Federal Reports

The Veteran-Directed Care (VDC) program provides veterans with a budget to hire caregivers and purchase the goods and services that will best meet their needs and allow them to remain in their homes longer. The Veterans Health Administration (VHA) administers the program to maximize veterans’ functional independence and prevent or lessen the burden of disability on older, frail, and chronically ill patients, as well as their families and caregivers.Since fiscal year (FY) 2017, the VDC program has grown significantly. The number of veterans in the program has more than doubled to 4,400 in FY 2020. During this time, VDC program expenditures have increased by about 97 percent. The VA Office of Inspector General (OIG) audited the program to determine if VHA budgets and manages resources to ensure veterans in the program receive authorized goods and services to help them remain in their homes.The OIG found that VHA provided VDC services to veterans that addressed their care needs. However, due to weaknesses in program management, VHA lacks assurance that veterans are safe, provider agencies are paid correctly, and taxpayer dollars are properly spent. The OIG also identified opportunities for VHA to improve VDC policies and funding to ensure medical facilities can effectively implement and manage the program to help veterans stay in their homes.The OIG recommended the under secretary for health ensure program coordinators document their quarterly monitoring of the services veterans receive, improve the provider agency billing and payment process, and establish guidance to ensure veterans do not receive the same personal care services through the VDC program and the Family Caregiver Program. The OIG also recommended establishing procedures to assist in identifying staffing needs and tracking demand for program services.

The PRAC’s objective was to review pandemic-related federal contracts and identify first-time contractors and contracts awarded without competitive bidding. We found that first-time federal contractors received $4.4 billion worth of pandemic contracts in Fiscal Year 2020 and that $128 million was deobligated from contracts with first-time federal contractors during the same period. Additionally, we identified the four most common flexibilities identified to justify limited competition were urgency, only one source, simplified acquisition procedures, and authorized by statute. Of these, we found that 11% of non-competitive contracts used the “only one responsible source” authority, which is defined to be used when supplies and services are available from only one source in certain conditions. A limited sample revealed that 10 of 14 contracts either shouldn’t have selected that authority or had data entry errors within the Federal Procurement Data System.

This compendium analyzes currently open and unresolved recommendations. From March 2017 through March 2021, the EPA OIG issued nine semiannual reports to Congress that identified an average of 99 open recommendations and 18 unresolved recommendations issued by the OIG to the EPA. The total potential monetary benefit was, on average, $167 million for the open recommendations and $7.5 million for the unresolved recommendations.

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 Mann-Grandstaff VA Medical Center and multiple clinics in Idaho, Montana, and Washington. The inspection covers key clinical and administrative processes that are associated with promoting quality care. This inspection focused on Leadership and Organizational Risks; COVID-19 Pandemic Readiness and Response; Quality, Safety, and Value; Medical Staff Privileging; Medication Management: Long-Term Opioid Therapy for Pain; Mental Health: Suicide Prevention Program; Care Coordination: Life-Sustaining Treatment Decisions; Women’s Health: Comprehensive Care; and High-Risk Processes: Reusable Medical Equipment.At the time of the OIG site visit, the leadership team had worked together for about one month and had vacancies in two of four positions. Employee satisfaction survey results for the medical center and leaders were similar to or higher than Veterans Health Administration averages. Patients generally appeared satisfied with the care provided, but indicated opportunities to improve appointment scheduling for female veterans. The OIG’s review of accreditation findings, sentinel events, and disclosures did not identify any substantial organizational risk factors, but the OIG noted potential risks with the medical center’s expected electronic health record system implementation. Leaders were knowledgeable about selected data used in Strategic Analytics for Improvement and Learning models and should continue to take actions to sustain and improve performance.The OIG issued 13 recommendations for improvement in five areas:(1) Quality, Safety, and Value• Protected peer reviews• Root cause analyses(2) Medical Staff Privileging• Focused professional practice evaluations(3) Mental Health• Patient follow-up• Suicide prevention safety plans• Community outreach activities• Suicide risk training(4) Women’s Health• Gynecologic care coverage• Women veterans health committee• Quality assurance data collection and tracking• Women veterans program manager duties(5) High-Risk Processes• Annual risk analysis• Competency assessments

This Office of Inspector General (OIG) Comprehensive Healthcare Inspection Program report provides a focused evaluation of the leadership performance and oversight by Veterans Integrated Service Network (VISN) 20: VA Northwest Health Network in Vancouver, Washington, covering leadership and organizational risks and key processes associated with promoting quality care. This inspection focused on Quality, Safety, and Value; Medical Staff Credentialing; Environment of Care; Medication Management: Long-Term Opioid Therapy for Pain; Women’s Health: Comprehensive Care; and High-Risk Processes: Reusable Medical Equipment. The OIG conducted this unannounced review during concurrent virtual site visits of VISN 20 facilities.The executive leaders had worked together for approximately one month at the time of the OIG virtual review. The VISN office and leaders’ selected employee satisfaction survey averages were generally better than VHA averages, with the exception of the Deputy Network Director and Chief Medical Officer’s scores. Overall, VISN leaders appeared to maintain an environment where employees felt safe bringing forth issues and concerns. Patient experience survey scores were similar to or better than VHA averages. Leaders were knowledgeable within their scope of responsibilities about selected data used in Strategic Analytics for Improvement and Learning models and should continue to sustain and improve performance.The OIG issued four recommendations for improvement in two areas:(1) Medical Staff Credentialing• Credentials file review and approval for physicians with potentially disqualifying licensure actions(2) High-Risk Processes• Sharing of VISN-led facility reusable medical equipment inspection results with executive leaders• Posting of inspection results to the reusable medical equipment SharePoint site• Oversight of facility corrective action plan development and action item tracking

Over the past 20 years, digital diversion of communication, growth in ecommerce, changing customer needs and expectations, and new sources of competition have transformed the mail and parcel industry. In this white paper, the OIG researched public and private organizations with similarities to the Postal Service that managed to adapt and succeed in other disrupted markets. We highlighted specific insights from these case studies that can be informative for the Postal Service as it sets its strategies for the future.

We conducted a performance audit of two National Endowment for the Arts (Arts Endowment) Partnership awards issued to the Washington State Arts Commission (ArtsWA). Based on our review, we determined ArtsWA generally met the financial and compliance requirements in the award documents. However, we identified some areas requiring improvement. For instance, we found that ArtsWA: included $31,000 in unallowable cost share on its Federal Financial Reports (FFRs); included $19,458 in unallowable entertainment costs on its FFRs; did not notify all subrecipients of Federal subaward management requirements; and did not verify potential vendors were eligible to receive Federal funds. We believe the evidence obtained during the audit provides a reasonable basis for our findings and conclusions based on our audit objectives. We are questioning $50,458 ($31,000 plus $19,458) in unallowable costs. We also made six recommendations to address the audit findings -- four to ArtsWA and two to the Arts Endowment.