Federal Reports

Nutritional marasmus (diagnosis code E41) and unspecified severe protein-calorie malnutrition (diagnosis code E43) are two types of severe malnutrition. Previous OIG audits of severe malnutrition found that hospitals had incorrectly billed Medicare by using severe malnutrition diagnosis codes when they should have used codes for other forms of malnutrition or no malnutrition diagnosis code at all. Diagnosis codes E41 and E43 (severe malnutrition diagnosis codes) are each classified as a type of major complication or comorbidity (MCC). Adding MCCs to a Medicare claim can result in a higher Medicare payment.

The Department complied with IPERA because it met all six compliance requirements. The Department’s improper payment estimate and methodology for the Restart program was generally accurate and complete. However, the Department published improper payments estimates that were unreliable for the Federal Pell Grant (Pell), William D. Ford Federal Direct Loan (Direct Loan), and the Temporary Emergency Impact Aid for Displaced Students (Emergency Impact Aid) programs in its FY 2019 Agency Financial Report (AFR). Specifically, the improper payment estimation methodologies the Department developed and the estimates it produced were not accurate, complete, and statistically valid, as described in Finding 1 and Finding 2.

The Office of Inspector General (OIG) is initiating an audit of the Central Nonprofit Agency (CNA) Selection of Nonprofit Agencies (NPAs) for Project Assignment and Allocation of Orders. Our overall objective is to assess the extent to which the implementation of the project assignment and allocation process by the CNAs is effective and follows applicable laws and regulations as well as established policies and procedures.

This audit report is one of a series of OIG reports that addresses the identification, reporting, and investigation of incidents of potential abuse and neglect of our Nation's most vulnerable populations, including children, the elderly, and individuals with developmental disabilities. OIG is committed to detecting and combating such abuse and neglect.

We contracted this audit with Cotton & Company LLP, which found FEMA did not ensure Collier County, Florida (the County) established and implemented policies, procedures, and practices to account for and expend Public Assistance (PA) program grant funds awarded in disaster areas in accordance with Federal regulations and FEMA guidance. Specifically, the County could not provide documentation to support $4,602 in force account costs claimed. Additionally, the subrecipient monitoring process needs improvement. The State has not evaluated the risk of subrecipients’ noncompliance with Federal requirements, obtained subrecipient audit reports, or developed plans for monitoring subrecipients. We made four recommendations that, when implemented, should improve Collier County, Florida’s management of FEMA PA funds. FEMA concurred with our four recommendations.

The Office of Inspector General (OIG) is initiating an audit of the Procurement List Addition Process, Procedures, and Practices. Our overall objective is to determine whether the Procurement List addition process is transparent and performed efficiently, effectively, and in compliance with applicable laws, regulations, and policies.

Four Chicago-based employees were terminated from employment on June 18, July 6, and July 9, 2020, and another retired on June 25, 2020, prior to her administrative hearing. The five former employees participated in a medical fraud scheme in violation of company policies.Our investigation found that the former employees provided a chiropractor, based in Dolton, Illinois, with their medical and personally identifiable information, typically their names and dates of birth or those of their dependents, in exchange for cash kickbacks. The chiropractor used the information to fraudulently bill Amtrak’s health insurance plan for services that were not provided. In addition, all five employees were uncooperative or lied to our agents during their interviews.

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 Harry S. Truman Memorial Veterans’ Hospital in Columbia, Missouri and multiple outpatient clinics. 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 two months prior to the OIG visit. Survey results revealed that employees were generally satisfied with executive leaders. Patient experience survey data, including both male and female satisfaction scores, indicated that patients were generally satisfied with their care. The OIG’s review of the system’s accreditation findings, sentinel events, and disclosures did not identify any substantial organizational risk factors. In addition, the executive leaders were knowledgeable within their scope of responsibilities about VHA data used by the Strategic Analytics for Improvement and Learning models. The OIG issued 14 recommendations for improvement across seven areas: (1) Quality, Safety, and Value • Utilization management processes • Root cause analysis processes (2) Medical Staff Privileging • Ongoing professional practice evaluations • Provider exit review forms (3) Medication Management • Behavior risk assessment • Urine drug testing • Informed consent • Follow-up after therapy initiation (4) Mental Health • Annual suicide prevention training (5) Care Coordination • Life sustaining treatment decisions progress notes • Multidisciplinary committee establishment (6) Women’s Health • Advisory Committee For Women Veterans membership (7) High-Risk Processes • Staff competency assessments

