Federal Reports

Program operations staff in the Veterans Benefits Administration (VBA) conduct site visits to regional offices to ensure that veterans service centers follow policies and procedures for disability compensation benefits. The VA Office of Inspector General (OIG) examined whether program operations staff conducted site visits and identified deficiencies at regional offices, and if managers took sufficient follow-up action on frequently identified errors to improve disability claims processing. The OIG found that program operations staff generally identified deficiencies during site visits and communicated results to the relevant offices, which addressed those deficiencies. VBA’s Compensation Service summarized the site visit findings on its internal website, which all regional office managers can review. Staff also conducted trend analyses of deficiencies and shared an informal summary of error trends each year with VBA’s Office of Field Operations, which is responsible for providing direction to regional offices. However, the Office of Field Operations did not fully use the information from site visits to improve claims processing nationwide. The deputy under secretary for field operations expected regional office managers to be aware of issues raised in other regional office site visit reports, but there was no written policy for addressing frequently identified errors. The OIG made three recommendations to VBA for achieving nationwide improvement in the consistency and accuracy of veterans’ claims decisions. These recommendations included a formal annual report from the Compensation Service to the Office of Field Operations on all recurring deficiencies and action items identified by the site visit program during the inspection year, and a recurring action plan to address them. The OIG also recommended that VBA establish a follow-up process to monitor compliance with the new requirement and hold regional office managers accountable for making corrections and addressing action items in a timely manner.

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 Robert J. Dole VA Medical Center and multiple outpatient clinics in Kansas. The inspection covers key clinical and administrative processes that are associated with promoting quality care. For this inspection, the areas of focus were 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 since 2018. The Director had served in the role since 2016. Employee satisfaction scores revealed opportunities for the Associate Director for Patient Care Services to improve employee attitudes towards senior leaders. Patients appeared satisfied with their care and leaders appeared actively engaged. The OIG identified significant concerns regarding incident review processes and identifying sentinel events and/or institutional disclosures. Leaders were able to speak knowledgeably about performance actions and survey results. Leaders were also generally knowledgeable about Strategic Analytics for Improvement and Learning data. The OIG issued 26 recommendations for improvement in all eight areas: (1) Quality, Safety, and Value • Utilization management data review • Root cause analysis processes • Annual patient safety report (2) Medical Staff Privileging • Professional practice evaluations • Provider exit reviews (3) Environment of Care • Supply storage • Environmental cleanliness • Privacy (4) Medication Management • Behavior risk assessment • Informed consent • Patient follow-up (5) Mental Health • Patient follow-up • Suicide safety plans • Staff training (6) Care Coordination • Multidisciplinary committee (7) Women’s Health • Women Veterans Health Committee membership (8) High-Risk Processes • Annual risk analysis • Airflow and infection control • Endoscope storage

In July 2020, our office issued a report on Amtrak’s management of its police department. Our objective was to evaluate the extent to which Amtrak employed key practices to ensure the efficiency and effectiveness of its police force. When we initiated our assessment, there were no agreed-upon best practices for rail policing in the relevant literature or from discussions with professional organizations and researchers, and there was no commonly accepted list of the top performers. Therefore, we conducted extensive research to develop a list of key practices to assess Amtrak.

To determine these practices, we reviewed and compiled information from a range of public- and private-sector sources. This included information from semi-structured interviews and site visits with 14 of the 16 largest rail organizations in the United States, which cover 90 percent of the nation’s ridership. We also visited national rail police and security departments in Canada, France, Germany, Great Britain, and Italy. We chose these based on expert opinion about high-quality rail police departments and comparable track miles to Amtrak. We then combined the results of our research with commonly accepted management standards.

This guide is intended to share the results of our work by providing the key practices for police management that we identified, which may be applicable to other rail and transit organizations.

