Federal Reports

The Tennessee Valley Authority (TVA) Standard Programs and Processes (SPP) 04.021, TVA Inventory Management Process, defines "surplus" as material that is not expected to be used within the next 3 years by TVA. Due to the risk of disposing of needed materials, and as a result of employee concerns shared during organizational effectiveness reviews at Cumberland and Kingston Fossil Plants in 2015, we initiated an evaluation of TVA's coal plant surplus materials process. The objective of our evaluation was to determine if coal plant materials designated for surplus were appropriate. The scope of our evaluation was materials surplused between October 1, 2013, and March 31, 2017. We found that materials designated as surplus at active and transitional plants were generally appropriate. Of the $49.7 million of surplused materials from October 1, 2013, to March 31, 2017, less than 1 percent was repurchased by coal plants. However, retired plant materials may have been surplused unnecessarily resulting in missed opportunities to redeploy materials, including inventory and noninventory, within the fleet. Based on our review of TVA SPPs and best practices, we identified opportunities for TVA to improve its redeployment of both inventory and noninventory materials in future plant retirements. In addition, we identified conflicting criteria related to the time frame used in designating materials as surplus.

We determined that two DHS Components – CBP and U.S. Immigration and Customs Enforcement (ICE) created their own internal authorizations for executive protection details and staffed them without clear legal authority. We made two recommendations to the DHS secretary to direct CBP and ICE to (1) discontinue security details pending a legal review by the DHS General Counsel and (2) develop directive regarding the scope and circumstances when a security detail is permitted for DHS component heads including the requirements for departmental level authorization; pending the results of the legal review.

Blue Cross Blue Shield Association claimed $68,605 of unallowable fiscal intermediary contract Medicare postretirement benefit costs on its Final Administrative Cost Proposals for fiscal years 2011 through 2015.

This is our evaluation of the Census Bureau’s Interactive Review (IR) Address Canvassing operation. The objective of our review—which began in December 2015—was to gain an understanding of the IR process and evaluate the quality control procedures developed to ensure accurate results. This review supplements the previously issued 2016 Address Canvassing Test audit report, which can be found on OIG’s website.

Limited scope audits involve a limited review of financial and non-financial information to ensure validity and accuracy of award recipients' reported information and compliance with state and Federal requirements. Our audit was conducted in accordance with the Government Auditing Standards (2011), issued by the Comptroller General of the United States, and concluded that the John F. Kennedy Center for the Performing Arts (Kennedy Center) generally complied with financial management system requirements. However, we found that the Kennedy Center's review process of Federal Financial Reports did not allow for accurate, current, and complete disclosure of financial results. Additionally, we found that the Kennedy Center did not adhere to federal requirements when reporting costs to NEA awards.

TSA's Office of Inspection Accountability Act of 2015 (Public Law 114-53), required us to review the Federal Air Marshal Service’s (FAMS’) policies and procedures for identifying misuse of Government resources, as well as the administration of FAMS’ code of conduct or integrity policies with respect to instances of misconduct. We incorporated this requirement into our ongoing department-wide audit of conduct and discipline, which seeks to determine whether DHS and its components have sufficient processes and procedures to address conduct issues. We determined that FAMS has sufficient policies and procedures to establish expectations for appropriate conduct, identify misuse of government resources, and address misconduct allegations. The report contains no recommendations.

This report contains classified information that is exempt from disclosure under the Freedom of Information Act. 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.

Sierra Nevada Memorial Hospital (the Hospital), located in Grass Valley, California, generally complied with Medicare requirements for reporting wage data in its fiscal year 2014 Medicare cost report. However, errors in reporting wage data did occur. We estimated that, as a result, Medicare overpaid 173 other hospitals in California a total of $216,594 for inpatient services in the first 6 months of Federal fiscal year 2017.

When Nevada billed manufacturers for rebates for physician-administered and pharmacy drugs, it did so correctly. However, Nevada estimated that it did not bill for rebates of $520,137 ($327,624 Federal share) for physician-administered and pharmacy drugs that were eligible for rebates. In addition, Nevada did not bill for rebates for 19,650 claim lines for other physician-administered and pharmacy drugs that may have been eligible for rebates. 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). Nevada's internal controls did not ensure that it billed for and collected rebates for all drugs dispensed to enrollees of Medicaid managed-care organizations (MCOs).