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 John J. Pershing VA Medical Center, Poplar Bluff, Missouri. 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. The executive team had been working together as a group for two months, although several team members had been in their positions for more than a year. Employee satisfaction survey results revealed opportunities for the Associate Director for Patient Care Services and Associate Director to decrease staff’s feelings of moral distress in the workplace. Patients appeared satisfied with their care. The OIG did not identify any substantial organizational risk factors. The leaders were knowledgeable about Strategic Analytics for Improvement and Learning data and should continue to take actions to sustain and improve performance. The OIG issued 17 recommendations for improvement across six areas: (1) Quality, Safety, and Value • Utilization management data review (2) Medical Staff Privileging • Focused professional practice evaluations • Provider exit review forms (3) Medication Management • Aberrant behavior risk assessments • Concurrent therapy with benzodiazepines • Urine drug testing • Informed consent • Follow-up after therapy initiation • Pain Management Sub-Committee activities (4) Mental Health • Follow-up visits • Suicide prevention training (5) Women’s Health • Women’s health primary care providers • Women Veterans Health Committee membership (6) High-Risk Processes • Standard operating procedures • Annual risk analysis • Staff competency assessments

With certain exceptions, self-administered drugs are typically not covered under Medicare Part B. However, in a November 2017 report, OIG found that CMS and a Federal court interpret relevant statute to require the inclusion of versions of drugs not generally covered under Part B in limited circumstances when setting Medicare payment amounts. As a result, CMS included noncovered, self-administered versions of Orencia and Cimzia when determining payments for those two drugs. The inclusion of these noncovered versions caused Medicare and its beneficiaries to pay an extra $366 million from 2014 through 2016. OIG recommended that CMS seek a legislative change that would provide the agency with flexibility to determine when noncovered versions of a drug should be included in the calculation of the Part B payment amount. CMS did not concur with our recommendation and, to date, no action has been taken to close the payment loophole.

The Office of the Inspector General determined that the Tennessee Valley Authority's (TVA) implementation of a grid access charge was revenue neutral because it resulted in an immaterial change in revenue to TVA. We determined TVA collected about $2 million less in revenue from the local power companies that implemented the grid access charge in fiscal year 2019.

We have performed audits in several States in response to a congressional request concerning deaths and abuse of residents with developmental disabilities in group homes.Federal waivers permit States to furnish an array of home and community-based services to Medicaid beneficiaries with developmental disabilities so that they may live in community settings and avoid institutionalization. CMS requires States to implement a critical incident reporting system to protect the health and welfare of Medicaid beneficiaries receiving waiver services. Our objective was to determine whether Texas complied with Federal waiver and State requirements for reporting and monitoring critical incidents involving Medicaid beneficiaries with developmental disabilities who resided in community-based settings from January through December 2016.

The Office of Special Reviews substantiated allegations that Peter Shelby, while serving as VA’s Assistant Secretary for Human Resources and Administration (HR&A), improperly steered a $5 million contract for the benefit of individuals with whom he had a personal relationship. The OIG determined that VA could not use the contract services, resulting entirely in waste. In February 2018, VA awarded a one-year contract to a Service-Disabled Veteran-Owned Small Business (SDVOSB) (the Small Business) that provides leadership development training. The contract also included talent assessment services for evaluating whether to hire or promote candidates. When the contract concluded in August 2019, it became evident that VA had purchased services far in excess of what it could use. VA used only 232 of the 17,000 one-year training licenses it purchased for $3.8 million and VA received no value whatsoever for the talent assessment services because required privacy and security certifications were not obtained. The OIG determined that this waste occurred as a direct result of Mr. Shelby’s misuse of his official position by directing his senior staff to arrange for the award of this contract to the Small Business on a sole-source basis (i.e., without competition). The OIG determined that although there was statutory authority to contract with SDVOSBs, use of VA’s sole source authority in this case was not supported by an adequate justification as required by VA policy and regulation. Mr. Shelby resigned from federal service in July 2018 after learning that he had been recommended for possible removal for reasons unrelated to this contract. The OIG makes eight recommendations for process improvements spotlighted by this investigation and for VA to consider whether any administrative action should be taken for certain employees. VA concurred with all eight recommendations.

