U.S. Senate. There will also be 13 state and territorial elections for governor and numerous other state and local elections. Due to the COVID-19 pandemic, there is an expected increase in the number of Americans who will choose to vote by mail and avoid in-person voting. Our objective was to evaluate the Postal Service’s readiness for timely processing of Election and Political Mail for the 2020 general elections.

The Child Care and Development Block Grant Act (CCDBG Act) of 2014 added new requirements for States that receive funding from the Child Care and Development Fund (CCDF) to conduct comprehensive criminal background checks on staff members and prospective staff members of child care providers every 5 years. Criminal background check requirements apply to any staff member who is employed by a child care provider for compensation or whose activities involve the care or supervision of children or unsupervised access to children.Our objective was to determine whether Indiana’s monitoring of child care providers ensured provider compliance with State requirements related to criminal background checks established under the CCDBG Act.

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

At the request of the Tennessee Valley Authority's (TVA) Supply Chain, we examined the cost proposal submitted by a company for engineering, design, and construction support services. Our examination objective was to determine if the company's cost proposal was fairly stated for a planned 5-year, $20.5 million contract.In our opinion, the company's cost proposal was overstated. Specifically, we found the proposed total labor markup rate, for recovery of the company's indirect costs, was overstated compared to recent actual costs. In addition, we found the company's proposed costs for the request for proposal's (RFP) example projects contained a cost markup not provided for by the RFP's draft contract. We estimated TVA could avoid about $2.24 million over the planned $20.5 million contract by negotiating a reduced total labor markup rate to more accurately reflect the company's recent actual costs. (Summary Only)

In the National Historic Preservation Act of 1966, Congress established a comprehensive program to preserve the historical and cultural foundations of the nation as a living part of community life. Section 106 of the Act requires federal agencies to consider the effects of projects they carry out, approve, or fund on historic properties. The Tennessee Valley Authority's Cultural Compliance group performs historic preservation reviews (called Section 106 reviews) to assess (1) whether or not historic properties are present, (2) adverse effects of projects on historic properties, and (3) how to mitigate the adverse effects. Due to concerns raised about the efficiency of historic preservation reviews, we performed an evaluation to determine if the process for performing historic preservation reviews was efficient. We determined Section 106 reviews were not consistently tracked resulting in a lack of data to determine the time and costs of the reviews. However, we were able to identify inefficiencies in the Section 106 process. Specifically, we determined the process had inefficiencies regarding (1) prioritization of projects, (2) incorporation of Cultural Compliance in planning, (3) communication between organizations, (4) workload of Cultural Compliance personnel, (5) reliance on contractors, and (6) tracking of cultural resources. We made recommendations to the Vice President, Environment, to address inefficiencies in Section 106 reviews.

The Office of Inspector General evaluated NASA’s policies and practices regarding the use of non-Agency mobile IT devices to conduct NASA business.

The VA Office of Inspector General (OIG) conducted a healthcare inspection to determine the validity of allegations related to the management of staff exposure to a patient diagnosed with COVID-19 at the VA Portland Medical Center (facility) in Oregon. The events under review involved the facility’s first patient diagnosed with COVID-19. The OIG did not substantiate that emergency department staff failed to notify imaging department staff that a patient was suspected to have COVID-19 before sending the patient to the imaging department. At the time of the patient’s transport to the imaging department, emergency department staff had not identified suspicion of COVID-19. However, emergency department staff failed to alert imaging department staff of the patient’s potential influenza. The OIG did not substantiate that imaging department supervisors failed to properly and promptly notify imaging department staff who had contact with a patient who was diagnosed with COVID-19 after admission to the facility, or that leaders failed to take appropriate action following staff exposure to a patient with COVID-19. The OIG identified some missteps in the facility’s processes when responding to staff exposure, which affected the accuracy of exposure risk assessments and monitoring for some exposed staff. While missteps were noted, the facility made a significant and timely effort to identify staff with potential exposure and respond in accordance with the most current guidance from the Centers for Disease Control and Prevention and Oregon Health Authority. Facility leaders and infection prevention and control staff developed and revised COVID-19-related policies as new guidance became available. The OIG made five recommendations to the facility director related to communicating infection control precautions prior to transfer, management of staff with exposure to high-consequence infections, and inclusion of a detailed staff exposure management process in relevant facility policies.

