Federal Reports

The Consumer Product Safety Improvement Act of 2008 (CPSIA) requires that the Office of Inspector General of the U.S. Consumer Product Safety Commission annually provide to the appropriate congressional committees the findings, conclusions, and recommendations from our reviews and audits performed under subsection 205(a) of the CPSIA as well actions taken with regard to employee complaints under subsection 205(b). The attached report fulfills these requirements for fiscal year 2023.

Retention is a shared responsibility between the U.S. Department of Housing and Urban Development’s (HUD) Office of the Chief Human Capital Officer (OCHCO) and HUD’s other program offices. OCHCO sets the departmentwide retention strategy, while the program offices have responsibility for managing retention within their offices. Our evaluation determined that HUD’s departmentwide retention strategy in fiscal years (FY) 2019-2022 mostly aligned with best practices and that OCHCO had a proactive approach to retention. We found that OCHCO had taken the initiative to conduct an exit survey of all departing HUD employees, but also that HUD could better leverage the data it was collecting to address causes of attrition identified in the survey.We met with retention leads from seven of HUD’s program offices and found that those program offices varied in their strategic management of retention. All seven program offices had access to attrition data, which they used to identify positions or grade levels in which it was particularly challenging to retain employees or in which attrition caused greater risks to the mission. Four program offices described specific retention activities or strategies they worked on with OCHCO. However, the seven program offices varied in whether they identified the underlying causes of low retention and addressed them with specific actions, as well as in how they measured the effectiveness of retention activities.Our analysis showed that HUD’s overall voluntary attrition rate was below the average rate of the three comparable agencies. However, when we analyzed the voluntary attrition rates by subgroups, we noticed several significant trends. For example, support-focused offices had the top four highest voluntary separation rates. Additionally, the voluntary attrition rate for governmentwide mission-critical occupations rose during the period FY 2019-2022, while the average of the comparable agencies decreased. HUD’s voluntary attrition rate for employees in field offices in large cities also rose during the period, compared to Washington, DC, and field offices in midsize and small cities. During our analysis, we also determined that HUD had room to improve the quality of its data about HUD-specific mission-critical occupations and position titles.The use of retention incentives varies across HUD. HUD offers coaching, mentoring, and career development programs. We observed that some program offices used remote work to improve retention in hard-to-fill positions. Retention incentives that make use of compensation and special pay rates have U.S. Office of Personnel Management requirements that limit their applicability to HUD employees.We provided HUD with five recommendations. Three recommendations are related to improving the quality and usefulness of retention-related data. Two recommendations relate to determining causes behind higher than benchmarked attrition in subgroups within HUD and addressing those causes. We closed recommendations 1 and 2 before issuance of the final report based on documentation OCHCO provided to us.

Objective: To determine whether the Social Security Administration issued payments to beneficiaries who were deceased according to Puerto Rico vital statistics records.We referred 225 records of beneficiaries in current or suspended payment statuses who had matching Puerto Rico death records – 155 to OIG Office of Investigations in November 2023 and 70 to SSA in December 2023. (Questioned costs is the total of payment amounts made to the beneficiaries after their deaths through September 2023. Funds put to better is an estimated future loss calculated by multiplying the monthly payment amount each beneficiary in current pay received in September 2023 by 12.)

We found the PRIA Fund’s financial statements to be fairly presented and free of material misstatement.

We performed audits at the North Houston Processing and Distribution Center (P&DC) and three delivery units serviced by the P&DC in the Houston, Texas region during the week of September 11, 2023. The delivery units included the Fairbanks Station, New Houston, TX; Oak Forest Station, Houston, TX; and Conroe Main Post Office, Conroe, TX.We issued individual reports for the three delivery units and the P&DC we visited. We also issued another report summarizing the results of our audits at all three delivery units with specific recommendations for management to address.