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The objective for this management advisory report was to assess the effectiveness of the company’s management and oversight of the program, including the extent to which it has identified and mitigated schedule and budget risks.We found that the company has taken significant steps to remedy early program management deficiencies on the Moynihan program. This included changes to the program’s leadership and team and significant improvements in cost management, as well as, the development of a reliable schedule. It did not, however, take these actions soon enough to avoid cost increases and ensure that it can complete its entire station relocation by the scheduled opening by the end of 2020. These ongoing cost and schedule risks are the result of ineffective executive oversight coupled with inexperienced program staff during the company’s first two years on the program, and a failure to follow the company’s program management standards. In December 2019, the company changed the program’s leadership and team, assigning trained program and construction managers who significantly improved the program’s structure, management, and oversight. Nevertheless, the new team has not been able to fully recover from these earlier program management deficiencies. Because of this, the company has had to request an additional $72.8 million from the Board of Directors since the program’s start, and parts of the program needed for opening day may be at risk of delays.We did not identify any additional actions that the company could take to better mitigate the risks of delays because of the limited time remaining on the Moynihan program. Continued active program management and ongoing executive oversight will help the company meet its planned schedule for opening the station.

On March 27, 2020, the President signed into law the Coronavirus Aid, Relief, and Economic Security Act (CARES Act). Among its provisions, the CARES Act provided the U.S. Department of the Interior (DOI) with $756 million to support the needs of DOI programs, bureaus, Indian Country, and the Insular Areas.This report presents the DOI’s progress as of July 31, 2020, in spending CARES Act appropriations. Specifically, the DOI’s expenditures to date total $502,312,984 and its obligations total $599,016,669.We are also monitoring the DOI’s progress on reporting milestones established by the CARES Act and the Office of Management and Budget.We anticipate issuing updated status reports monthly.

The MRC is the Postal Service’s “lost and found” department, serving a vital customer service role by processing undeliverable and lost items. The MRC receives items deemed “undeliverable” from Postal Service facilities throughout the country, including post offices, delivery units, and distribution centers. These items may be designated as undeliverable because of incomplete addresses, damaged mailing labels, etc. The MRC received about 67 million items in fiscal year (FY) 2019. Our objective was to evaluate the effectiveness of U.S. Postal Service Mail Recovery Center (MRC) operations and identify opportunities for improvement.

The report addresses the extent to which GAO has established effective policies and procedures for managing its voluntary leave transfer program. While the program has functioned to facilitate leave donations to GAO employees, GAO OIG found weaknesses related to the agency’s ability to confirm leave recipients’ initial or continued program eligibility, and to ensure that leave balances reflect properly supported donated leave received and used. GAO agreed with the findings and outlined planned actions for each of the four recommendations in the report.

The Postal Service purchases IT equipment, such as webcams and printers, through the eBuy Plus system. As of April 2020, the Postal Service had about 73,000 printers. Of these, 63,357 are categorized as [redacted] which are maintained by local information specialists. The remaining 9,352 are categorized as managed printers because they are managed and maintained using enterprise tools by [redacted], including application of firmware updates. Firmware is a software program embedded on a device that gives instructions for how to communicate with other devices. Our objective was to determine if controls for purchasing and maintaining information technology (IT) equipment, specifically printers, webcams, and [redacted] cameras, are effective in identifying, assessing, and mitigating vulnerabilities and related cybersecurity risks to the U.S. Postal Service’s IT infrastructure.

The Child Care and Development Block Grant Act (CCDBG Act) of 2014 added new requirements for States that received 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.

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 included labor markup rates for the recovery of indirect costs that were misstated. We estimated TVA could save $7.44 million over the planned $200 million contract by negotiating revisions to the labor markup rates to more accurately reflect the company's recent actual costs. In addition, we found the proposed labor rate ranges were not reflective of the actual salary costs of the company.(Summary Only)

OIG reviewed USDA’s rural housing programs to determine potential areas ofoverlap, duplication, and fragmentation.

The purpose of this memorandum is to provide the Office of Inspector General’s (OIG) comments on the Wildland Fire Response Plans (WFRP) that were developed in order to more safely and effectively combat wildland fires during the coronavirus (COVID-19) pandemic

Prior Office of Inspector General audits of State Medicaid agencies that used random moment timestudies (RMTSs) to allocate costs for school-based administrative (SBA) costs determined that States did not always correctly claim Federal Medicaid reimbursement for SBA services. Nebraska, whose SBA costs we have not previously audited, uses RMTSs to allocate those costs.