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 Captain James A. Lovell Federal Health Care Center and outpatient clinics in Illinois and Wisconsin. The inspection covers key clinical and administrative processes associated with promoting quality care. This inspection focused on Leadership and Organizational Risks; Quality, Safety, and Value; Medical Staff Privileging; Environment of Care; 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. At the time of this inspection, the healthcare center’s leaders had been working together for four months. Employee satisfaction survey results revealed opportunities for the Chief Medical Executive and VA Chief Nurse Executive to improve employees’ feelings of “moral distress” at work. Patient experience surveys indicated general satisfaction; however, female veteran scores were less favorable. The leaders were knowledgeable within their scopes of responsibility about Strategic Analytics for Improvement and Learning data and should continue to take action to sustain and improve performance. The OIG issued 27 recommendations for improvement in seven areas: (1) Quality, Safety, and Value • Committee processes • Utilization Management processes (2) Medical Staff Privileging • Focused and ongoing professional practice evaluations • Provider exit reviews (3) Environment of Care • Environmental cleanliness • Privacy and security (4) Medication Management • Quality measure oversight (5) Mental Health • Suicide prevention training (6) Women’s Health • Primary Care Mental Health Integration services • Community-based outpatient clinic women’s health primary care providers • Women Veterans Health Committee membership • Quality data monitoring (7) High-Risk Processes • Standard operating procedures • Annual risk analysis • Airflow testing • Eyewash station testing • Environmental cleanliness • Equipment storage and tracking • Staff training

Delivery System Reform Incentive Payment (DSRIP) Program payments are incentive payments made to hospitals and other providers that develop programs or strategies to enhance access to health care, increase the quality and cost-effectiveness of care, and increase the health of patients and families served. These incentive payments have significantly increased funding to providers for their efforts related to the quality of services. Texas made DSRIP Program payments totaling almost $10 billion for 5 years.Our objective was to determine whether Texas used permissible funds as the State share of DSRIP Program payments.

DHS components used inconsistent processes for administrative forfeitures under the Civil Asset Forfeiture Reform Act of 2000 (CAFRA). Specifically, we found inconsistencies among DHS components regarding the forms used to notify property owners and the process for responding to claims. Further, CBP inappropriately used waivers to extend deadlines for responding to claims. We recommended DHS implement a department-wide structure to oversee component forfeiture activities across DHS by designating an office at headquarters for this role. Additionally, DHS should develop Department-wide policies and procedures, as well as review component policies, to ensure forfeiture processes and practices are consistent. We made two recommendations to improve oversight across DHS and provide consistent processes for handling administrative forfeitures. DHS concurred with recommendation two, which we consider resolved and open, but did not concur with recommendation one, which is unresolved and open.

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 Clement J. Zablocki VA Medical Center and multiple outpatient clinics in Wisconsin. The inspection covers key clinical and administrative processes that are associated with promoting quality care. This inspection focused on Leadership and Organizational Risks; Quality, Safety, and Value; Medical Staff Privileging; Environment of Care; 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. The medical center’s executive leadership team had been working together for over two years. Employee satisfaction survey results revealed opportunities for the Deputy Director and Assistant Director to decrease employee feelings of moral distress at work. Patient experience survey data noted satisfaction with care. Survey results for males and females were generally more favorable than VHA results nationally. The review of accreditation findings did not identify any substantial organizational risk factors. The OIG identified significant concerns with sentinel events identification. Executive leaders were generally able to speak knowledgeably about actions taken during the previous 12 months to maintain or improve performance, and were knowledgeable within their scopes of responsibilities about Strategic Analytics for Improvement and Learning data. The OIG issued 28 recommendations for improvement in seven areas:(1) Quality, Safety, and Value • Committee processes • Utilization management processes (2) Medical Staff Privileging • Professional practice evaluations • Provider exit reviews (3) Environment of Care • Safety and cleanliness • Information security (4) Medication Management • Behavior risk assessment • Urine drug testing • Informed consent • Patient follow-up (5) Mental Health • Patient follow-up (6) Women’s Health • Gynecologic care coverage • Committee membership • Quality data • Women veteran program manager position (7) High-Risk Processes • Annual risk analysis • Environmental cleanliness • Equipment storage