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John Mckoy previously pleaded guilty in U.S. District Court, Eastern District of Pennsylvania, on June 14, 2019, to multiple health care fraud charges related to a scheme to defraud Amtrak’s health care plan. McKoy was the owner and operator of several neighborhood health carefacilities, including Mt. Pleasant Medical Management, Inc. and Harris Medical Management, Inc. Between November 2004 and October 2007, McKoy submitted, and caused to be submitted, hundreds of false and fraudulent claims to United Health Care Corporation and was paid approximately $291,000 for services purportedly rendered to predominately Amtrak patients who were never seen or treated for those services. On July 8, 2020, McKoy was sentenced to six months imprisonment, three years’ supervised probation, and ordered to pay restitution to Amtrak in the amount of $291,255.In addition to Amtrak OIG, this joint investigation was conducted with the U.S. Postal Inspection Service, Department of Labor OIG, and the Federal Bureau of Investigation.

What We Looked AtTitle XI of the Merchant Marine Act of 1936 established the Maritime Administration’s (MARAD) Federal Ship Financing Program (Title XI), which provides loan guarantees to private companies for ship construction and shipyard modernization. The Fiscal Year 2019 John S. McCain National Defense Authorization Act requires us to audit MARAD’s policies and procedures for reviewing and approving loan guarantee applications. Our audit objectives were to assess (1) the completeness of the program’s policy for application reviews and (2) the program’s adherence to the policy in its application reviews. What We FoundMARAD’s Title XI policy manual does not fully cover 13 of 28 regulatory requirements that address program eligibility and applications. A MARAD official acknowledged that the manual does not cover all requirements but pointed out that missing requirements are not frequently relevant to application reviews. However, lack of inclusion of all requirements creates a risk that the program will omit attention to relevant requirements, and in turn, diminish the reliability of information the program uses to assess applicants’ eligibility and creditworthiness.MARAD lacks adequate procedures to ensure that staff fully comply with requirements. The program also takes longer to process applications than the 9-month statutory review period, and the program’s controls are inadequate to ensure staff comply with policy requirements. According to the Government Accountability Office, management must enforce accountability for the entity’s internal control, including through supervisory feedback. However, the program supervisor reviews applications for completeness on an ad-hoc basis. The lack of internal controls could inhibit assessments of applicants’ eligibility and creditworthiness. RecommendationsWe made three recommendations, and MARAD concurred with all three.

The Administration for Children and Families (ACF), within HHS, requested that we audit Sharon Baptist Head Start (Sharon Baptist) after ACF identified instances of noncompliance with Federal requirements in a January 2014 monitoring review.Our objective was to determine whether Sharon Baptist complied with Federal requirements applicable to related party-rent and related-party receivable transactions.

