Federal Reports

Beginning in 2018, the Medicare program will change the way it sets payment rates for clinical diagnostic laboratory tests (lab tests) under Part B. CMS will replace current payment rates with new rates based on current charges in the private health care market. 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 lab tests. This data brief provides the third set of annual baseline analyses of the top 25 lab tests.

DOI OIG - BLM Manager Falsified Employment Information

The nursing home complaint process is a critical safeguard to protect vulnerable residents of nursing homes. CMS relies on the States' respective survey agencies to serve as the front-line responders to address health and safety concerns raised by residents, their families, and nursing home staff. State survey agencies must conduct onsite investigations within certain timeframes for the two most serious levels of complaints-those that allege serious injury or harm to a nursing home resident and require a rapid response to address the complaint and ensure residents' safety. However, previous reports by OIG and the Government Accountability Office found that States did not conduct onsite investigations within the required timeframes for some of these complaints.

OIG conducted a healthcare inspection to assess allegations of delays in patients receiving transcatheter aortic valve replacement (TAVR) procedures at the VA Palo Alto Health Care System (system) Palo Alto, CA, due to Veterans Health Administration (VHA) policy requirements. We received complaints alleging: Patient A’s TAVR was delayed; VHA’s requirement that TAVR procedures occur in a hybrid operating room (HOR) is too stringent and not the community standard; patients were “affected” by the HOR requirement for the TAVR procedure; the system requested and was denied a waiver of the HOR requirement for TAVR procedures; HOR construction delays prevented system TAVR program implementation; and to avoid delays in patient care, the system enrolled patients in research studies so they could undergo TAVR procedures. We did not substantiate Patient A experienced a delay in obtaining the TAVR procedure. Once Patient A was recommended for a TAVR, the procedure was completed within a timeframe consistent with his medical needs. We substantiated VHA requires TAVR procedures be performed in a HOR. VHA reviewed best practices and obtained expert consensus to establish this requirement. We substantiated patients were affected by VHA’s requirement that TAVR procedures be performed in a HOR as the system did not have a HOR and was unable to perform non-research TAVR procedures. However, we found the system referred patients for care. We substantiated that construction on a TAVR HOR was not completed on the projected date and affected the system’s program. Patients obtained the TAVR procedure through other services during that time. We substantiated that system providers enrolled patients in TAVR procedure research studies. We were unable to determine if by doing so, they avoided delays in care. We identified lapses in the documentation necessary to maintain accurate records including communication and continuity of care. We made one recommendation.

The Centers for Medicare & Medicaid Services (CMS) contracted with National Government Services (NGS) to process Part B claims under Medicare contract 00630. CMS requested that we perform an audit of NGS's Medicare Part B final administrative cost proposal for the last three quarters of fiscal years 2011 and 2012.

The Centers for Medicare & Medicaid Services (CMS) contracted with National Government Services (NGS) to process Part A claims under Medicare contract 00130. CMS requested that we perform an audit of NGS's Medicare Part A final administrative cost proposal for the last three quarters of fiscal years 2011 and 2012.

The Centers for Medicare & Medicaid Services (CMS) contracted with National Government Services (NGS) to process Part A claims under Medicare contract 00450. CMS requested that we perform an audit of NGS's Medicare Part A final administrative cost proposal for the last three quarters of fiscal years 2011 and 2012.

The Office of the Inspector General previously conducted an evaluation of Environmental Permitting and Compliance (EP&C) (Evaluation Report 2016-15366 issued September 28, 2016) to identify strengths and risks that could impact EP&C’s organizational effectiveness. Our final report identified several strengths and risks along with recommendations for addressing those risks. In response to a draft of that report, Tennessee Valley Authority management provided their management decision. The objective of this follow-up evaluation was to assess management’s actions to address risks from our initial organizational effectiveness evaluation. In summary, we determined EP&C has taken actions to address most of the risks outlined in our initial organizational effectiveness evaluation. However, concerns with two managers’ behaviors remained unresolved. Management had taken some actions to address behaviors of one manager but had not addressed the behaviors of the other manger. In addition, employees expressed continued concerns related to the process and database used to request environmental reviews of projects and accountability.