We determined that children brought to Port Isabel on July 15, 2018, waited extended periods, and in many cases overnight, to be reunited with their parents. U.S. Immigration and Customs Enforcement (ICE) was not prepared to promptly reunify all children who arrived at Port Isabel on the first day of attempted mass reunifications. ICE and U.S. Health and Human Services had fundamentally different understandings about the timing and pace of reunifications, and ICE personnel at Port Isabel underestimated the resources necessary to promptly out-process the parents of arriving children. As a result, some children waited in vehicles at Port Isabel, while others waited in unused detention cells, though all children were in climate-controlled environments and had continuous access to food, water, and restrooms. As the mass reunifications continued, ICE personnel responded to processing and space issues, which generally resulted in shorter wait times for children who arrived at Port Isabel closer to the court’s July 26, 2018 deadline. The report contains no recommendations.

ICE’s Homeland Security Investigations (HSI) is effectively contributing to the Federal Bureau of Investigation’s (FBI) Joint Terrorism Task Force (JTTF) counterterrorism efforts by leveraging its authorities, experience, skills, and staffing. However, existing agreements and guidance on HSI’s participation in the JTTF and its terrorism financing investigations are outdated. Additionally, we determined existing agreements and policy impose restrictions that delay and hinder sharing and access to information in the JTTF. We recommended DHS JTTF contributors evaluate and update agreements governing JTTF participation as needed. HSI should renegotiate and update the 2003 agreement on terrorism financing, as well as update its related guidance accordingly. We also recommended DHS coordinate with Department of Justice and Department of State, as well as within the DHS, to develop agreements to allow for the more direct sharing of critical investigative information. We made five recommendations that aim to improve counterterrorism efforts and information sharing. DHS concurred with two recommendations and non-concurred with three.

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, $90 million contract.In our opinion, the company's cost proposal was overstated. Specifically, we found the methodology the company used to calculate its proposed labor markup rates was not reflective of the divisions that would be performing the anticipated scopes of work. We estimated TVA could avoid about $5.17 million over the planned $90 million contract by negotiating reductions to the labor markup rates to more accurately reflect the costs from the company divisions who would be performing work under the potential contract.(Summary Only)

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This Office of Inspector General (OIG) Comprehensive Healthcare Inspection Program (CHIP) report provides a focused evaluation of the quality of care delivered in the inpatient and outpatient settings of the Jesse Brown VA Medical Center and multiple outpatient clinics in Illinois and Indiana. The inspection covers key clinical and administrative processes that are associated with promoting quality care. For this inspection, the areas of focus were 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 one vacancy in its five key positions. The Medical Center Director had served in an acting capacity for two weeks, and the chief of staff position had been filled for three months. Survey results indicated opportunities to improve employee satisfaction. Patient survey results indicated overall satisfaction. The OIG did not identify any substantial organizational risk factors. Executive leaders were generally knowledgeable about Strategic Analytics for Improvement and Learning measures and actions taken during the previous 12 months to maintain or improve performance. The OIG issued 22 recommendations for improvement in seven areas: (1) Quality, Safety, and Value • Utilization management processes (2) Medical Staff Privileging • Professional practice evaluations • Provider exit reviews • State licensing board reporting (3) Medication Management • Behavior risk assessments • Concurrent medication therapy • Urine drug testing • Informed consent • Patient follow-up • Pain Committee (4) Mental Health • Patient follow-up • Suicide safety plans • Suicide prevention training (5) Care Coordination • Multidisciplinary committee (6) Women’s Health • Women’s health primary care providers • Women Veterans Health Committee (7) High-Risk Processes • Standard operating procedures • Annual risk analysis • Competency assessments

The Office of the Inspector General conducted a review of the Watts Bar Nuclear Plant (WBN) Site Security (SS) organization to identify factors that could impact WBN SS's organizational effectiveness. Our report identified strengths that positively affected WBN SS related to (1) organizational alignment, (2) positive interactions within WBN SS, (3) first-line management support, and (4) positive ethical culture. We also identified risks that could impact the effectiveness of WBN SS to achieve its responsibilities in support of the Nuclear vision and TVA mission. These risks included (1) communication deficiencies, (2) safety concerns, (3) perceptions of inadequate staffing, (4) reporting of performance data, and (5) ineffective relationships with support organizations.

Plant load agreements are special arrangements between the U.S. Postal Service and certain commercial mailers. Mailers interested in establishing a plant load agreement must already have a Postal Service-approved detached mail unit (DMU) at their mailer facility, wherein a Postal Service clerk is on-site performing mail verification, acceptance, dispatch, and other related functions. Mail is then transported from the DMU to a Postal Service facility for acceptance and processing. Our objective was to assess the effectiveness of plant load agreements in the Santa Ana District. We selected this district based on volume and revenue declines from fiscal year (FY) 2018 to FY 2019, totaling 190 million pieces (22 percent) and $37.5 million (18 percent).