o Since 2017, DHS has continued to make progress in meeting its Digital Accountability and Transparency Act of 2014 (DATA Act) reporting requirements, but challenges remain. To enable more effective tracking of Federal spending, DHS must continue to take action to accurately align its budgetary data with the President’s budget, reduce award misalignments across DATA Act files, improve the timeliness of financial assistance reporting, implement and use government-wide data standards, and address risks to data quality. Without these actions, DHS will continue to experience challenges in meeting its goal of achieving the highest possible data quality for submission to USAspending.gov. We made five recommendations to help strengthen DHS’ controls for ensuring complete, accurate, and timely spending data. The Department concurred with all five recommendations.

As part of our annual audit plan, we performed an audit of costs billed to the Tennessee Valley Authority (TVA) by Thalle Construction Company, Inc. (Thalle) for construction and modification services for civil projects and coal combustion product management under Contract No. 10061. The contract provided for TVA to compensate Thalle for work on either a cost reimbursable, target cost estimate (TCE), or fixed price basis. Our audit objectives were to determine if (1) costs were billed in compliance with the terms and conditions of the contract and (2) tasks were issued using the most cost efficient pricing methodology. Our scope included about $16.2 million in costs billed to TVA from May 20, 2015, through December 20, 2018. This included about $14.7 million for fixed price projects, $1.3 million for TCE projects, and $186,000 for cost reimbursable projects. In summary, we determined:Thalle overbilled TVA $78,414 on a TCE project, including (1) $24,716 for ineligible costs billed and (2) $53,698 in overstated TCE cost savings.Thalle overbilled TVA $70,751 in equipment costs on cost reimbursable projects, including (1) $54,755 in overbilled TVA Equipment Support Services equipment rental costs and (2) $15,996 in overbilled costs for Thalle owned equipment.The use of fixed price or unit rate payment terms on projects caused TVA to pay at least $2.1 million more than it would have if cost reimbursable payment terms had been used for those projects. Additionally, we determined the unit rate payment terms used by TVA to compensate Thalle were not provided for in the contract's terms and conditions.We also noted several opportunities to improve contract administration by TVA.(Summary Only)

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 Edward Hines, Jr. VA Hospital and multiple outpatient clinics in Illinois. The inspection covers key clinical and administrative processes that are associated with promoting quality care. This inspection focused on Leadership and Organizational Risks; Quality, Safety, and Value; Medical Staff Privileging; Environment of Care; 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. The executive leadership team had worked together for five months at the time of the OIG site visit. The medical center director position had been vacant for five months; the Associate Director had served as acting Director since October 2019. Selected patient experience survey scores generally reflected similar or higher ratings than the VHA average; however, female veterans reported less positive specialty care experiences than female patients nationally. The OIG determined that opportunities exist to improve the institutional disclosure process and considered the vacant director position a vulnerability. Executive leaders were generally knowledgeable within their scopes of responsibilities about data used in Strategic Analytics for Improvement and Learning quality measures and should continue to take actions to sustain and improve performance. The OIG issued 23 recommendations for improvement in six areas: (1) Quality, Safety, and Value • Committee processes • Peer review processes • Utilization management processes (2) Medical Staff Privileging • Professional practice evaluations • Provider exit review processes (3) Environment of Care • Expired supplies • Environmental cleanliness (4) Medication Management • Pain screening • Behavior risk assessment • Urine drug testing • Informed consent • Patient follow-up (5) Mental Health • Staff training (6) High-Risk Processes • Bioburden testing • Traffic restriction • Climate control • Staff training • Competency assessments

Overtime pay is a premium that eligible employees receive when they perform work in excess of eight paid hours in a day, or 40 paid hours in a week. Per union contracts, regular overtime is paid at one and one-half times an employee’s hourly rate to non-exempt employees, while penalty overtime is paid at double an employee’s hourly rate under specific conditions. Employees must be paid for all overtime work they perform, even if that time was not authorized. Unauthorized overtime occurs when an employee’s clock time exceeds eight hours in a day or 40 hours in a week without prior authorization from a manager. Our objective was to assess Postal Service controls over managing overtime.