The VA Office of Inspector General (OIG) reviewed the accessibility of dermatology, orthopedics, and urology specialty care for patients in the 17 Veterans Health Administration (VHA) community-based outpatient clinics (CBOCs) classified as highly rural. The OIG also reviewed accessibility, barriers, and the availability and utilization of resources for the time frame March 1, 2018 (or from the date the CBOC became highly rural), through February 28, 2019. VHA utilized clinical consults, electronic consults (eConsults), telehealth, and community care to provide specialty care at the highly rural CBOCs. Sites in this review mostly utilized referrals to their parent facility and community specialty providers. These sites rarely used telehealth, inter-facility consults, and eConsults. Staff identified limited access to community providers as the top barrier in the selected specialties. The OIG identified discrepancies regarding site operating days and hours among the available listing locations for clinic operations. Of the five highly rural CBOCs located in a non VA community hospital or health care center, not all community resources available at the sites were used. The OIG completed a review of the environment of care at the 16 sites visited and found they generally met the standards reviewed. Four recommendations were made to the Under Secretary for Health related to assessing specialty care needs including internet bandwidth and telehealth equipment, ensuring validation of the VHA Site Tracking system, ensuring the maintenance of accurate and current information on VA websites, and assessing whether highly rural CBOCs located in non-VA health care centers fully utilized resources in the facilities. Following the conclusion of this review, VHA implemented the Office of Emergency Management coronavirus disease 2019 Response Plan. Four of the 17 highly rural CBOCs closed and 13 listed pre-pandemic operations on their websites.

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 Tomah 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 executive leadership team consisted of the acting Medical Center Director, Chief of Staff, acting Associate Director for Patient Care Services (ADPCS), and acting Associate Director. Survey scores related to employees’ satisfaction with the medical center leaders were generally similar to or better than the VHA averages; however, opportunities exist for the ADPCS to decrease staff’s feelings of moral distress in the workplace. Patient experience survey data reflected higher care ratings than the VHA averages in the outpatient setting, while inpatient results appeared to highlight opportunities for improvement. The OIG’s review of the medical center’s accreditation findings, sentinel events, and disclosures did not identify any substantial organizational risk factors. The executive leadership team was generally knowledgeable within their scope of responsibility about selected VHA data used by the Strategic Analytic for Improvement and Learning models and should continue to take actions to sustain and improve performance. The OIG issued four recommendations for improvement in three areas: (1) Mental Health • Annual suicide prevention refresher training (2) Women’s Health • Community-based outpatient clinic women’s health primary care providers • Women Veterans Health Committee membership (3) High-Risk Processes • Annual risk analysis

On April 9 and April 16, 2020, we received requests from U.S. Senators Tammy Baldwin and Ron Johnson and U.S. Representatives Gwen Moore and Bryan Steil to investigate reports of absentee ballots not delivered in a timely manner for the Wisconsin primary election held Tuesday, April 7, 2020. This management alert responds to the congressional requests and presents our results and recommendations to address the issues identified in this report.

Unaddressed management challenges will impede the ability of the CSB to function effectively.

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

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

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 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 Freedom Orthotics, Inc. (Freedom), an orthotic braces supplier in Dunedin, Florida.

Under the Wildlife and Sport Fish Restoration Program (WSFR), the U.S. Fish and Wildlife Service (FWS) provides grant funds to eligible States to conserve, restore, and manage wildlife and sport fish resources. States may provide WSFR funds in the form of a subaward to other non-Federal entities, such as universities, to accomplish grant objectives.The National Bobwhite Conservation Initiative (NBCI) at the University of Tennessee provides data and tools to various States and external partners (such as nongovernmental organizations) to restore wild populations of bobwhite quail. State fish and wildlife agencies fund the NBCI through WSFR subawards and State hunting and fishing license revenues. The NBCI also receives subawards from external partners and direct grants from other non-FWS Federal agencies.This management advisory (1) summarizes our findings about NBCI cost allocation during audit periods prior to the NBCI’s 2017 implementation of a recharge center accounting methodology, (2) presents our determination why the currently used recharge center is not compliant with Federal regulations and WSFR guidelines, and (3) presents a potential opportunity for the NBCI to continue its work in a way that complies with Federal regulations.We make three recommendations to the FWS that address the NBCI’s compliance with Federal regulations and an additional recommendation that the FWS identify any other programs that have similar issues.

CARES Act Section 3610 allows Federal agencies to reimburse their contractors and subcontractors for any paid leave, including sick leave, that the contractors provide to keep their employees or subcontractors in what the section refers to as a “ready state.” Because these reimbursements present a number of risks and the U.S. Department of the Interior (DOI) is already receiving Section 3610 claims from contractors, the DOI urgently needs to put policies in place to ensure consistent oversight of reimbursed leave costs.In this management advisory memorandum, we offer three recommendations that, if implemented, will help the DOI prevent fraud, waste, and abuse related to costs reimbursed under Section 3610.