Although the Oklahoma Department of Human Services (State agency) performed the required onsite monitoring at all 22 group homes, this onsite monitoring did not ensure that foster care group homes complied with State licensing and Federal requirements related to the health and safety of children in foster care. We determined that 17 of the 22 group homes did not comply with 1 or more State health and safety requirements. Specifically, we found that 12 of the group homes did not comply with transportation requirements; 12 of the group homes did not comply with building, utilities, and grounds requirements; 10 of the group homes did not comply with fire safety requirements; 4 of the group homes did not comply with food service requirements; 4 of the group homes did not comply with safety and emergency preparedness requirements; and 1 group home did not comply with physical facility and equipment requirements.

The OIG used data analytics to identify offices with lost or stolen stamp stock shipments. We identified expenses related to stamp stock shipments between May 1, 2016, and April 30 2017, for the Anderson, IN, Post Office, and Anderson Stations B and C, two small finance stations whose stamp stock is shipped to the Anderson Post Office. When retail units do not resolve discrepancies timely, Accounting Services records an expense to the units for the difference. The objective of this audit was to determine whether internal controls over stamp stock shipments were in place and effective at the Anderson Post Office.

The objective of this audit was to assess to what extent the Smithsonian had processes in place to prevent, detect, and resolve security vulnerabilities on the Smithsonian’s publicly accessible websites. The audit focused on obtaining an inventory of publicly accessible websites; conducting vulnerability testing, which included an in-depth test of websites to simulate a focused attack by a skilled adversary; and reviewing the Smithsonian’s policies, procedures, and processes to manage website security.

We determined that FEMA is unable to assess flood hazard miles to meet its program goal and is not ensuring mapping partner quality reviews are completed in accordance with applicable guidance. FEMA needs to improve its management and oversight of flood mapping projects to achieve or reassess its program goals and ensure the production of accurate and timely flood maps. We made four recommendations that would help FEMA strengthen its management and oversight of flood mapping projects to achieve program goals. FEMA concurred with all four recommendations.

When Congress established average sales price (ASP) as the basis for Medicare Part B drug reimbursement, it also provided a mechanism for monitoring market prices and limiting potentially excessive payment amounts. The Social Security 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 2 previous quarters or 3 of the previous 4 quarters.

OIG administers the Medicaid Fraud Control Unit (MFCU or Unit) grant awards, annually recertifies the Units, and oversees the Units' performance in accordance with the requirements of the grant. As part of this oversight, OIG conducts periodic reviews of all Units and prepares public reports based on these reviews. These reviews assess the Units' adherence to the 12 MFCU performance standards and compliance with applicable Federal statutes and regulations.

This is our final audit report on the effectiveness of NOAA real property management. Specifically, we assessed whether NOAA has an adequate understanding of its repair needs and is monitoring real property utilization.

We performed this audit to determine whether NARA's FOIA process was efficient, effective, and complied with current laws and regulations. We also assessed internal controls in place to ensure NARA responded to FOIA requests timely and accurately.

Of the $10.0 million in Low-Income Home Energy Assistance Program (LIHEAP) grant funds that the Administration for Children and Families awarded to the Turtle Mountain Band of Chippewa Indians (TMT) for Federal fiscal years 2010 through 2013, TMT did not administer LIHEAP grant funds totaling $587,248 in compliance with Federal laws, regulations, and guidance. In addition, TMT could not determine whether an additional $96,932, which home energy suppliers had returned to the tribe, was subject to repayment because it did not track from which grant period those additional funds originated. TMT is a federally recognized Native American tribe located in North Dakota. The errors we identified occurred because TMT did not have policies and procedures or internal controls in place to prevent them.

In this classified report, we identified vulnerabilities with TSA's screener performance, screening equipment, and associated procedures. Details related to our testing results presented in the report are classified or designated Sensitive Security Information. We are making eight recommendations that when implemented, should improve TSA's screening checkpoint operational effectiveness.