We audited Task Order No. 140G0218F0251 and Contract No. G16PC00016 between Quantum Spatial, Incorporated (QSI) and the U.S. Geological Survey (USGS) to determine whether (1) QSI complied with all applicable Federal regulations and terms and conditions of the task order and the governing contract, (2) the USGS complied with all applicable Federal regulations, USGS policies and procedures, and award terms and conditions when awarding and monitoring the contract and the task order, and (3) the USGS negotiated a fair and reasonable price for services rendered under the task order. We reviewed supporting documentation and compliance from the beginning of the solicitation phase in October 2014 through December 2018.We found that QSI and the USGS did not always comply with applicable regulations, policies, and contract terms and conditions. Specifically:• QSI submitted invoices that were mathematically incorrect.• QSI submitted invoices that did not include contract line item numbers as required.• The USGS did not include a required clause in the contract.• The USGS did not document the contract negotiations properly.In addition, we found that the USGS negotiated a fair and reasonable price for the task order.We make two recommendations regarding invoice review and three recommendations regarding contract administration to help the USGS improve its contract oversight and maintain complete and comprehensive documentation. Based on the USGS’ response to our draft report, we consider all five recommendations to be resolved but not implemented.

We audited the costs claimed by the State of Kansas, Department of Wildlife, Parks and Tourism (Department), under grants awarded by the U.S. Fish and Wildlife Service (FWS) through the Wildlife and Sport Fish Restoration Program. The audit included claims totaling $49.3 million on 69 grants that were open during the State fiscal years that ended June 30, 2017, and June 30, 2018. The audit also covered the Department’s compliance with applicable laws, regulations, and FWS guidelines, including those related to the collection and use of hunting and fishing license revenues and the reporting of program income.We found that the Department generally ensured that grant funds and hunting and fishing license revenue were used for allowable fish and wildlife activities and complied with applicable laws and regulations, FWS guidelines, and grant agreements. We noted, however, issues with indirect costs, subawards, and equipment management. We questioned $139,087 ($103,191 Federal share) as ineligible. We recorded a potential diversion of $30,728 in license revenue. We also found control deficiencies with the Department’s subaward reporting policies, and we repeated a finding on real property.The FWS concurred with our six recommendations and repeat recommendations and will work with the Department to implement corrective actions.

Medicaid telemedicine services are health services delivered via telecommunication systems. A Medicaid patient at an originating site uses audio and video equipment to communicate with a health professional at a distant site. Before the COVID-19 public health emergency, Medicaid programs were seeing a significant increase in payments for telemedicine services and expect this trend to continue. This audit, conducted before the COVID-19 public health emergency, is one in a series of audits to determine whether selected States complied with Federal and State requirements when claiming Federal reimbursement for telemedicine services.Our objective was to determine whether Illinois made payments for Medicaid telemedicine services in accordance with Federal and State requirements.

The Medicaid program pays for nonemergency medical transportation (NEMT) services that a State determines to be necessary for beneficiaries to obtain care. Prior OIG audit reports have consistently identified NEMT services as vulnerable to fraud, waste, and abuse.Our objective was to determine whether Indiana claimed Federal Medicaid reimbursement for NEMT service claims in accordance with Federal and State requirements.

For a covered outpatient drug to be eligible for Federal reimbursement under the Medicaid program’s drug rebate requirements, manufacturers must pay rebates to the States. States bill the manufacturers for rebates to reduce the cost of drugs to the program. However, previous Office of Inspector General (OIG) audits found that States did not always bill and collect all rebates due for drugs administered by physicians to enrollees of Medicaid managed-care organizations (MCOs). For this audit, we reviewed the Michigan Department of Health and Human Services’ (State agency’s) billing of rebates for both pharmacy and physician-administered drugs dispensed to MCO enrollees. Our objective was to determine whether the State agency complied with Federal Medicaid requirements for billing manufacturers for rebates for drugs dispensed to MCO enrollees.

When an overpayment is identified in Medicare Part A or Part B, providers have the right to contest the overpayment amount using the Medicare administrative appeals process. If a statistical estimate of an overpayment (an extrapolated overpayment) is overturned during the administrative appeals process, then the provider is liable for the overpayment identified in the sample but not the extrapolated amount. Given the large difference between overpayment amounts in the sample and extrapolated amounts, it is critical that the process for reviewing extrapolations during an appeal is fair and reasonably consistent. In the first and second levels of the appeals process, such extrapolated overpayments are reviewed by Medicare administrative contractors (MACs) and qualified independent contractors (QICs), respectively.Our objective was to determine whether the Centers for Medicare & Medicaid Services (CMS) ensured that MACs and QICs reviewed appealed extrapolated overpayments consistently and in a manner that conforms with existing CMS requirements.