The VA Office of Inspector General (OIG) conducted a healthcare inspection to review allegations of a delay in diagnosis of a patient’s prostate cancer and lung cancer at the Central Texas VA Health Care System (facility) in Temple, Texas.The OIG substantiated a delay in the diagnosis of the patient’s prostate cancer, identified concerns with the quality of care provided by two nurse practitioners in the urology clinic, and found facility leaders failed to ensure the competency of nurse practitioners to practice independently. The OIG was unable to substantiate a delay in the patient’s lung cancer diagnosis. However, the OIG identified a related concern regarding leaders’ failure to communicate expectations that providers offer patients low-dose computed tomography (CT) scans in the community for lung cancer screening.Two nurse practitioners failed to offer the patient a prostate biopsy despite elevated prostate-specific antigen levels and an abnormal prostate exam. Additionally, facility leaders did not complete required focused professional practice evaluations when the nurse practitioners were granted independent privileges and ongoing professional practice evaluations did not include any urology-specific indicators. Finally, although facility leaders informed providers about low-dose CT for lung cancer screening, the communication lacked clear expectations and direction for which patients should be screened.The OIG made four recommendations to the Facility Director: (1) to review the care both nurse practitioners provided to the patient, (2) to review the care both nurse practitioners provided to other urology patients, (3) to review the privileging and professional practice evaluation processes and performance indicators for nurse practitioners granted full practice authority in specialty care clinics, (4) and to ensure that facility leaders communicate expectations related to low-dose CT to facility primary care providers.

The Office of Inspector General performed an inspection of the Forest Se1vice to determine the likely level of sophistication an attacker would need to compromise selected USDA systems or data.

The fiscal year 2024 investigative priorities address the most significant challenges related to the programs and operations of the EPA and the CSB.

The Fiscal Year 2024 Oversight Plan describes our planned and ongoing oversight projects. The plan reflects the priority work that the OIG believes is necessary to keep the EPA, the CSB, and Congress fully informed about issues related to the administration of Agency programs and operations.

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

Ensuring access to VA’s information and communications technologies is essential to accomplishing its mission. VA is required by law to make information from its websites and data systems accessible to people with disabilities. The OIG conducted this audit to address concerns from Congress and a veterans service organization about the accessibility of VA websites and information systems.VA also is required to report to Congress the status of its progress in ensuring its internal and public-facing websites comply with Section 508 of the Rehabilitation Act of 1973.The OIG found areas where VA’s efforts and monitoring of Section 508 requirements could be improved to ensure websites and information technology systems are equally accessible to all. Specifically, web managers did not routinely maintain the Web Registry as required, and websites were not consistently scanned for compliance until recently. Further, VA officials did not always keep administrations and staff offices apprised of requirements and related procedures, resulting in noncompliant VA information technology systems and an inaccurate VA Systems Inventory. Finally, three directives were not recertified within the required timeline. Until VA addresses all compliance issues, the information access provided to individuals with disabilities may not be comparable to the access provided to those without disabilities.The OIG made six recommendations to address these shortcomings and safeguard accessibility that included developing and implementing a strategy with milestones for identifying all VA websites, confirming their inclusion in VA’s Web Registry, certifying their accuracy annually or as changes occur, and establishing a mechanism for web communication offices across VA to enforce web policy. System owners should also be educated on policy requirements to request accessibility audits and ensure information technology system accessibility designations are accurate in the VA Systems Inventory, and the three deficient directives need to be updated and republished.

We performed a self-initiated audit at the Eastern Shore Processing and Distribution Facility and four delivery units serviced by the P&DF during the week of September 11, 2023. The delivery units included the Cambridge, Easton, and Salisbury Post Offices.We issued individual reports for the three delivery units and the P&DF we visited. We issued another report summarizing the results of our audits at all three delivery units with specific recommendations for management to address.

OIG audited USDA’s consolidated financial statements for fiscal years 2023 and 2022.

Department of Homeland Security components did not consistently apply information technology (IT) access controls to ensure only authorized personnel had access to systems, networks, and information. This capping report summarizes access control practices and deficiencies reported in three components — U.S. Citizenship and Immigration Services (USCIS), Federal Emergency Management Agency (FEMA), and U.S. Immigration and Customs Enforcement (ICE) — over the last 12 months.

This update highlights oversight activities of the EPA OIG from October 1 to December 31, 2023.

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

David Pugliese, a resident of Palm Beach County, Florida, was sentenced on January 12, 2024, in U.S. District Court, Southern District of Florida, for Conspiracy to Commit Health Care Fraud. Pugliese was sentenced to 30 months in prison, two years’ probation, and was ordered to pay restitution in the amount of $2,238,699. Pugliese was the manager and registered agent of Capital Advantage Diagnostics, LLC, which was purportedly in the business of performing a variety of laboratory tests for various health care providers.Our investigation found that Pugliese and others submitted false and fraudulent claims to Medicare and Amtrak’s insurance providers for claims that were not medically necessary or for laboratory tests that were never performed. Pugliese solicited beneficiary information and specimens for testing through the use of individual laboratory representatives and paid bribes to these representatives for specimens they provided. As a result of the scheme, Amtrak’s insurance providers were billed approximately $315,474.