Our report contains 13 recommendations directed to the post and headquarters. We recommend that the post improve controls related to Volunteer health information, billing and collection, and imprest fund. Additionally, we recommend that headquarters revise policies and procedures related to the distribution of medical supplies to Volunteers, as well as administration of financial-system user roles.

The VA Office of Inspector General (OIG) initiated an inspection in response to anesthesia provider practice concerns, including unsafe practices such as technique and choice of medications, alleged to have affected patient care at the W.G. (Bill) Hefner VA Medical Center in Salisbury, North Carolina. The OIG did not substantiate unsafe practices within the context of nine patient electronic health records reviewed. The OIG did not identify issues related to the quality of anesthesia care. However, initial hiring process deficiencies were noted related to the provider’s reporting, and the facility’s verification, of previous employment. The provider did not document a prior discharge from a position with a locum tenens contracting company, and facility credentialing and privileging staff did not complete timely verifications. The OIG also found gaps in the provider’s personnel file—proficiency reports for fiscal years 2013 and 2014 were missing, and when asked, facility staff were unable to locate them. The OIG noted that current Veterans Health Administration (VHA) policy does not specifically require physician applicants to list locum tenens contracting companies as part of their employment history, which could result in omissions and place facilities at risk for selecting unsuitable providers. The OIG determined that facility staff did not consistently follow VHA policy to report patient safety events and quality of care concerns, which affected facility leaders’ ability to respond and take action. The OIG made five recommendations including one to the Under Secretary for Health to review VHA’s credentialing policy related to applicants listing prior positions with contracting companies. The other four recommendations to the Facility Director related to ensuring timely applicant credentialing and privileging, completing and maintaining annual proficiency reports, providing performance and competency information to the Professional Standards Board for consideration during probationary and reprivileging reviews, and training facility staff on patient safety reporting.

The VA Office of Inspector General (OIG) conducted a healthcare inspection to evaluate an allegation that a clinical pharmacy specialist (CPS) failed to act on a patient’s abnormal test results in fall 2018, which led to the patient going undiagnosed and untreated for pancreatic cancer for three months. The OIG determined that three months prior to the event, during an annual physical examination, a facility primary care provider failed to acknowledge or assess the patient’s unintentional weight loss. The OIG substantiated that the CPS failed to act on a patient’s abnormal test results and communicate those results to the patient. However, the OIG was unable to determine if immediate action by the CPS would have led to the patient receiving a prompt diagnosis and treatment for pancreatic cancer. The OIG found that the CPS also did not document a change in the patient’s plan of care. The current electronic health record used within the Veterans Health Administration (VHA) lacks a process to ensure that test results are communicated and acted upon by ordering providers. The OIG determined that facility policies and practices supported CPSs collaborating with primary care providers when a patient’s condition changed. Although the OIG found no evidence to indicate an overall lack of collaboration between providers and CPSs, in this case, the OIG determined that an opportunity for collaboration was missed. The OIG found that facility leaders provided oversight of patient care delivered by CPSs. The OIG made one recommendation to the Veterans Integrated Service Network Director to conduct a comprehensive review of the patient’s episode of care and take action as indicated. The OIG made one recommendation to the facility Director to ensure staff are aware of and follow the VHA directive regarding communication of test results.