Drug diversion, counterfeiting, and the importation of unapproved drugs may result in potentially dangerous drugs entering the drug supply chain, posing a threat to public health and safety. To enhance drug supply chain security, the Drug Supply Chain Security Act (DSCSA) requires trading partners in the drug supply chain to create a record of each drug product transaction. FDA can then use such tracing records to investigate suspect and illegitimate drug products and potential diversion.

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Our objectives were to assist U.S. Office of Personnel Management (OPM) in assessing the reasonableness of U.S. Postal Service employee retirement, health benefits and life insurance withholdings; Postal Service benefit contributions; and enrollment information submitted via the headcount report by the Postal Service; and to assist OPM in identifying and correcting errors related to processing and distributing Combined Federal Campaign payroll deductions. This report is not suitable for any other purpose.

Arkansas did not always make the supplemental Medicaid payments in accordance with Federal requirements. Sixteen of the 120 supplemental payments in our stratified random sample were correct. For 88 of the remaining 104 supplemental payments, Arkansas incorrectly calculated the amount of the payments. An additional six supplemental payments were correctly calculated but were made to ineligible providers. The remaining 10 supplemental payments were both calculated incorrectly and were made to ineligible providers.

New York improperly claimed reimbursement for 36 of 100 payments made to Medicaid Managed Long-Term Care (MLTC) plans. Specifically, New York did not ensure that MLTC plans documented eligibility assessments of program applicants and reassessments of those already in the program, and conducted these assessments in a timely manner. New York also did not ensure that the plans provided services to beneficiaries according to a written care plan. Further, New York did not ensure that the plans enrolled and retained only those beneficiaries who required community-based services, and disenrolled beneficiaries who requested disenrollment in a timely manner.

The Wisconsin Department of Children and Families (DCF) did not always comply with Maternal, Infant, and Early Childhood Home Visiting (MIECHV) program requirements and the terms and conditions of the program's grants, resulting in unallowable expenditures totaling $275,175. Specifically, for the five subrecipients reviewed, DCF did not ensure that one subrecipient used grant funding for allowable purposes. We also found that for three of the five subrecipients, DCF did not ensure that subrecipients' time-and-effort reporting systems complied with Federal requirements. In addition, DCF did not have adequate procedures to monitor subrecipients, could not provide an approved budget for one of its subrecipient agreements, and did not comply with Federal Funding Accountability and Transparency Act of 2006 (FFATA) reporting requirements. We did not identify any unallowable expenditures at the State level.

In April 2017, we evaluated the San Juan VA Regional Office (VARO) to assess timeliness and accuracy of claims processing, rating reductions, systems compliance and specially controlled correspondence. We found Veterans Service Center (VSC) staff did not consistently process one of the two types of disability claims reviewed. We reviewed 30 veterans’ traumatic brain injury (TBI) claims and found all were accurately processed. OIG reviewed 23 special monthly compensation (SMC) claims and found four claim inaccurately processed. The errors occurred because second signature reviews were ineffective. Overall, VSC staff accurately processed 49 of the 53 veterans’ disability cases. These cases included improper payments totaling approximately $4,900. VSC staff generally processed proposed rating reductions accurately but needed better oversight to ensure claims are completed at the expiration of the due process period. OIG reviewed all 16 benefits reduction cases and found processing delays in four cases resulting in overpayments of approximately $12,300. VSC staff entered inaccurate or incomplete claim and claimant information into the electronic systems in 19 of 30 claims reviewed. In general, these errors occurred because employees were inexperienced and lacked training related to the proper procedures for establishing claims while adhering to systems compliance requirements. VSC staff accurately, but slowly processed the single inquiry requiring special control received between December 1, 2016 and February 28, 2017. It took VSC staff 59 days to provide the final response. We also found staff did not input the correct received date for the inquiry we reviewed. We recommended the VARO Director develop and implement a plan to ensure secondary reviewers accurately evaluate higher-level SMC and ancillary benefits claims, implement a plan to ensure all claims processing staff receive additional training on claims establishment procedures, and monitor the effectiveness of that training. The VARO Director concurred with our recommendations. Management’s planned actions are responsive and we will follow up as required.