During fiscal year (FY) 2019, we issued 32 audit reports related to financial controls at Postal Service retail units. We identified inconsistencies with Postal Service policies for performing financial transactions. The purpose of this report is to bring attention to these issues and make recommendations for corrective action. Our objective was to assess current refund and local purchases and payments policies for retail units and to determine if policies were consistent.

The United States has been grappling with the opioid crisis for several years. In 2018, nearly 47,000 opioid-related overdose deaths occurred in the United States. OIG has been tracking opioid use in Medicare Part D since 2016. In particular, OIG has identified beneficiaries at serious risk of opioid misuse or overdose and prescribers with questionable opioid prescribing for these beneficiaries.

We audited the U.S. Department of Housing and Urban Development’s (HUD) controls over employee benefits expensed at public housing agencies (PHA) due to a previous external review of the Waterbury, CT, Housing Authority, which determined that employee benefits expensed were unsustainable. Our audit objective was to determine whether HUD ensured that employee benefits expensed at PHAs were reasonable.Analysis of PHA data showed that generally, PHAs expensed employee benefit contributions reasonably; however, HUD could strengthen controls in this area. Federal regulations indicate that employee benefit contributions are allowable provided that the benefits are reasonable and are required by law. Further, the average percentage of employee benefits to total compensation for State and local government employees nationally was 31 percent and the PHA data we reviewed showed that employee benefits were generally within the national average. However, 69 of 3,755 PHAs expensed at least $100,000 in employee benefit contributions over 40 percent of total compensation, which may be unreasonable. In addition, PHAs did not always enter accurate financial data regarding employee benefits into the Financial Assessment Subsystem – Public Housing (FASS-PH) system. This condition occurred because HUD did not have specific controls over employee benefit contributions and generally did not review those costs as they were controlled mostly by State laws governing pension plans and negotiated labor union agreements. In addition, PHA financial data received by HUD were at a combined level, which prevented it from easily reviewing benefit costs without having the transaction-level detail required for a meaningful review. As a result, HUD did not have assurance that employee benefit contributions expensed at 69 PHAs were reasonable or that the data entered into FASS-PH were accurate.We recommend that HUD (1) evaluate the risk that employee benefit contributions expensed at PHAs may be unreasonable and (2) develop and implement additional guidance to ensure that PHAs enter accurate employee benefit data into FASS-PH.

The Federal Emergency Management Agency’s (FEMA) Individuals and Households Program (IHP) has no assurance of applicants’ eligibility for Small Business Administration (SBA) Dependent Other Needs Assistance (ONA) payments. According to OMB Circular A-123, Appendix C, when documentation or verification is non-existent to support eligibility payment decisions it must be considered improper. FEMA did not collect sufficient income and dependent documentation or verify self-reported information to determine whether applicants below the income threshold, known as Failed Income Test (FIT), were eligible for SBA Dependent ONA payments. FEMA believed requiring documentation or verification would delay the disbursement of assistance and relied on an honor system to make eligibility and payment decisions. We determined, according to FEMA-provided data, it has paid, and we are questioning, the more than $3.3 billion in improper payments to applicants deemed as FIT for SBA Dependent ONA since 2003. Additionally, FEMA has not evaluated the program risk associated with not collecting or verifying income information. Per Federal requirements, agencies must conduct risk assessments to determine whether programs are susceptible to improper payments. Rather, FEMA assessed IHP at the overall program level and did not specifically evaluate each IHP form of assistance, such as SBA Dependent ONA. These weaknesses have allowed applicants self-certifying income and dependent information to receive less oversight, despite posing the greatest risk for improper payments. FEMA cannot assure Congress and taxpayers it is a prudent steward of Federal resources, and adequately assesses the risks of improper payments. FEMA did not concur with all three report recommendations. Therefore, these recommendations are considered 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 VA St. Louis Health Care System and multiple outpatient clinics in Illinois and Missouri. The inspection covers key clinical and administrative processes that are associated with promoting quality care. For this inspection, the areas of focus were 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 over two years. Survey results indicated that employees were generally satisfied. However, patient survey results were often lower than the corresponding VHA averages, indicating multiple opportunities for system leaders to improve satisfaction. The OIG identified the lack of a permanent pain director as an area of vulnerability for the healthcare system. Executive leaders were able to speak knowledgeably about performance improvement actions taken during the previous 12 months, employee satisfaction, and patient experiences. The OIG issued 20 recommendations for improvement in seven areas: (1) Quality, Safety, and Value • Improvement action implementation and monitoring • Utilization management processes • Root cause analysis processes (2) Medical Staff Privileging • Professional practice evaluation processes • Provider exit review forms (3) Environment of Care • Geriatric mental health unit safety (4) Medication Management • Behavior risk assessment • Urine drug testing • Informed consent • Patient follow-up after therapy initiation • Pain Committee activities (5) Mental Health • Community outreach activities • Patient follow-up visits • Staff training (6) Women’s Health • Women Veterans Health Committee membership and activities (7) High-Risk Processes • Bioburden testing • Staff training

