Federal Reports

Since 1975, the Postal Service has leveraged its expansive retail network to accept passport applications on behalf of the U.S. Department of State (State Department). The State Department is primarily responsible for nationwide passport services. This includes designating entities to accept passport applications, providing passport information to the public, issuing U.S. passports, and ensuring program integrity. The Postal Service’s role is to accept passport applications at designated facilities, ensure all application documents are correct, and submit documents to the State Department. The Postal Service and State Department have an interagency agreement that governs passport acceptance. Our objective was to assess the Postal Service’s passport application acceptance operations and identify opportunities for improvement.

The NASA Office of Inspector General found the Agency appropriately managed those funds to meet congressional mandates as well as federal and Agency guidance.

This Office of Inspector General (OIG) Comprehensive Healthcare Inspection Program report provides a focused evaluation of the quality of care delivered in the inpatient and outpatient settings of the Sheridan VA Medical Center and multiple outpatient clinics in Wyoming. The inspection covers key clinical and administrative processes associated with promoting quality care. For this inspection, the areas of focus were Leadership and Organizational Risks; COVID-19 Pandemic Readiness and Response; Quality, Safety, and Value; Registered Nurse Credentialing; Mental Health: Emergency Department and Urgent Care Center Suicide Risk Screening and Evaluation; Care Coordination: Inter-facility Transfers; and High-Risk Processes: Management of Disruptive and Violent Behavior.At the time of the OIG review, the leadership team had worked together for over two years. The Director, who was permanently assigned in August 2017, was the most tenured leader. Selected employee survey responses revealed satisfaction with leadership and a workplace where staff felt respected and discrimination was not tolerated. Patient experience survey results were generally higher than VHA averages for male inpatient care, but opportunities for improvement were identified for both genders in outpatient settings. Review of the facility’s accreditation findings, sentinel events, and disclosures did not identify any substantial organizational risks. The executive leaders were generally knowledgeable about selected data used in Strategic Analytics for Improvement and Learning models and factors contributing to poorly performing quality and efficiency measures.The OIG issued three recommendations for improvement in three areas:(1) Quality, Safety, and Value• Peer review committee recommendation of improvement actions(2) Registered Nurse Credentialing• Primary source verification of registered nurses’ licenses prior to appointment(3) High-Risk Processes• Disruptive behavior committee attendance

The EPA could achieve cost savings and potentially put Agency funds to better use by improving compliance with BPA requirements.

DOL's reported Unemployment Insurance improper payment rate of 9.17 percent is compliant with Payment Integrity Information Act of 2019, it is not representative of total unemployment expenses for program year 2020. This occurred for the following reasons: (1) DOL excluded CARES Act of 2020 because these unemployment payments were not in existence for more than 12 months, and (2) DOL received direction from Office of Management and Budget to utilize the results from the first three quarters of the program year. This allowed state workforce agencies to suspend work on improper payment sampling to reduce the burden on program resources. The DOL-OIG's initial pandemic audit and investigation work indicate UI program improper payments, including fraudulent payments, is likely higher than 10 percent.

Effective January 1, 2015, the Centers for Medicare & Medicaid Services (CMS) established a policy for Medicare to pay under the Medicare Physician Fee Schedule for chronic care management (CCM) services rendered to beneficiaries whose medical conditions meet certain criteria. Effective January 1, 2017, CMS unbundled complex CCM from noncomplex CCM and began paying separately for complex CCM. Although scope of service and billing requirements are the same for noncomplex CCM as for complex CCM, the two types of services differ as to clinical staff time, medical decisionmaking, and care planning. CCM services are a relatively new category of Medicare-covered services and are at higher risk for overpayments. This audit expands on the findings of a previous OIG audit.

During our audit period, CDS was a subsidiary of Blue Cross Blue Shield of South Carolina (BCBS South Carolina), whose home office is in Columbia, South Carolina. CDS was created after being awarded the Enterprise Data Center (EDC) contract effective March 10, 2006. The EDC contract was replaced by a Virtual Data Center contract on November 15, 2012, which is still in effect. Upon creation of the CDS Medicare segment, BCBS South Carolina and CDS elected to follow CAS regulations regarding segmented accounting. The disclosure statement that CDS submits to CMS states that CDS uses pooled cost accounting. Medicare contractors use pooled cost accounting to calculate the indirect cost rates (whose computations include pension and PRB costs) that they submit on their ICPs. Medicare contractors use the indirect cost rates to calculate the contract costs that they report on their ICPs. In turn, CMS uses these indirect cost rates in determining the final indirect cost rates for each contract. Medicare Reimbursement of Pension CostsCMS reimburses a portion of the annual contributions that contractors make to their pension plans. The pension costs are included in the computation of the indirect cost rates reported on the ICPs. In turn, CMS uses indirect cost rates in reimbursing costs under cost-reimbursement contracts. To be allowable for Medicare reimbursement, pension costs must be (1) measured, assigned, and allocated in accordance with CAS 412 and 413 and (2) funded as specified by part 31 of the FAR. In claiming costs, contractors must follow cost reimbursement principles contained in the FAR, the CAS, and the Medicare contracts. Previous Audits of Allocable Pension CostsWe previously reviewed CDS’s allocable pension costs (A-07-17-00511; Aug. 28, 2017) and BCBS South Carolina’s allocable pension costs (A-07-17-00509; Aug. 28, 2017). Our previous CDS audit report identified allocable pension costs that CDS should have used when calculating its indirect cost rates for CYs 2008 through 2012. We recommended that CDS increase the allocable pension costs for CYs 2008 through 2012 by $30,436. Our previous BCBS South Carolina audit report identified Other segment allocable pension costs that its subsidiaries’ Medicare segments should have used when calculating BCBS South Carolina’s indirect cost rates for CYs 2006 through 2012. We recommended that BCBS South Carolina decrease the allocable pension costs used to calculate its Medicare segments’ indirect cost rates for CYs 2006 through 2012 by $6,193,748. Incurred Cost Proposal AuditsAt CMS’s request, Figliozzi & Company CPAs P.C. (Figliozzi), Mayer Hoffman McCann P.C. (McCann), the Defense Contract Audit Agency (DCAA), and CohnReznick (Reznick) performed audits of the ICPs that CDS submitted for CYs 2012 through 2016. The objectives of these ICP audits were to determine whether costs were allowable in accordance with applicable Federal regulations. For our current audit, we relied on the Figliozzi, McCann, DCAA, and Reznick ICP audit findings and recommendations when computing the allowable pension costs discussed in this report. We incorporated the results of the Figliozzi, McCann, DCAA, and Reznick ICP audits into our computations of the audited indirect cost rates, and ultimately the pension costs claimed, for the contracts subject to the FAR. CMS will use our report on allowable pension costs, as well as the Figliozzi, McCann, DCAA, and Reznick ICP audit reports, to determine the final indirect cost rates and the total allowable contract costs for CDS for CYs 2012 through 2016. The cognizant Contracting Officer will perform a final settlement with the contractor to determine the final indirect cost rates. These rates ultimately determine the final costs of each contract.