Post office foot traffic varies widely. The 450 largest locations have on average about as much foot traffic as Best Buy stores, while the next 7,000 largest have about as much traffic as CVS locations. An OIG survey shows that Millennials visit post offices more often than older generations, but for different purposes. Following on the footsteps of the retail sector, USPS could use proven foot traffic measurement solutions to make better retail decisions and improve customer services and sales.

At the request of the Tennessee Valley Authority's (TVA) Supply Chain, we examined the cost proposal submitted by a company for civil projects and coal combustion residual program management work at TVA's steam electric power plants. Our examination objective was to determine if the company's cost proposal was fairly stated for a planned <br> $100 million contract.In our opinion, the company's cost proposal was overstated as follows:The company's proposal for a Cumberland Fossil Plant project included overstated (1) equipment costs, (2) overhead markup rates, and (3) material costs. In addition, the company's proposed fee rate exceeded the maximum allowable fee rate in TVA's request for proposal (RFP).Proposed time and material (T&M) rates were not supported by the company's actual costs.The company did not comply with the RFP requirements regarding cost reimbursable work.We estimated TVA could avoid about $11.1 million on the planned $100 million contract by (1) negotiating the appropriate reductions to the company's proposed equipment costs, material costs, and overhead rate, and (2) limiting the company's fee rate to the RFP's maximum allowable rate. In addition, we suggest TVA negotiate revisions to the company's T&M rates to more accurately reflect its actual costs and require compliance with the RFP's cost reimbursable provisions.(Summary Only)

HHS oversees States' use of various Federal programs, including Medicaid. State agencies are required to establish appropriate computer system security requirements and conduct biennial reviews of computer system security used in the administration of State plans for Medicaid and other Federal entitlement benefits (45 CFR § 95.621). This review is one of a number of HHS OIG reviews of States' computer systems used to administer HHS-funded programs. Our objective was to determine whether Alabama adequately secured its Medicaid data and information systems in accordance with Federal requirements.

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Please also see the link below for the DOJ OIG's related Memorandum for the Deputy Attorney General, "Recommendation for a Department of Justice Policy Establishing Standards for its Security Offices to Review Misconduct Investigations for Security Clearance Adjudications," which was issued in conjunction with this report.

This memorandum was issued in conjunction with the DOJ OIG's related "Report of Investigation of the Actions of Former DEA Leadership in Connection with the Reinstatement of a Security Clearance." Please see the link below to access that report.

CNCS-OIG investigation disclosed that YMCA staff violated 45 CFR § 2540.100(f) Nondisplacement, when they knowingly allowed 13 AmeriCorps members to fill vacant staff daycare teachers and assistant teacher positions with the YMCA’s School Age Learning Center program for up to three months until the YMCA could hire suitable employees.Agency management concurred with CNCS-OIG recommendations and took the following action: (1) disallowed and recouped $22,312 in stipend payments disbursed to thirteen members placed in staff positions; (2) disallowed and recouped $22, 237.86 in Segal Education Awards awarded to eight members whose hours included staff displacement; and (3) elevate the risk level of the North Dakota Commission due to the poor program management of the YMCA grant. CNCS management declined to disallow any staff salary used as non-Federal match because the YMCA’s match contribution exceeded the legally required match amount.

OIG conducted a healthcare inspection to evaluate stroke care at the Manchester VA Medical Center (facility), Manchester, NH pursuant to an April 2015 request of Congresswoman Ann McLane Kuster. The request was in response to a Federal court ruling that the facility failed to adequately diagnose and treat a stroke patient when he presented to the Urgent Care Clinic (UCC) in 2010. The purpose of the review was to determine whether system issues may have led to poor care of the patient and to evaluate changes that the facility may have made in response to this incident.We found that the patient should have been transferred to another facility with the capability to perform a complete diagnostic workup and care for stroke patients (acute care facility) and should not have received any diagnostic evaluations at the facility.We found deficiencies with the facility’s Peer Review process. Discussion of the specifics of the deficiencies is prohibited by 38 U.S.C. §5705.To determine compliance with VHA and facility policy and assess whether the system issues from 2010 remain today, we reviewed the records of 23 patients who presented to the UCC with a presumptive stroke between June 2014 and May 2015. UCC providers did not always transfer patients prior to conducting a diagnostic test and did not always designate the patient's primary care provider as a co-signer of the UCC discharge summary. When UCC providers transferred patients with a presumptive stroke to an acute care facility, they did not consistently observe facility managers' expectations to transfer patients to a non-VA acute care hospital, approximately 2.5 miles away (closest acute care hospital). During a follow-up site visit in February 2016, we found that facility managers made system and procedural changes in the UCC.We made three recommendations.