In FY 2015, the Postal Service began planning the acquisition process for a new purpose-built, Next Generation Delivery Vehicle (NGDV) to start replacing the current LLV fleet beginning in FY 2018 through FY 2019. However, by the end of FY 2019, the Postal Service had not awarded the estimated $5-6 billion contract(s) for the production of the NGDV. Due to frequent changes to the NGDV acquisition timeline, the planned production deployment date is now scheduled for January 2022. Our objective was to assess the Postal Service’s acquisition strategy for delivery and collection vehicles.

When Congress established average sales price (ASP) as the basis for reimbursement for Medicare Part B drugs (generally, drugs that are injected or infused in physicians’ offices or hospital outpatient settings), it also provided a mechanism for monitoring market prices and limiting potentially excessive payment amounts. The Social Security Act (the Act) mandates that OIG compare ASPs with average manufacturer prices (AMPs). If OIG finds that the ASP for a drug exceeds the AMP by a certain percentage (currently 5 percent), the Act directs the Secretary of Health and Human Services to substitute the ASP-based payment amount with a lower calculated rate. Through regulation, CMS outlined that it would make this substitution only if the ASP for a drug exceeded the AMP by 5 percent in the two previous quarters or three of the previous four quarters.

When Congress established average sales prices (ASPs) as the basis for Medicare Part B drug reimbursement, it also provided a mechanism for monitoring market prices and limiting potentially excessive payment amounts. Generally, Part B-covered drugs are those that are injected or infused in physicians' offices or hospital outpatient settings. The Social Security Act (the Act) mandates that OIG compare ASPs with average manufacturer prices (AMPs). If OIG finds that the ASP for a drug exceeds the AMP by a certain percentage (currently 5 percent), the Act directs the Secretary of Health and Human Services to substitute the ASPbased payment amount with a lower calculated rate. Through regulation, CMS outlined that it would make this substitution only if the ASP for a drug exceeds the AMP by 5 percent in the two previous quarters or three of the previous four quarters.

We identified debris removal contract performance issues and concerns. In the report, we discuss our observations regarding the use of pre-disaster debris removal contracts in Florida following Hurricane Irma. We also emphasize how FEMA can benefit from implementing effective controls to track systemic issues after a disaster and ensure FEMA follows procedures for uploading required documentation to support debris removal costs for proper grant management. The report contains no recommendations.

The OIG investigated allegations that a U.S. Fish and Wildlife Service (FWS) manager accepted gifts from prohibited sources, awarded contracts to personal friends, directed improper credit card purchases, and violated travel regulations.We did not find evidence that the manager’s actions violated ethics, procurement, or travel regulations as alleged.

We investigated whether career U.S. Department of the Interior (DOI) staff were directed to delay releasing documents responding to a Freedom of Information Act (FOIA) request that was being litigated in U.S. district court, and whether withholding these documents conflicted with the court’s order to the DOI to review a certain number of potentially responsive pages every month.We found that after David Bernhardt’s nomination for Interior Secretary was announced on February 4, 2019, then Counselor to the Secretary Hubbel Relat directed career DOI staff to temporarily withhold documents related to Bernhardt from a release of FOIA documents scheduled to occur under the court order. As a result, 253 pages of information were not included in the scheduled release, but most of those pages were released later in 2019. Accordingly, we have determined that this matter does not warrant further investigation and that the court is the proper venue to determine whether the DOI met its obligations under the court order.