The VA Office of Inspector General (OIG) conducted a healthcare inspection to assess allegations of inadequate preoperative evaluations and the management of postoperative care for a patient approved for bariatric surgery at the VA Pittsburgh Healthcare System. The patient did not receive three required laboratory tests prior to bariatric surgery; however, the OIG did not substantiate that the patient was inappropriately approved for surgery. These omissions did not affect the clinical indication for surgery or the outcome. The OIG did not substantiate that the patient was inadequately evaluated by mental health providers prior to surgery. The Bariatric Surgery Program team considered the patient’s complex mental health history prior to approving the patient for surgery. The OIG substantiated that the Managing Overweight and/or Obesity for Veterans Everywhere coordinator overstated the patient’s mental health treatment and did not correct the documentation error after discovering it. Concerns were noted regarding the lack of a checklist and the use of informal communication instead of documenting interdisciplinary team discussions. The OIG concluded that an improved process could diminish the risk of an incomplete preoperative evaluation for future patients. The patient successfully underwent bariatric surgery in 2019. The OIG did not substantiate that the patient was insufficiently monitored following surgery. The patient received monitoring for medication, weight loss, and mental health symptoms. Approximately three months after surgery, the patient was seen in the Emergency Department and denied thoughts of self-harm in the previous two weeks. The patient completed suicide five days after the Emergency Department visit. The OIG made six recommendations to the Facility Director related to developing a facility policy for bariatric surgery; ensuring bariatric patients receive all preoperative medical and mental health evaluations; reviewing, correcting, and educating staff on documentation errors; documenting preoperative bariatric interdisciplinary team discussions; and reviewing the Bariatric Surgery Program.

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 Oscar G. Johnson VA medical center and multiple outpatient clinics in Michigan and Wisconsin. 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 included four positions, one was permanently filled less than four months and one (chief of staff) had been vacant for three months prior to the OIG visit. Employee satisfaction survey results for the Director and the ADPCS were markedly higher than VHA averages. Leaders supported efforts to improve and maintain patient safety, quality care, and other positive outcomes. The leadership team was extremely knowledgeable within their scope of responsibility about Strategic Analytics for Improvement and Learning data and should continue to act to sustain and improve performance. No substantial organizational risk factors were identified. The OIG issued 11 recommendations for improvement: (1) Medical Staff Privileging • Professional practice evaluation processes (2) Medication Management • Aberrant behavior risk assessment • Urine drug testing • Informed consent • Follow up after therapy initiation • Pain Committee activities (3) Women’s Health • Women Veterans Program Manager collateral duties (4) High-Risk Processes • Sterile Processing Services annual risk analysis • Staff training

The objective for this report was to evaluate the extent to which the company employs key practices to ensure the efficiency and effectiveness of its police force. We found that, over the past two years, the company has significantly improved its oversight and management of its police department but has not reached a consensus on the full scope of Amtrak Police Department’s (APD) role and priorities—a foundational decision from which all other policing decisions flow. Further, the company has not developed systematic processes to determine APD’s optimum size or composition. As a result, the company does not have reasonable assurance that it is using its police department efficiently and effectively and could be exposed to unforeseen risks to its security, operations, finances, and brand.To better ensure that APD is effectively and efficiently meeting the company’s needs and addressing its risks, we recommended that the company and police department reach a consensus on the full scope of APD’s role and priorities. Once it has done so, we recommended that the company develop data‐driven, risk‐based processes to determine the department’s optimal size and staffing composition and ensure that those decisions—as well as decisions about allocation, goals, and metrics—align with APD’s role and priorities.

OIG evaluated FSIS’ controls to ensure the safety of imported meat and poultry.

We found violations of U.S. Immigration and Customs Enforcement (ICE) detention standards undermining the protection of detainees’ rights and the provision of a safe and healthy environment. Although the conditions varied among the facilities and not every problem was present at each, our observations, interviews with detainees and staff, and review of documents revealed several common issues. At three facilities, we found segregation practices infringing on detainee rights. Detainees at all four facilities had difficulties resolving issues through the grievance and communication systems, including allegations of verbal abuse by staff. Two facilities had issues with classifying detainees according to their risk levels, which could affect safety. Lastly, we identified living conditions at three facilities that violate ICE standards. We recommended the Acting Director of ICE ensure the Enforcement and Removal Operations field offices overseeing the detention facilities covered in the report address identified issues and ensure facility compliance with relevant detention standards. We made one recommendation that will help ICE ensure compliance with detention standards. ICE concurred with the recommendation.