In May 2017, OIG evaluated the St. Louis, MO, VA Regional Office (VARO) to determine how well Veterans Service Center (VSC) staff processed disability claims, processed proposed rating reductions, accurately input claims-related information, and responded to special controlled correspondence. VSC staff did not consistently process one of the two types of disability claims reviewed. OIG reviewed 30 veterans’ traumatic brain injury claims and found staff accurately processed 29. Additionally, OIG reviewed 30 veterans’ special monthly compensation (SMC) or ancillary benefit claims and found staff incorrectly processed four. This resulted in improper payments totaling approximately $39,900. Errors occurred because staff did not see these cases frequently enough to gain familiarity with them. VSC staff needed to improve timeliness and accuracy in processing rating reductions. OIG reviewed 30 rating reduction cases and found staff delayed or incorrectly processed 16. Delays were due to prioritization of other workloads and resulted in about $83,100 in overpayments. Inaccuracies were due to ineffective training and resulted in approximately $5,300 in improper payments. VSC staff needed to improve accuracy of data entered into electronic systems during claims establishment. OIG reviewed 30 claims and found staff did not correctly establish 16 due to ineffective training. VSC staff needed to improve timeliness and accuracy in processing special correspondence. OIG reviewed 30 special correspondences and found staff incorrectly processed 25 due to insufficient staffing and lack of training. OIG recommended the VARO Director implement plans to provide training for SMC, rating reductions, and special correspondence. OIG also recommended the Director monitor the effectiveness of recent training for claims establishment procedures, ensure SMC decisions receive second signature reviews by designated staff, ensure benefit reductions are processed at due process expiration, and allocate resources to process special correspondence. The VARO Director concurred with the recommendations, and planned actions are responsive.

The VA Office of Inspector General (OIG) evaluated the quality of care delivered at the Michael E. DeBakey VA Medical Center. This included reviews of key clinical and administrative processes that affect patient care outcomes—Quality, Safety, and Value; Environment of Care; Medication Management; Coordination of Care; Diagnostic Care; Moderate Sedation; Community Nursing Home Oversight; and Management of Disruptive/Violent Behavior. OIG also provided crime awareness briefings to 171 employees.OIG identified certain system weaknesses in utilization management; environmental cleanliness; anticoagulation processes and staff competency; employee competencies for point-of-care testing; community nursing home committee representation, annual reviews, and cyclical monthly documentation; and establishment of an Employee Threat Assessment Team and employee training for management of disruptive/violent behavior.As a result of the findings, OIG could not gain reasonable assurance that: 1. Facility managers effectively monitor the documentation of physician advisors’ decisions in the required database. 2. Facility managers maintain clean floors and patient rolling equipment and ensure damaged patient rolling equipment is repaired.3. The facility reviews quality assurance data for the anticoagulation management program, clinicians obtain all required laboratory testing prior to initiating anticoagulants, and employees involved in the anticoagulant program complete competency assessments.4. The facility develops and implements employee competencies for glucometer point-of care testing and assesses competencies annually.5. Facility managers ensure required disciplines participate in Community Nursing Home Oversight Committee functions, monitor the community nursing home program, and assure the safe care of patients in those homes.6. The facility has an Employee Threat Assessment Team, and employees receive training to reduce and prevent disruptive behaviors.OIG made recommendations for improvement in the following six review areas: (1) Quality, Safety, and Value; (2) Environment of Care; (3) Medication Management; (4) Diagnostic Care; (5) Community Nursing Home Oversight; and (6) Management of Disruptive/Violent Behavior.