As a part of our IT Audit program, the OIG reviewed a Postal Service IT system to assess the security posture. This audit involved a technical review to identify potential issues and provide recommendations. The technical details of our work are shared directly with Postal Service management. Due to the sensitive nature of this information, we did not post details of our work.

Under the Medicare home health prospective payment system (PPS), the Centers for Medicare & Medicaid Services pays home health agencies (HHAs) a standardized payment for each 60-day episode of care that a beneficiary receives. The PPS payment covers intermittent skilled nursing and home health aide visits, therapy (physical, occupational, and speech-language pathology), medical social services, and medical supplies.

The DHS Chief Information Officer (CIO) and most component CIOs had conducted strategic planning efforts to help prioritize legacy Information Technology (IT) systems and infrastructure to better accomplish mission goals. However, due to a lack of standard guidance and funding, not all components have complied with or fully embraced Department-wide IT modernization initiatives to adopt cloud-based computing, and to consolidate data centers. Meanwhile, DHS continues to rely on deficient and outdated IT systems to perform mission-critical operations. Additionally, DHS has not yet leveraged the Modernizing Government Technology Act mandate to accelerate ongoing IT modernization efforts, as DHS and its components questioned whether the benefits of the Act outweighed the additional effort needed to use the resources provided under the Act. Until DHS addresses these issues, it will continue to face significant challenges to accomplish mission operations efficiently and effectively. We made three recommendations for the DHS OCIO to develop guidance for implementing cloud technology and migrating legacy IT systems to the cloud, coordinate with components to develop and finalize a data center migration approach, and establish a process to assign risk ratings for major legacy IT investments. The Department concurred with all three recommendations.

On August 10, 2020, OIG sent letters to the leadership of state and territorial public utility commissions seeking to strengthen its ongoing relationships with these important partners. Frequently the first to receive complaints and concerns regarding the Lifeline program (and other FCC-administered programs) from beneficiaries and the public, OIG encourages public utility commissions to continue sharing information critical to fulfilling our mandate to detect and combat fraud, waste and abuse in FCC programs.

Under the Medicare home health prospective payment system (PPS), the Centers for Medicare & Medicaid Services pays home health agencies (HHAs) a standardized payment for each 60-day episode of care that a beneficiary receives. The PPS payment covers intermittent skilled nursing and home health aide visits, therapy (physical, occupational, and speech-language pathology), medical social services, and medical supplies.

From January 1, 2016, through May 31, 2018 (audit period), Medicare paid $1.5 billion for knee, back, and ankle-foot braces (selected orthotic braces) provided to Medicare beneficiaries. Prior OIG audits and evaluations found that some suppliers of durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) billed for orthotic braces that did not comply with Medicare billing requirements. During our audit period, the Centers for Medicare & Medicaid Services found that orthotic braces were among the top 20 DMEPOS items with the highest improper payment rates. After analyzing Medicare claims data, we selected for audit Visionquest Industries, Inc. (Visionquest), an orthotic braces supplier in Irvine, California.

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

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MEMORANDUM FOR JOSEPH PISHIONERI, CONTRACTING OFFICER, BUREAU OF ENGRAVING AND PRINTINGThis Memorandum is Sensitive But Unclassified. To obtain further information, please contact the OIG Office of Counsel at OIGCounsel@oig.treas.gov, (202) 927-0650, or by mail at Office of Treasury Inspector General, 1500 Pennsylvania Avenue, Washington DC 20220.

In fiscal year (FY) 2019, we audited nine local Postal Service units in eight different districts that addressed issues related to local purchases and payments. One of the issues we tested was exceeding the $1,000 invoice limit by using multiple no-fee money orders for local purchases and payments. These reports resulted in 11 recommendations to district management to reiterate policies and procedures, train applicable employees, and provide tax reportable documentation to vendors receiving payments. Our objective this time was to evaluate whether corrective actions taken by the Postal Service, in response to those reports, sufficiently addressed the issue of exceeding the $1,000 invoice limit by using multiple no-fee money orders for local purchases and payments.

Our objective was to determine whether the Social Security Administration (SSA) appropriately assigned Social Security numbers (SSN) to noncitizens with a valid nonwork reason.