The performance audit of AmeriCorps grants awarded to Serve DC, the Mayor’s Office on Volunteerism and Partnership, and three of its 16 subgrantees (including the Jumpstart for Young Children, Center for Inspired Teaching, and Inspired Teaching Demonstration Public Charter School) identified approximately $1.7 million of questioned Federal and match costs covering three calendar years from 2017 through 2019. The Inspired Teaching Demonstration Public Charter School became the Center for Inspired Teaching and had no claimed costs. In particular, the audit identified concerns regarding Serve DC and subgrantee’s inadequate documentation for personnel expenses, inadequate support for Serve DC’s in-kind match, Serve DC’s inadequate accounting records, subgrantee’s inadequate criminal history checks, and Serve DC and subgrantees’ insufficient internal controls that resulted in under or excess reporting of costs. Serve DC and Jumpstart for Young Children responded separately to address the report findings and recommendations; the Center for Inspired Teaching did not respond to the draft report. Serve DC did not concur with eight of the 16 recommendations, involving the questioning or disallowing of costs. Jumpstart also did not concur with its only recommendation which was related to the disallowance of match costs. AmeriCorps concurred with all our recommendations and promised to work with Serve DC to strengthen its internal controls surrounding the audit findings and will ensure Serve DC’s financial reporting aligns with financial management system standards.

As part of our annual audit plan, we performed an audit of costs billed to the Tennessee Valley Authority (TVA) by USA DeBusk, LLC (DeBusk) for industrial cleaning services provided under Contract Nos. 12042 and 17143. Our audit objective was to determine if the costs were billed in compliance with the terms of the contracts. Our audit scope included approximately $16 million in costs billed between January 1, 2021, and November 30, 2022, including $13.3 million in costs billed under Contract No. 12042 and $2.7 million billed under Contract No. 17143. In summary, we determined DeBusk overbilled TVA $21,157 in travel costs, including (1) $14,033 for ineligible daily commuting costs and (2) $7,124 in unsupported per diem costs. In addition, we identified opportunities to improve contract administration by TVA. Specifically,Pricing schedules for Contract No. 12042 were missing and could not be provided by TVA. As a result, we were unable to determine whether $12.97 million in labor, equipment, and travel costs billed to TVA were in compliance with the contract's pricing schedules or TVA's Project Maintenance and Modification Agreement. TVA could have saved an estimated $12,082 in fuel surcharges by stipulating the use of a fuel adjustment index more closely aligned with TVA's service region. Both contracts contained contradictory compensation terms and may not have conveyed the parties' intent regarding travel and temporary living allowance reimbursements.Invoice packages submitted to TVA for approval did not contain all of the required supporting documentation or match the costs billed through TVA's Maximo system.(Summary Only)

The PACT Act authorizes VA to deliver veterans’ health care and benefits associated with exposure to environmental hazards during military service. VA may use the Cost of War Toxic Exposures Fund (TEF) to ensure proper claims processing by the Veterans Benefits Administration (VBA) and the administration of health care for eligible veterans. Congress authorized an initial appropriation of $500 million to set up the TEF for fiscal years 2023 and 2024 and required that VA produce a spending plan detailing funding allocation; it later appropriated an additional $5 billion in TEF support through fiscal year 2027, which was not part of this examination.As requested by the VA Secretary, the VA Office of Inspector General (OIG) examined the initial TEF appropriation. This memorandum focused on funds allocated to VBA, the Office of Information and Technology (OIT), and the Veterans Health Administration (VHA). Among its allowable uses, VBA, OIT, and VHA planned for 2,400 full-time employees. VA submitted a required spend plan to Congress. Estimation methodologies explaining specifically how funds will be used had been completed only for VHA, with the remaining methodologies anticipated in December 2023 and February 2024. This memorandum was issued to draw VA leaders’ attention to identified weaknesses. These included that VBA and OIT had not yet provided methodologies to explain their plan estimates; some spending plans had to be amended to avoid violations of the Purpose Statute; and monthly spending reports contained minor calculation inaccuracies.The OIG commends the Office of Management for proactively seeking legal guidance from the Office of General Counsel to ensure TEF allocations are used in accordance with their authorized purposes. No specific recommendations were made, but the OIG requested being informed of any additional actions taken to ensure proper use of the TEF once VBA and OIT finalize their estimation methodologies.