In accordance with our Annual Performance Plan Fiscal Year 2020, dated October 2019, the Office of Inspector General (OIG) conducted a review of the United States Capitol Police (USCP or the Department) Office of Professional Responsibility (OPR). The scope of the review included existing policies and procedures related to OPR for Fiscal Year (FY) 2019 through March 31, 2020.  OIG objectives were to determine if the Department (1) established adequate internal controls and processes for ensuring compliance with Department policies and (2) complied with policies and procedures, laws, regulations, and best practices.

Our objective was to determine if the Postal Service developed the HERO system in accordance with policies, procedures, and industry best practices, and whether it is functioning as management intended.

National Provider Identifiers (NPIs) for physicians and nonphysician practitioners who order and/or refer services (ordering providers) are essential for safeguarding the program integrity of durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS); clinical laboratory services; imaging services; and home health services in Medicare. NPIs are critical for identifying inappropriate billing and ordering patterns among providers and investigating fraud and abuse. Both CMS and OIG rely on NPIs for ordering providers to conduct oversight and pursue fraud investigations.

What We Looked AtWe performed a quality control review (QCR) on the single audit that PBMares, LLP performed for the Metropolitan Washington Council of Governments' (MWCOG) fiscal year that ended June 30, 2018. During this period, MWCOG expended approximately $17.9 million from the U.S. Department of Transportation's (DOT) grant programs. PBMares determined that DOT's major programs were the Highway Planning and Construction Cluster, and the Metropolitan Transportation Planning and State and Non-Metropolitan Planning and Research Program.Our QCR objectives were to determine (1) whether the audit work complied with the Single Audit Act of 1984, as amended, and the Office of Management and Budget's Uniform Guidance, and the extent to which we could rely on the auditors' work on DOT's major programs; and (2) whether MWCOG's reporting package complied with the reporting requirements of the Uniform Guidance.What We FoundPBMares' audit work complied with the requirements of the Single Audit Act, the Uniform Guidance, and DOT's major programs. We found nothing to indicate that PBMares' opinion on each of DOT's major programs was inappropriate or unreliable. However, we identified a deficiency in MWCOG's reporting package that required correction and resubmission.

We determined CBP’s use of tear gas on these dates, in response to physical threats, appeared to be within CBP’s use of force policy. However, U.S. Border Patrol obtained an acoustic device and used it in an “alert tone” mode on November 25, 2018, which did not conform to CBP’s Use of Force policy because Border Patrol did not get advance authorization to have a device with this capability. CBP’s Use of Force policy would have permitted use of the alert tone in a manner reasonable and necessary for self-defense or the defense of another person in threatening, emergent situations. However, the policy does not authorize the carrying of any weapon for duty use that is not authorized, included on the Authorized Equipment List, or specifically approved by the LESC director. Using the acoustic device in alert mode may increase the risk of temporary or permanent hearing loss to those exposed to the sound and thereby increase the Government’s liability. CBP’s own internal investigation of the November 25, 2018 incident regarding the acoustic device was incomplete and inaccurate and did not provide all the information CBP needed to determine whether the CBP officer and Border Patrol agents involved had complied with the use of force policy. In addition, not all Border Patrol agents had the required training and certification to carry less-lethal devices. This occurred because Border Patrol lacked internal controls to ensure agents had fulfilled these requirements. Border Patrol agents using less-lethal devices for which they are not certified could result in unintended serious injury or death, increasing the Government’s liability. We made four recommendations to CBP to ensure compliance with its Use of Force policy and improve its investigative process. CBP concurred with all four recommendations.

In accordance with our Annual Performance Plan Fiscal Year 2020, the Office of Inspector General OIG) conducted a performance audit of the United State Capitol Police (USCP or the Department) Student Loan Repayment Program (SLRP).  OIG objectives were to determine if the Department (1) established adequate internal control and processes for ensuring compliance with Department policies and 2) complied with applicable policies and procedures. a well as applicable laws, regulations, and best practices. Our scope included controls, processes, and operations during Fiscal Year (FY) 2019.