The VA Office of Inspector General (OIG) conducted its fourth determination of Veterans Health Administration (VHA) occupations with the largest staffing shortages as required by Section 301 of the Veterans Access, Choice, and Accountability Act of 2014 (VACAA). We determined that the largest critical need occupations were Medical Officer, Nurse, Psychologist, Physician Assistant, and Medical Technologist.Our analysis of the staffing gains and losses for this year’s report shows that for critical need occupations, a significant percentage of the total gains continue to be offset by staff losses. At the time of the writing of this report, VHA still does not have operational staffing models that comprehensively cover critical need occupations. In the absence of facility-specific staffing targets or an operational staffing model, determining whether facilities are making meaningful progress in filling critical staffing shortages is challenging.VHA chartered a work group to consider ways to reduce regrettable losses. The work group’s report focused on the need for additional studies to determine causative and other factors related to regrettable losses. The work group reported issuing a follow-up report in September 2017. In an effort to better understand staffing processes and identify staffing barriers, we conducted a survey of 141 VHA facilities in May 2017. We received a request from Senator Thom Tillis to evaluate staffing requirements and demand for select non-physician professionals. We included questions in the survey related to those professionals (optometrists, pharmacists, and medical technicians). We made four recommendations to the Acting Under Secretary for Health.

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

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

Hawaii did not fully comply with Federal Medicaid requirements for billing manufacturers for rebates for drugs dispensed to enrollees of Medicaid managed-care organizations. Hawaii properly billed manufacturers for some rebates for pharmacy and physician-administered drugs. However, it did not bill for and collect from manufacturers rebates of $18.8 million ($9.7 million Federal share). For drugs that were eligible for rebates, Hawaii did not bill for rebates of $8 million (Federal share) for pharmacy drugs and $1.6 million (Federal share) for single-source and top-20 multiple-source physician-administered drugs. For drugs that may have been eligible for rebates, Hawaii did not bill for rebates of $57,783 (Federal share) for non-top-20 multiple-source physician-administered drugs with National Drug Codes. In addition, Hawaii did not bill for rebates for 122,436 claim lines for other physician-administered drugs. Hawaii did not provide us sufficient drug utilization data to determine whether these drugs were eligible for rebates and the amount of any rebates that may have been due.

Washington did not fully comply with Federal Medicaid requirements for billing manufacturers for rebates for drugs dispensed to enrollees of Medicaid managed-care organizations. Washington properly billed manufacturers for some rebates for pharmacy and physician-administered drugs. However, it did not bill for and collect from manufacturers rebates of $34.1 million ($17 million Federal share). For drugs that were eligible for rebates, Washington did not bill for rebates of $14.2 million (Federal share) for pharmacy drugs and $2.4 million (Federal share) for single-source and top-20 multiple-source physician-administered drugs. For drugs that may have been eligible for rebates, Washington did not bill for rebates of $395,746 (Federal share) for non-top-20 multiple source physician-administered drugs with National Drug Codes. In addition, Washington did not bill for rebates for 17,140 claim lines for other physician-administered drugs. Because there was insufficient information to determine the amount of any rebates that may have been due, we set aside these claim lines for resolution by the Centers for Medicare & Medicaid Services (CMS).

To see our report, click on the link below

Please see the link below for a video and podcast discussing the results of this review.

The VA Office of Inspector General conducted a healthcare inspection at the request of Senator John McCain, Senator Jeff Flake, Congresswoman Martha McSally, former Congresswoman Ann Kirkpatrick, and Congressman Raúl M. Grijalva to assess the merits of allegations regarding patients’ delayed access to primary care and contaminated reusable medical equipment at the Southern Arizona VA Health Care System (system), Tucson, AZ. We also followed up on registered nurse staffing concerns identified in the fiscal year (FY) 2014 Employee Assessment Review survey.We substantiated that the number of primary care patient appointments taking 30 days or more to schedule from FY 2015 to FY 2016 had increased. We also found an increase in the number of new and established patients waiting more than 30 days from the preferred to the appointment date.We determined that primary care wait times were affected by complex scheduling templates containing different appointment types and provider vacancies. System leaders increased physician recruitment by offering financial incentives to attract providers to a rural clinic. While we substantiated that reusable medical equipment (endoscopes) were contaminated and reused on two patients, we did not substantiate it was due to reduced staffing. We found this was a process issue. System staff notified the patients, who were tested, and we found no related adverse patient outcomes. System managers modified the process and trained staff.We found that since FY 2014, registered nurse staffing improved in the inpatient medical/surgical and mental health units, the community living center, the special procedures unit, and the Emergency Department. We made one recommendation.