OIG conducted a healthcare inspection at the July 2014 request of Congressman Mac Thornberry to assess allegations at the Amarillo VA Health Care System (facility), Amarillo, TX, concerning provision of care at the Childress, TX, and Clovis, NM, community based outpatient clinics (CBOC); nursing supervision at the Childress, TX, CBOC; and scheduling issues at the Lubbock, TX, CBOC. We substantiated that from November 2012 through November 2014, the Clovis and Childress CBOCs had more than 100 patients who had not been seen for more than one year. However, we did not find a requirement that patients be seen yearly. We did not substantiate that in March 2016, the Childress CBOC had (1) inadequate space to provide care and ensure privacy, or (2) did not provide comprehensive care or the same level primary care that was provided at the facility. Services not available on-site were offered via other mechanisms. We substantiated that in January 2015, Registered Nurses (RN) and Licensed Vocational Nurses (LVN) performed clerical duties because the facility did not assign clerical staff to CBOCs. However, this was not a violation of Veterans Health Administration policy. We did not substantiate that in January 2015, nurses at the Childress CBOC lacked supervisory nursing oversight. Nursing staff were supervised and able to contact supervisors by phone and email. We substantiated that LVNs may have exceeded their scope of practice. After our 2015 visit, facility staff instituted a new process to provide patients access to an RN and/or a provider by phone when an RN or provider was not available on-site. We did not substantiate that in August 2014, Lubbock CBOC staff lacked training in scheduling patient appointments and/or destroyed documents and kept paper wait lists. We made two recommendations.

OIG conducted a healthcare inspection at the request of Senators Tammy Baldwin, Chuck Grassley, and Ron Johnson, and Representatives Ron Kind and Timothy Walz, to assess improper dental infection control practices and administrative action taken by the Veterans Health Administration (VHA) at the Tomah VA Medical Center, (facility) Tomah, WI. These practices potentially exposed 592 veterans to bloodborne pathogens (BBP), including human immunodeficiency virus and hepatitis B and C viruses. Facility leadership were unaware of the improper infection control practices until October 2016, when acting supervisor Dentist B reported to the Chief of Staff that Dentist A (hired in October 2015) used a non-VA unsterile bur during a dental procedure. Two factors that contributed to facility leaders not being aware of Dentist A’s improper infection control practices sooner were (1) failure of staff, despite safety and infection-control training, to report Dentist A’s breach of infection control practices, and (2) advance notification and other issues associated with Dental Clinic inspections. OIG determined that the facility, Veterans Integrated Service Network (VISN) 12, and VHA took appropriate follow-up actions and responded timely to patients’ potential exposure to BBP. The facility removed the non-VA unsterile bur from the operatory, reported the incident to Human Resources, briefed VISN 12 leadership, and directed Dentist A to leave the clinic. Dentist A subsequently submitted a letter of resignation. The Deputy Under Secretary for Health for Operations and Management convened a clinical episode response team (CERT) to identify steps to take in response to the potential exposure of patients to BBP which included identifying, testing, and treating patients. Facility leaders made timely large-scale disclosure to 592 patients and flagged patient Electronic Health Records as needed to alert primary care physicians to discuss follow-up. We made one recommendation to the VISN 12 Director and four recommendations to the Facility Director.

Due to concerns identified in a prior review related to the length of time Transmission and Power Supply (TPS) direct charge materials had been stored at the Muscle Shoals Distribution Center (MSDC), we initiated an evaluation to determine if TPS direct charge materials were being managed appropriately. In summary, we determined TPS direct charge materials were not being managed appropriately because: (1) direct charge materials were not purchased in accordance with TVA policy, (2) TPS does not keep track of direct charge materials stored at MSDC, and (3) direct charge materials are being stored at MSDC even though the work orders for which they were purchased have closed. Inappropriately managing TPS direct charge materials could increase the risk of loss, theft, or the over purchase of materials. In addition, project costs could be overstated and funds spent on items that go unused.

The Office of the Inspector General conducted an evaluation of Safety and Performance Improvement (SPI) to identify strengths and risks that could impact SPI's organizational effectiveness. Our evaluation identified strengths within SPI related to (1) organizational alignment, (2) customer focus, (3) management support of employees, (4) employee teamwork and collaboration, and (5) proactive identification of safety risk behaviors. However, we identified issues that, if left unresolved, could increase the risk that SPI will be unable to effectively meet its objective in the future. These issues include (1) mixed messaging on the importance of safety, including the use of Recordable Injury Rate in TVA's Winning Performance Program, placement of the Designated Agency Safety and Health Official within TVA's organizational structure, and frequent movement and reorganization of the safety function and (2) nuclear Safety Consultants reporting structure. However, none of these risks are within the control of SPI, but are dependent on other TVA organizations for resolution.