We audited the U.S. Department of Housing and Urban Development’s (HUD) oversight of lead in the water of Housing Choice Voucher Program and public housing program (assisted) units based on our goal of strengthening the soundness of public and Indian housing. The audit was part of the activities in our fiscal year 2019 audit plan. Our objective was to determine whether HUD’s Office of Public and Indian Housing had sufficient policies, procedures, and controls to ensure that households living in assisted units had a sufficient supply of safe drinking water.HUD’s Office of Public and Indian Housing did not have sufficient policies, procedures, and controls to ensure that households living in assisted units had a sufficient supply of safe drinking water. Public housing agencies had assisted units served by public water systems that reported levels of lead above the Environmental Protection Agency’s lead action level. However, HUD had limited requirements concerning lead in the drinking water of assisted units and generally did not require public housing agencies to take action regarding the potential for lead in the drinking water. These weaknesses occurred because HUD relied on the Agency to ensure that public water systems provided water that was safe to drink. As a result, HUD lacked assurance that households, including households with children age 6 or under, lived in assisted units that had a sufficient supply of safe drinking water.We recommend that the General Deputy Assistant Secretary for Public and Indian Housing develop and implement an action plan that includes sufficient policies, procedures, and controls that address households living in assisted units having a sufficient supply of safe drinking water.

At the request of the Tennessee Valley Authority's (TVA) Supply Chain, we examined the cost proposal submitted by a company for engineering, design, and construction support services. Our examination objective was to determine if the company's cost proposal was fairly stated for a planned 5-year, $200 million contract.In our opinion, the company's cost proposal was fairly stated. However, we found the company's proposed labor rate ranges were not reflective of the actual salary costs for company employees. Specifically, we found the company had actual salary rates (1) lower than the minimum labor rates proposed for some categories and (2) higher than the maximum labor rates proposed for some labor categories. (Summary Only)

We audited the U.S. Department of Housing and Urban Development’s (HUD) oversight of lead in the water of multifamily housing units based on our goal of strengthening the soundness of multifamily housing. The audit was part of the activities in our fiscal year 2019 audit plan. Our objective was to determine whether HUD’s Office of Multifamily Housing Programs had sufficient policies, procedures, and controls to ensure that households living in multifamily housing units had a sufficient supply of safe drinking water.HUD’s Office of Multifamily Housing Programs did not have sufficient policies, procedures, and controls to ensure that households living in multifamily housing units had a sufficient supply of safe drinking water. Multifamily housing properties were served by public water systems that reported levels of lead above the Environmental Protection Agency’s lead action level. However, HUD had limited requirements concerning lead in the drinking water of multifamily housing units and did not require multifamily property owners or management agents to take action regarding the potential for lead in the drinking water. These weaknesses occurred because HUD relied on the Agency to ensure that public water systems provided water that was safe to drink. As a result, HUD lacked assurance that households lived in multifamily housing units that had a sufficient supply of safe drinking water.We recommend that the Director of Multifamily Asset Management and Portfolio Oversight develop and implement an action plan that includes sufficient policies, procedures, and controls that address households living in multifamily housing units having a sufficient supply of safe drinking water.

The Office of the Inspector General audited TVA's management of Mac® desktops and laptops to determine if Mac® desktop and laptop patching and configuration management followed TVA policy. In summary, we found (1) TVA is at potential risk for compromise of Mac® desktops and laptops due to inaccurate inventory, (2) TVA was not patching Mac® systems in the designated time frames in TVA policy, and (3) TVA did not have a Mac® baseline as required by TVA policy. TVA management agreed with our findings and recommendations.