We engaged with an independent public accounting (IPA) firm to audit DIA's FY 2023 financial statements. We evaluated the reliability of data supporting the financial statements, determined the reasonableness of the statements produced, and examined disclosures in accordance with applicable guidance.

The VA Office of Inspector General (OIG) conducted a healthcare inspection to assess the quality of care provided during a patient’s hospitalization, which ended with the patient’s death at the Lt. Col. Luke Weathers, Jr. VA Medical Center (facility) in Memphis, Tennessee. The OIG also evaluated facility leaders’ response to the patient’s care.A telemetry technician’s failure to follow a series of communications within the time frame established in the facility’s cardiac telemetry monitoring policy delayed initiating a blue alert, which may have affected the patient’s outcome. A charge nurse’s failure to assign a nurse to care for the patient or provide accurate nursing assignments to the telemetry technician may have also contributed to the delay. Additionally, an intensive care unit fellow did not document a response to a critical care consult and did not recall the patient, rendering the OIG unable to determine the clinical decision-making rationale.Facility leaders’ factfinding and root cause analysis reviews of the patient’s care were not thorough, which hindered identification of systemic and causal factors. Contributing factors included a nursing leader who did not issue an authorization letter to provide the factfinding investigator guidance on the focus of the review, and the root cause analysis team who did not interview some staff directly involved with the patient event, as required.The OIG made five recommendations to the Facility Director related to compliance with the cardiac telemetry monitoring policy, making and communicating nursing assignments, documenting critical care consults, conducting factfindings and root cause analyses, and consideration of another root cause analysis.

The Cybersecurity and Infrastructure Security Agency (CISA) had extensive products and services to manage risks and mitigate cybersecurity threats to critical water and wastewater infrastructure and increase its resiliency. However, CISA did not consistently collaborate with the Environmental Protection Agency and the Water and Wastewater Systems Sector to leverage and integrate its cybersecurity expertise with stakeholders’ water expertise.

During fiscal years 2018 through 2022, we issued 61 reports and 178 recommendations for improving conditions at the Southwest border. As of August 17, 2023, 144 recommendations were closed, 31 recommendations were resolved and open, and 3 recommendations remained unresolved.

This Office of Inspector General (OIG) Comprehensive Healthcare Inspection Program report describes the results of a focused evaluation of the care provided at the Tomah VA Medical Center in Wisconsin. This evaluation focused on five key operational areas:• Leadership and organizational risks• Quality, safety, and value• Medical staff privileging• Environment of care• Mental health (suicide prevention initiatives)The OIG issued five recommendations for improvement in three areas:1. Medical staff privileging• Ongoing Professional Practice Evaluations2. Environment of care• Environment of care inspections• VA police response times to panic alarm testing in the inpatient mental health unit3. Mental health• Monthly outreach activities• Monthly suicide-related data reporting to local mental health and quality management leaders

This report contains information about recommendations from the OIG's audits, evaluations, reviews, and other reports that the OIG had not closed as of the specified date because it had not determined that the Department of Justice (DOJ) or a non-DOJ federal agency had fully implemented them. The list omits information that DOJ determined to be limited official use or classified, and therefore unsuitable for public release.The status of each recommendation was accurate as of the specified date and is subject to change. Specifically, a recommendation identified as not closed as of the specified date may subsequently have been closed.

The Office of the Inspector General conducted an evaluation to determine if the Tennessee Valley Authority (TVA) is performing preemployment suitability and onboarding steps necessary for access in a timely manner. We found TVA was allowing access to TVA facilities while not always performing preemployment suitability and onboarding steps in a timely manner. Specifically, we determined that the Form I-9, for 381 of 1,571 personnel (24 percent) hired between October 1, 2021, and June 30, 2023, was either not completed in a timely manner or never completed in accordance with the Immigration Reform and Control Act of 1986 and 8 Code of Federal Regulations §§ 274a.1-274a.14. However, according to TVA Police and Emergency Management personnel, physical access should have been revoked but was not because Human Resources and Administration does not notify them when the I-9 threshold is exceeded. Additionally we identified opportunities to strengthen TVA Standard Programs and Processes to better align with federal requirements.