Seek link below for the full report, report summary, multimedia or any agency follow-up

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

We scheduled an audit of the Tennessee Valley Authority's (TVA) long-term wind power contracts after noting TVA paid about $37.7 million to four wind farm contractors for energy it did not receive between November 1, 2012, and January 3, 2017. Our audit objectives were to determine if (1) TVA's decision to enter into long-term wind power contracts was in TVA's economic interest and (2) the $37.7 million in energy curtailment payments were in TVA's economic interest.TVA's decision to enter into long-term wind power contracts has not proven to be in TVA's economic interest. The decision to enter into the wind power contracts was primarily due to TVA management's assumptions that (1) TVA and other utilities could be required to provide a greater portion of the electricity they sell by using renewable resources, (2) early approval of the wind power contracts would allow TVA to proactively obtain cost effective renewable and clean generation agreements prior to enactment of renewable energy standard legislation, and (3) the wind power contracts were competitive with forecasted market electricity prices. However, the assumptions TVA used in its decision-making process proved to be inaccurate.TVA accepted a significant amount of risk by locking into level fixed prices over the contract terms. TVA relied on net present value (NPV) analyses based in part on long-term forecasts of electricity prices over a 20-year time horizon. TVA's NPV analyses showed most of the contracts to have only a small positive NPV and a significant probability that the NPV would be negative. In addition, TVA's own analyses showed it would only begin to receive value, if any, in the last 10 years of the contracts' 20-year terms.As of TVA's most recent NPV calculation performed in March 2016, the total NPV of these contracts was a negative $1.4 billion. If TVA had issued one initial contract for 200 MW instead of contracting with nine wind farms for approximately 1,700 MW all at once, TVA management could have learned valuable insights into wind power contracting and the related risks.With regard to the $37.7 million in energy curtailment payments TVA made between November 1, 2012, and January 3, 2017, we determined these payments were in TVA's economic interest at the time the decisions were made.We recommended TVA's Senior Vice President, Distributed Energy Resources:Take a measured approach for large projects in areas TVA does not have familiarity or that are new to TVA. For instance, rather than entering into several large contracts in a short period of time, consideration should be given to entering into one small contract to gain a better understanding of the industry and market. Provide positive financial value earlier in future power purchase contract terms by negotiating terms that do not set a level fixed price over the contract term. Instead, use periodic price adjustments (quarterly or annually) based on a specific economic index or escalating the price at a predetermined rate over the contract term.TVA management concurred with our recommendations and noted actions taken to address them.(Summary Only)

The Office of the Inspector General conducted a review of Human Resources (HR) to identify operational and cultural strengths and risks that could impact HR's organizational effectiveness. Our report identified strengths within HR related to (1) organizational alignment, (2) collaboration within the departments, and (3) management support from some HR management. However, we also identified risks related to (1) management responsibilities and behaviors, including (a) performance reviews, (b) opportunities for advancement, (c) training and resources, and (d) relationship issues with three managers; (2) execution of HR strategy and programs; (3) perceptions by some of unethical practices; and (4) inclusion that could negatively affect the ability of HR to contribute to the Chief Human Resources Office's mission and to the success of the Tennessee Valley Authority.

The U.S. Postal Service has a substantial network of about 35,000 retail facilities, including post offices, stations, and branches. The Philadelphia Metropolitan District includes over 250 retail units with a combined retail revenue of over $175 million for fiscal year (FY) 2016. Retail and customer service operations are integral parts of the Postal Service’s ability to retain customers and ultimately generate revenue. The Postal Service aims to provide customers with a positive retail experience and efficient customer service operations. Our objective was to assess retail and customer service operations in the Philadelphia Metropolitan District. We selected this district as it was one of the most inefficient districts in the country during 2016 based on retail and customer service operation data.