Amtrak (the company) contracted with the independent public accounting firm of Ernst & Young LLP to audit its consolidated financial statements as of and for the fiscal year then ended, September 30, 2019, and to provide a report on internal control over financial reporting and compliance with certain provisions of laws, regulations, contracts and grant agreements, and other matters, which they issued on January 28, 2020. Because the company receives federal financial assistance, it must obtain an audit performed in accordance with U.S. generally accepted government auditing standards. The contract also required Ernst & Young to perform a Single Audit of the company’s federal financial assistance for the fiscal year ended September 30, 2019, in accordance with the audit requirements of Title 2 U.S. Code of Federal Regulations Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards (Uniform Guidance). The objective of the Single Audit was to test internal control over compliance with major federal program award requirements and determine whether the company complied with the laws, regulations, and provisions of contracts or grant agreements that may have a direct and material effect on its major federal program.

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The VA Office of Inspector General (OIG) determined that the Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA) had not been given the authority to require drug manufacturers to make drugs available at discounted prices to VA if the same items had been dispensed to veterans through VA pharmacies. If CHAMPVA had this authority, VA could have saved about $69 million of the $181 million the CHAMPVA insurance program paid for retail pharmacy claims in FY 2018. VA is one of four federal agencies eligible by law to receive at least a 24 percent discount for prescription drugs purchased for its facilities and dispensed directly to patients. However, for prescription drugs purchased through retail pharmacies for CHAMPVA beneficiaries, VA pays the higher average contracted wholesale price because it does not have the authority to require drug manufacturers to provide the drugs at discounted prices. The OIG estimated VA could save about $345.1 million over the next five years if CHAMPVA had proper statutory authority, regulations, and processes to buy drugs through retail pharmacies at discounted prices. VA officials also identified the potential for other VA programs, in addition to CHAMPVA, to save money when purchasing drugs from retail pharmacies if VA was given authority to receive price discounts from drug manufactures for these purchases. The OIG recommended VA conduct a formal analysis to determine what steps are needed to require drug manufacturers to provide discounted prices for covered prescription drugs purchased through retail pharmacies to achieve parity with those purchased through VA pharmacies. It also recommended the under secretary collaborate with the Office of Regulatory and Administrative Affairs to pursue statutory or other changes needed to give VA the appropriate legal authority to purchase all prescription drugs through retail pharmacies at those discounted prices.

VA and other government agencies spend billions of taxpayer dollars annually through VA’s Federal Supply Schedule (FSS) contracting program. The FSS program provides the government a simplified process for acquiring commercial supplies and services in varying quantities while obtaining volume discounts. This report is a synopsis of the Office of Inspector General’s (OIG) 19 FSS pharmaceutical proposal reviews completed before VA awarded the contracts (preaward reviews) during fiscal year 2019 in order to help VA obtain the best pricing. OIG preaward reviews of FSS pharmaceutical proposals are internal reports for VA contracting officers that are unpublished due to protected sensitive commercial pricing information. The OIG is publishing this summary to provide more information on the impact of these reviews. Preaward reviews provide VA with information on whether commercial pricing disclosures are reliable for negotiations. The reviews also make pricing recommendations based on the offeror’s commercial selling practices. Preaward reports are used by contracting officers to negotiate fair and reasonable prices for the government and taxpayers. The OIG determined that commercial pricing disclosures were not reliable for negotiations for 14 of the 19 proposals and recommended VA obtain revised disclosures before awarding the contracts. The OIG’s lower FSS pricing recommendations collectively reflected more than $1 billion in estimated cost savings to VA. Nearly $203 million has been sustained by VA as of May 8, 2020. The 19 proposals included 862 offered drug items.

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OIG evaluated RMA’s controls over the development and approval of insurance products under Section 508(h) of the Federal Crop Insurance Act.

This memorandum report presents performance data for the Senior Medicare Patrol (SMP) projects, which receive grants from ACL to recruit and train retired professionals and other older adults and community members to recognize and report instances or patterns of health care fraud. OIG has collected these performance data since 1997.