VA’s Financial Management Business Transformation Service (FMBTS) is leading and managing the implementation of the Integrated Financial and Acquisition Management System (iFAMS), an enterprise-wide modernization effort to replace legacy systems that facilitate the department’s financial and contracting activities. FMBTS personnel are responsible for training end users, which is critical to a successful iFAMS deployment across VA. FMBTS conducts a post-training survey but does not solicit feedback on end users’ tasks and daily activities, and the timing of this survey immediately after training does not allow FMBTS to assess how users apply instruction when conducting role-specific activities in iFAMS. The VA OIG surveyed a statistical sample of 255 end users to assess satisfaction with iFAMS training. The team found that end users had concerns with the training provided for some tasks and day-to-day activities, leaving FMBTS with opportunities to enhance the training program. Addressing training weaknesses now is important because over 100,000 employees have yet to be trained on the system.

Attached is the Defense Intelligence Agency (DIA) Office of the Inspector General (OIG) Semiannual Report (SAR) to Congress. This document highlights our oversight efforts from April 1, 2023 to September 30, 2023.

The purpose of this memorandum is to provide an update on the overall status of the U.S. Department of Housing and Urban Development’s (HUD) implementation of HUD Office of Inspector General’s (OIG) Priority Open Recommendations and to transmit the attached list of Priority Open Recommendations for fiscal year (FY) 2024. Our goal is to highlight key open recommendations from prior OIG reports that if implemented, would have the greatest impact on helping HUD achieve its mission and address its top management challenges. We track HUD’s progress in addressing all OIG recommendations, including those designated as priorities, on a Recommendations Dashboard that we launched in March 2023.

Complete and accurate reporting in USAspending.gov is critical, as it is the primary way the EPA informs the public of the purpose of its federal awards and where its funding ultimately goes.

This Office of Inspector General (OIG) Comprehensive Healthcare Inspection Program report describes the results of a focused evaluation of the care provided at the Wilmington VA Medical Center in Delaware. This evaluation focused on five key operational areas:• Leadership and organizational risks• Quality, safety, and value• Medical staff privileging• Environment of care• Mental health (suicide prevention initiatives)The OIG issued two recommendations for improvement in the environment of care topic area:• Inspection deficiency resolution tracking• Safe and clean environment

Our objective was to evaluate the process for, cause of, and validity of refunds associated with the PRS product and examine the accuracy of manifested prices — the postage payments consolidators submit based on contractual rates. We conducted site visits and interviews and analyzed package data and consolidator refund requests.

Since the formation of the modern Postal Service in 1971, various laws gave it more retirement liability than other federal agencies. As an independent agency within the federal government, USPS is expected to be self-sustaining and cover costs — including retirement costs — through revenue. Thus, while other federal agencies receive annual congressional appropriations to fund retiree pension and health care benefits, the Postal Service generally receives no direct tax dollars and pays for these expenses from the sale of postal products and services. USPS’s retirement costs are significant — $10 billion in FY 2023 alone.

Marc Hoang, a pharmacist based in West Covina, California, was sentenced on January 8, 2024, in U.S. District Court, Central District of California, for making a false statement related to a health care fraud investigation. Hoang was sentenced to two years’ probation.Our investigation found that Hoang knowingly and willfully made a materially false and fraudulent statement on a Drug Enforcement Administration (DEA) form. Hoang submitted the form to the DEA to renew the controlled substances registration for his former pharmacy. On the form, Hoang represented that he was the person who distributed the controlled substances and was the officer and point of contact for the pharmacy, when in fact, he was not. Hoang was part of a large health care fraud scheme, in which beneficiaries were solicited to provide their insurance information to a pharmacist for medication they did not seek or need. As a result of the scheme, Amtrak’s health care plan was billed $32,489 of which $26,962 was paid, and Tricare, the U.S. military’s health care plan, paid $12,264,685 on the fraudulently submitted claims.

(December 2023) The IC IG has released its semiannual report to the DNI and Congress for the period of April 1, 2023 - September 30, 2023

We are providing this summary report for your information and use. Our objective was to provide a joint report on actions taken during calendar years 2021 and 2022 to carry out the requirements of the Cybersecurity Information Sharing Act of 2015.

Due to the importance of monitoring the performance of the Tennessee Valley Authority’s (TVA) Safety Program, the TVA Office of Inspector General (OIG) performed an evaluation of TVA’s health and safety committees (HSC). The objective of this evaluation was to determine if HSCs were effectively monitoring the remediation of identified safety concerns. The TVA OIG determined TVA HSCs are generally effective at monitoring the remediation of identified safety concerns. However, there were limited instances when safety concerns were not monitored or remediation plans were not established. In addition, we found some HSCs were not following requirements to meet at least quarterly and maintain meeting minutes.