We evaluated the merits of two confidential Hotline allegations received after we published the Review of Alleged Misuse of VA Funds To Develop the Health Care Claims Processing System in March 2015. The complainants alleged that the Chief Business Office (CBO) continued to spend about $11 million of medical support and compliance (MS&C) appropriations on Health Care Claims Processing System (HCPS) development from August through September 2014, despite being told by OIG during an April 2014 meeting of OIG, CBO, and Financial Services Center that they should have used the Information Technology (IT) Systems appropriation. We confirmed that CBO spent MS&C funds to support HCPS during the OIG’s previous review, conducted from March through December 2014. This was prior to OIG’s official notification to VA in December 2014 that a potential Antideficiency Act violation had occurred. We confirmed that OIG personnel informed the former Deputy Chief Business Officer of the potential violation of appropriations law at an April 2014 meeting. However, CBO staff did not alter their spending patterns after learning of the potential violation. In addition, OIG did not formally notify the former Interim Under Secretary for Health of the potential violation until the draft report was issued in December 2014. The VA Secretary reported the violation of the Antideficiency Act as required by section 1351 of Title 31, United States Code. Therefore, we made no recommendations in the report.

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In February 2017, we evaluated the Wilmington VA Regional Office (VARO) to see how well staff processed disability claims, proposed rating reductions, and input claims information in the electronic system of record. Wilmington Veterans Service Center (VSC) staff did not consistently process one of the two types of disability claims we reviewed. We reviewed all 16 veterans’ claims available involving entitlement to Special Monthly Compensation (SMC) and related ancillary benefits completed by VSC staff in calendar year 2016. We found VSC staff inaccurately processed eight claims. Of the eight claims with errors, three affected veterans’ benefits—resulting in improper payments totaling approximately $25,500. Generally, the errors occurred because second signature reviews were ineffective, and staff were unaware of policy involving eligibility for certain ancillary benefits. VSC staff generally processed rating reductions accurately but needed to complete this workload to ensure timely action. We reviewed all seven cases within scope and found VSC staff delayed or incorrectly processed four of the reductions. Delays occurred because the VSC managers prioritized other workloads higher in order to meet established performance goals related to processing disability claims. These delays and processing inaccuracies resulted in approximately $25,300 in overpayments. VSC staff needs to improve the accuracy of information input into the electronic systems at the time of claims establishment. We randomly sampled 30 of 196 newly established claims and found VSC staff did not correctly input information into the electronic system for 16 claims due to the lack of a quality review process for staff establishing claims. We recommended the VARO Director assess the effectiveness of secondary reviews associated with SMC claims, provide training for SMC, and monitor the effectiveness of this training. We also recommended the VARO Director implement a quality review process for claims establishment. The VARO Director concurred with our recommendations.

Internal Controls Over Post Office Postage Meter Use―Canton Center, CT, Post Office

This Newsletter provides a bimonthly summary of selected investigative accomplishments.

EAC OIG, through the independent public accounting firm of McBride, Lock & Associates, LLC, audited $30.4 million in funds received by the Maryland State Board of Elections under the Help America Vote Act. The objectives of the audit were to determine whether the Board: 1) used payments authorized by Sections 101, 102 and 251 of the Grant in accordance with Grant and applicable requirements; 2) accurately and properly accounted for property purchased with Grant payments and for program income; 3) met HAVA requirements for Section 251 funds for creation of an election fund, providing required matching contributions, and meeting the requirements for maintenance of a base level of state outlays, commonly referred to as Maintenance of Expenditures (MOE).

On the basis of our review of 100 sampled deficiencies, we determined that the Kansas Department of Aging and Disability Services, Survey, Certification and Credentialing Commission (State agency), did not always verify nursing homes' correction of deficiencies identified during surveys in calendar year 2014 in accordance with Federal requirements. We estimated that the State agency did not obtain the nursing homes' evidence verifying correction of deficiencies in accordance with Federal requirements for 52 percent of the deficiencies identified during surveys in CY 2014. We also estimated that the State agency could not provide sufficient evidence that corrective actions had been taken for 13 percent of the deficiencies identified during those surveys. In addition, the State agency did not always conduct required standard surveys within 15 months of the previous standard surveys in CY 2014 in accordance with Federal requirements.