The Centers for Medicare & Medicaid Services (CMS) oversees implementation of health insurance provisions for the Affordable Care Act and works with States to establish marketplaces, which evaluate individuals' eligibility for qualified health plans (QHPs) and insurance affordability programs (i.e., the premium tax credit and cost-sharing reductions). Our prior reviews of seven State marketplaces found that not all of their internal controls were effective in ensuring that individuals were properly determined eligible for QHPs and insurance affordability programs. These deficiencies led us to review the effectiveness of CMS's oversight of State marketplaces. Our objective was to determine whether CMS provided effective oversight to ensure that State marketplaces determined individuals' eligibility for QHPs and insurance affordability programs according to Federal requirements.

This is our final audit report on the awarding of U.S. Census Bureau (the Bureau) noncompetitive contracts. Our objective was to determine whether the Bureau’s contracting personnel properly awarded noncompetitive contracts.

This is a classified report. We determined that the Office of Intelligence and Analysis continues to provide effective oversight of the department-wide intelligence system and maintains programs to monitor ongoing security practices. In addition, the United States Coast Guard is in the process of migrating its intelligence users to a system that is jointly managed by the Defense Intelligence Agency and the National Geospatial Agency. However, we determined that DHS’ information security program for intelligence systems is not effective, based on the maturity model included in this year’s reporting instructions. Specifically, DHS’ continuous monitoring tools for its intelligence system are not interoperable. DHS has not documented procedures, established formal training, and instituted qualitative and quantitative measures for continuous monitoring of its intelligence systems. We made no recommendations.

The Small Business Jobs Act of 2010 (the Act) requires the Department of Health and Human Services (the Department) to use predictive modeling and other analytics technologies (fraud-detection models) to identify improper Medicare Fee-for-Service claims that providers submit and prevent the payment of such claims. To fulfill this requirement, the Department designated the Centers for Medicare & Medicaid Services (CMS) to develop and implement the Fraud Prevention System (FPS).

The Postal Service has recognized the need to improve its ability to identify, document, configure, and manage software licenses throughout their lifecycle. In July 2015, the Postal Service approved an investment of about $35 million for a software asset management program, which includes software discovery, centralized inventory license management, and a new IT Asset Management group within IT with the responsibility for making strategic software-related decisions. Our objective was to determine whether the Postal Service’s software license management program is functioning according to Postal Service standards and industry best practices.

Each year roughly 48 million people in the United States get sick, 128,000 are hospitalized, and 3,000 die of foodborne diseases. To protect against foodborne illnesses, FDA inspects food facilities to ensure both food safety and compliance with regulations. Congress passed the Food Safety Modernization Act (FSMA), which enabled FDA to focus more on preventing food safety problems rather than reacting to them after the fact. FSMA requires FDA to inspect domestic food facilities within certain timeframes.

Stamp Fulfillment Services, Kansas City, MO, fulfills stamp orders from postal retail units. Retail units are responsible for identifying and locating missing stamp stock shipments. When retail units do not resolve discrepancies timely, Accounting Services records an expense to the units for the difference. Our objective was to determine whether internal controls over stamp stock shipments were in place and effective at the Central Square Post Office, Cambridge, MA.

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

The Reports Consolidation Act of 2000 (RCA)1 authorizes the CFTC to consolidate financial and performance management reports and to provide information in a meaningful and useful format for Congress, the President, and the public. The RCA requires the Inspector General to summarize the “most serious management and performance challenges facing the agency” and briefly assess the Agency’s progress in addressing those challenges.2 This memorandum fulfills our duties under the RCA.

Due to its classified nature, this report cannot be released publicly. The OIG has therefore released a 3-page public summary describing the information it contains.

Complainant is a Senior Special Agent with the United States Secret Service. For 20 years, he worked in a variety of investigative and protective duties until his security clearance was suspended in 2013. Complainant reported to us that the Secret Service suspended and revoked his security clearance as retaliation for disclosing alleged violations of federal antidiscrimination laws and for separately reporting abuse of authority on the part of his former Special Agent in Charge and other officials. As a result of these security clearance actions, the Secret Service placed Complainant on administrative leave and then indefinite suspension without pay, his current status with the agency.Underpinning this matter are allegations of whistleblower retaliation by adverse security clearance action. For the first time within the Department of Homeland Security, under Presidential Policy Directive 19 (PPD-19), we have substantiated an instance of retaliation related to security clearance actions.