From July 1, 2016, through December 31, 2018 (audit period), Medicare paid approximately $4 billion for orthotic braces provided to Medicare beneficiaries. Prior OIG audits and evaluations found that some suppliers of durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) billed for orthotic braces that did not comply with Medicare requirements. During our audit period, the Centers for Medicare & Medicaid Services found that orthotic braces were among the top 20 DMEPOS items with the highest improper payment rates. After analyzing Medicare claim data, we selected for audit Desoto Home Health Care, Inc. (Desoto), an orthotic braces supplier in Wauchula, Florida.

Effective in 2018, the Medicare program changed the way it sets payment rates for clinical diagnostic laboratory tests (lab tests). CMS replaced the previous payment rates with new rates based on private payer data collected from labs. This is the first reform in 3 decades to Medicare's payment system for lab tests. As part of the same legislation reforming Medicare's payment system, Congress mandated that OIG monitor Medicare payments for lab tests and the implementation and effect of the new payment system for those tests.

The VA Office of Inspector General (OIG) reviewed VA facilities and community providers for usage of health information exchanges (HIEs) in their respective communities and to identify any barriers that may impede the use of HIEs. HIEs share patient health record information electronically and coordinate care for enrolled veterans. The VA MISSION Act of 2018 included language to improve information sharing between the Veterans Health Administration (VHA) and the community. The Veterans Health Information Exchange program office has two methods to share information with the community, via internet exchange (VA Exchange) and email exchange (VA Direct). Exchanging health information electronically provides a secure method for healthcare providers to share veteran health information. The OIG conducted a survey and interviewed the 48 lower complexity level 2 and 3 VHA facilities because of the higher expected use of community providers. Additionally, the OIG interviewed staff from the offices of Veterans Health Information Exchange (VHIE), Information Technology, Community Care, and Rural Health; two state health information exchanges; and Cerner Corporation. VA has two contracts establishing community coordination for VHIE. The performance work statements for the contracts require coordinators to provide training, policy, and process assistance to VHA directors and staff. The OIG reviewed the performance work statements for these contracts. During facility interviews, the staff cited the most challenges in training, the need for more community partners, use of contract community coordinators, and technology. Those using either VA Exchange or VA Direct cited successes and felt with more community participation the goals of the program were achievable. The OIG made four recommendations to the Under Secretary for Health related to the need for increased utilization of VA Direct, education for staff and veterans on VA Exchange and VA Direct, expansion of community partnerships, and use of contract VHIE community coordinators.

This audit is a follow-up to our 2014 white paper on reform of the Federal Employees’ Compensation Act. Our objective was to determine the current status of Postal Service cost-containment activities related to workers’ compensation costs and liabilities.

We investigated allegations that two National Park Service (NPS) managers violated contracting regulations and procedures by using the Standard Form 182 (SF-182), which is meant to fund standardized training, to pay a company for extended work on an internal NPS training website. We also investigated allegations that NPS employees improperly hired NPS retirees and then re-issued or re-activated their Personal Identity Verification (PIV) cards.We found that the two NPS managers, who oversaw aspects of NPS training programs, improperly used the SF-182 to pay a company $1,041,117 to develop and maintain an internal training website, circumventing contracting regulations. The two NPS managers have since left the agency.We also found that one of the managers retained his PIV card after retiring and had another employee re-enable the card after he left Federal service, in violation of departmental policy. We also discovered a separate instance in which an NPS retiree performed fiscal and budget-related services for an NPS training center without a contract. The NPS retiree received a new PIV card under the guise of an unrelated contract.

The OIG investigated an allegation that an employee with the Office of the Assistant Secretary for Indian Affairs (AS-IA) may have improperly used entities that he owned or had a financial interest in to perform work at the U.S. Department of the Interior (DOI).We found that the employee was involved in choosing two unregistered entities with whom he or other DOI staff had personal relationships and repeatedly paid them with a charge card, rather than establish a contract as required. The employee violated DOI policy and Federal regulations by misusing his Government charge card; asking for and receiving cash from the entities while they performed work for the DOI; issuing numerous payments to the entities with no supporting documentation; and submitting altered invoices during an internal charge card review as support for payments he made. We also found the employee personally received funds from the DOI for a private group he operated, and he did not file a financial disclosure as required by his position.The U.S. Department of Justice declined prosecution and the employee left Federal service.