OIG conducted a healthcare inspection in response to complaints regarding consults at the Central Texas Veterans Health Care System (system), Temple, TX. The complainant provided 14 examples of patients at the Olin E. Teague Veterans’ Medical Center (facility) for whom he/she believed Physical Medicine and Rehabilitation Services (PMRS) consults were not scheduled timely and appointments were delayed as a result. We substantiated the allegation that 12 of the 14 patients experienced delays in scheduling consult appointments and in receiving care. Although patients experienced delays in PMRS consults, primary care teams continued to manage patients. We found the problem of delayed consult appointments was a systemic problem within PMRS. Some of the facility’s PMRS consult procedures did not comply with system policy and could have contributed to the delay in appointment scheduling. Multiple provider and managerial positions were filled by temporary personnel, and an absence of a fully staffed department affected the functioning of the service and contributed to the delays. Facility managers were aware of these problems and attempted to correct them by forming a Consult Management Committee to review consult data, and by requesting another Veterans Health Administration (VHA) facility review PMRS. Although facility managers provided Advanced Medical Support Assistants who scheduled appointments with additional scheduling training, they continued to be confused about scheduling procedures and did not meet scheduling competency evaluation requirements. We recommended that the Facility Director ensure that (a) consult clinical reviews and appointment scheduling for patients are conducted in compliance with VHA directives and policies, (b) PMRS have sufficient staffing to arrange for timely consults and appointments within the service, and (c) facility staff who schedule PMRS patient appointments receive annual scheduling competencies to ensure understanding of the correct process for compliance with VHA directives and staff are monitored for compliance.

In March 2017, OIG evaluated the Denver, CO, VA Regional Office (VARO) to determine how well Veterans Service Center (VSC) staff processed veterans’ disability claims, how timely and accurately they processed proposed rating reductions, how accurately they entered claims-related information, and how well they responded to special controlled correspondence. VSC staff generally processed the disability claims we reviewed correctly. OIG reviewed 30 veterans’ traumatic brain injury claims and found staff accurately processed 28. Additionally, OIG reviewed 30 veterans’ special monthly compensation (SMC) or ancillary benefit claims and found staff correctly processed 26. One error affected a veteran’s benefits and resulted in eight improper monthly underpayments totaling approximately $17,400. Systemic trends among these errors were not identified, so no recommendation for improvement was made. VSC staff generally processed rating reductions accurately, but needed to prioritize workloads to ensure timely action. OIG reviewed 30 reduction cases and found staff delayed or incorrectly processed 14. Delays were due to prioritization of other workloads by VARO management. Delays and errors resulted in approximately $51,400 in overpayments and $1,100 in underpayments. OIG reviewed 30 newly established cases and found staff did not correctly input claim information into the electronic systems at the time of claims establishment for 19, due to staff inexperience and ineffective oversight. VSC staff generally processed special correspondence timely and accurately. OIG reviewed 30 special correspondence and found one was processed untimely and four were processed inaccurately. Systemic trends were not identified among the errors, so no recommendation for improvement was made in this area. OIG recommended the VARO Director implement a plan to complete proposed rating reductions at end of due process, and implement a plan to have claims processing staff receive training on claims establishment procedures to improve oversight. The VARO Director concurred with our recommendations, and planned actions are responsive.

A large majority of Americans say they believe self-driving cars will be used for delivery and transportation within the next 10 years, but they are split over whether they like the idea — many are concerned about the concept’s safety. The more people know about self-driving vehicles, the more they tend to like the idea and believe in its potential safety benefits. USPS may be able to enhance its brand by implementing self-driving technology, but the public lacks faith that USPS could successfully deploy the concept.

This is our final audit report conducted to review Minority Business Development Agency (MBDA) grant programs as part of our annual risk-based audit plan. Our audit objective was to review the adequacy of MBDA’s management of its cooperative agreements. Specifically, for the MBDA Business Center (MBC) program, we (1) evaluated controls over application review and award approval processes; (2) reviewed processes for monitoring performance and compliance with programmatic requirements for MBC awards; and (3) determined whether performance accomplishments reported by MBCs are supported and verified.

State Medicaid agencies (Medicaid agencies) are required to suspend payments for health care items and services when there is a credible allegation of fraud against the provider, unless "good cause" exists not to suspend payment. Using payment suspensions, when appropriate, is important to protect Medicaid funds: payment suspensions based on credible allegations of fraud can swiftly stop the flow of Medicaid dollars to providers defrauding Medicaid. A payment suspension can remain in place throughout the law enforcement investigation and potential prosecution of the health care fraud case.