The VA Office of Inspector General (OIG) investigated allegations that the chief of staff at a VA medical center engaged in a conflict of interest by performing work for a private company that provides education services and misused his official position by recruiting VA physicians to work for that same company in 2017 and 2018. The OIG did not substantiate either alleged violation. The OIG did, however, identify a related misuse of government resources. After the OIG investigation began, the chief of staff sought advice from the VA Office of General Counsel regarding whether the work for the company presented a conflict of interest. The chief of staff was advised that there was no conflict of interest. In seeking this advice, the chief of staff disclosed that he had previously asked two VA physicians to do work for the company. The OGC ethics team advised that the VA physicians could continue working for the company; however, the chief of staff should not participate in any employment arrangements between the VA physicians and the company. The chief of staff confirmed that he would follow the advice. The OIG identified email threads exchanged between the chief of staff and the VA physicians in support of the outside business activities associated with the education company. When presented with these emails, the chief of staff apologized and expressed surprise. The two VA physicians indicated they believed (incorrectly) that the use of VA resources to conduct activities related to the company was permissible if it was done outside working hours. The OIG makes no recommendations. However, nothing in this report shall prevent the medical center director from taking appropriate administrative action with respect to the improper use of VA email resources by the chief of staff and the physicians.

The VA Office of Inspector General (OIG) conducted an inspection to evaluate a complaint regarding staffing, length of stay, and medical assessments on inpatient mental health units at the facility. Senator Elizabeth Warren referred similar concerns to the OIG regarding the inpatient mental health units. An allegation of inappropriate prescribing practices and identified concerns regarding nurse staffing methodology, recovery-oriented programming, and inpatient mental health levels of care were also reviewed. The OIG substantiated that from October 1, 2017, through September 30, 2019, inpatient psychiatry staffing was below expected staffing levels but was unable to determine if medical provider staffing was inadequate because the Veterans Health Administration (VHA) does not provide guidelines for medical staffing. The OIG did not substantiate patients had increased lengths of stay due to insufficient psychiatry staffing. From October 1, 2017, through September 30, 2019, staff did not complete the VHA-required number of utilization management reviews. The OIG did not substantiate patients remained on the acute inpatient mental health unit after psychiatric stabilization to treat medical issues that were overlooked during the admission process. The OIG did not substantiate that inpatient psychiatrists inappropriately prescribed antidepressant medications and vitamin B12 injections. From 2017 through 2019, facility leaders failed to complete VHA-required nurse staffing methodology. In January 2020, facility leaders approved the nurse staffing methodology. Inpatient mental health unit managers did not ensure the required recovery-oriented programming on Sundays, and programming did not consistently occur when scheduled. Facility leaders failed to convert sustained treatment and rehabilitation and specialized inpatient posttraumatic stress disorder beds to acute or residential beds, which resulted in staff’s failure to complete required utilization reviews. The OIG made seven recommendations related to inpatient mental health staffing, utilization management reviews, medical assessments, nurse staffing methodology, recovery-oriented programming, and inpatient mental health levels of care.

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

This Office of Inspector General (OIG) Comprehensive Healthcare Inspection Program report provides a focused evaluation of the leadership performance and oversight by the Veterans Integrated Service Network (VISN) 15: VA Heartland Network, covering leadership and organizational risks and key processes associated with promoting quality care. For this inspection, the areas of focus were Quality, Safety, and Value; Medical Staff Credentialing; Environment of Care; Medication Management: Long-Term Opioid Therapy for Pain; Women’s Health: Comprehensive Care; and High-Risk Processes: Reusable Medical Equipment. The OIG conducted this unannounced visit during concurrent inspections of VISN 15 facilities. The VISN’s executive leadership team appeared stable with the Network Director, Deputy Network Director, Chief Medical Officer, and Human Resources Officer serving together for the past four years. The Quality Management Officer joined the team in June 2019. Selected survey scores related to employee satisfaction and patient experience were similar to or higher than VHA averages. The OIG’s review of access metrics and clinical vacancies did not identify any substantial organizational risks. The executive team seemed to support efforts to improve and maintain positive outcomes (such as conducting site visits to improve performance and quality care for high-risk veterans and providing training for mental health and community living center staff). The team was also knowledgeable about Strategic Analytics for Improvement and Learning metrics but should continue to take actions to sustain and improve performance. The OIG issued 10 recommendations for improvement in four areas: (1) Quality, Safety, and Value • Utilization management annual summary review (2) Medication Management • Pain Management Strategy implementation and progress report • Pain committee establishment (3) Women’s Health • Interdisciplinary strategic planning activities • Quarterly program updates • Annual site visits • Educational resource development • Access and satisfaction data analysis • Maternity care outcome data tracking (4) High-Risk Processes • Facility corrective action plans