Amtrak (the company) contracted with the independent certified public accounting firm of Ernst & Young LLP to audit its consolidated financial statements as of September 30, 2023, and for the year then ended, and to provide a report on internal control over financial reporting and on compliance and other matters. Because the company receives federal assistance, it must obtain an audit performed in accordance with generally accepted government auditing standards.As required by the Inspector General Act of 1978, as amended, we monitored the audit activities of Ernst & Young to help ensure audit quality and compliance with auditing standards. Our monitoring focused on two Ernst & Young reports and disclosed no instances in which Ernst & Young did not comply, in all material respects, with generally accepted government auditing standards. We reached this conclusion by monitoring Ernst & Young’s audit activities, which included reviewing its reports, auditor independence and qualifications, audit plans, detailed testing results, summary work papers, and quality controls. We also attended key meetings.Our review disclosed no instances in which Ernst & Young did not comply, in all material respects, with generally accepted government auditing standards.

We determined whether the Natural Resources Conservation Service (NRCS) ensured that Conservation Stewardship Program (CSP) participants maintained control of land enrolled in CSP contracts.

This audit report determined that the Commission’s FY 2023 information security program was not in compliance with FISMA legislation, OMB guidance, and applicable NIST special publications. Five of the nine domains Kearney evaluated warrant additional management attention to address identified deficiencies - Risk Management, Supply Chain Risk Management, Configuration Management, Identity and Access Management, and Information Security Continuous Monitoring. Specifically, the FISMA evaluation report includes seven findings and offers 25 recommendations to improve the effectiveness of the FCC’s information security program controls. FCC continues to work towards an effective overall maturity level for its information security program.

Using a risk-based, tiered approach in developing this work plan to best focus our resources, AIE will initiate work in nine focus areas in 2024, including oversight of IIJA, IRA and other supplemental funding provided to the DOI.

This audit report determined that the Commission’s FY 2023 information security program was not in compliance with FISMA legislation, OMB guidance, and applicable NIST special publications. Five of the nine domains Kearney evaluated warrant additional management attention to address identified deficiencies - Risk Management, Supply Chain Risk Management, Configuration Management, Identity and Access Management, and Information Security Continuous Monitoring. Specifically, the FISMA evaluation report includes seven findings and offers 25 recommendations to improve the effectiveness of the FCC’s information security program controls. FCC continues to work towards an effective overall maturity level for its information security program.

In this legislatively mandated review, the OIG sought to determine whether VBA continues to use updated public disability benefits questionnaires and, because public questionnaires may pose a significant risk of fraud without adequate internal controls, to examine VBA’s oversight of their use. Publicly available questionnaires are to be completed by veterans’ non-VA medical providers, whereas internal questionnaires are completed by VA medical providers.The OIG team reviewed a sample of 100 claims for benefits completed from January 1 through December 31, 2022, supported by at least one public questionnaire. These 100 claims contained 207 public questionnaires because some claims had more than one questionnaire submitted. The team developed its own indicators of fraud risk because VBA lacked them.The team found that VBA generally accepted and used public questionnaires when determining entitlement to benefits. However, VBA does not have effective controls to mitigate the risk of using fraudulent forms to decide benefits. On the basis of its sample, the team estimated that of the 31,900 claims completed during the review period, approximately 22,000 claims (69 percent) had one or more fraud risk indicators. Although public questionnaires with fraud risk indicators show only possible instances of fraud, the team’s projections suggest that the monetary risk to VA could be approximately $390 million.The OIG made five recommendations to the under secretary for benefits, chief among them to continue developing a system for digitally capturing, analyzing, and monitoring public questionnaires to identify inauthentic or fraudulent questionnaires, and work with the Compensation Service to develop policies for reviewing and remediating any such public questionnaires identified. Other recommendations were to have outside providers certify that they completed the questionnaires under penalty of perjury, and to enhance guidance and training for claims processors.

An Amtrak Senior manager based in Philadelphia was terminated from employment on December 8, 2023, as the result of our investigation that found he submitted falsified applications to the Small Business Administration for a Coronavirus Aid, Relief, and Economic Security Act Economic Injury Disaster Loan. In addition, the former employee signed a civil settlement agreement with the U.S. Attorney’s Office, Middle District of Florida, and agreed to pay $25,441 in restitution related to the fraudulent loan.