Federal Reports

Staff at VA medical facilities work with contractors in the Contracted Residential Services (CRS) program to provide temporary housing and services to veterans experiencing homelessness. The OIG examined whether the Veterans Health Administration (VHA) effectively monitored veterans and administered CRS contracts to ensure veterans received needed services, contractors met the terms and conditions of their contracts, and funds were used appropriately.The OIG found facility staff did not consistently document case management and monitor the progress of veterans in the program. Case management involves evaluating veterans’ needs, planning and assessing their treatment, and advocating for treatment plan changes. Documenting this process helps facilities provide veterans with high quality care and establishes a record for continuity of that care.Further, four of the 14 CRS contracts reviewed had performance deficiencies, with one resulting in improper payments of $592,000. These deficiencies may affect the health and safety of veterans living in transitional settings. Moreover, VA lacks assurance that veterans received required services.There were also contract administration problems in 13 of 14 reviewed contracts. Contracting officers did not always properly delegate responsibilities to staff functioning as contracting officer’s representatives. Further, one facility’s representative did not ensure contractors provided meals or the means to purchase them, as required, and another lacked invoice supporting documentation for approval.The audit team estimated that 107 of 119 contracts had monitoring and administration deficiencies. Furthermore, the team estimated that VHA made $35.3 million in improper payments, of which approximately $21.6 million was technically improper because the individuals authorizing payment were not delegated authority to serve as contracting officer’s representatives.The OIG made five recommendations to VHA to address the issues identified such as establishing monitoring controls for CRS staff, contracting officers, and their representatives; updating the program handbook; and including quality assurance plans for contracts.

Our objective was to evaluate select mail delivery and customer service operations and determine whether internal controls were effective at the Newark Post Office.

What We Looked AtAfter Hurricane Sandy caused widespread damage to transportation infrastructure in October 2012, the Disaster Relief Appropriations Act (DRAA) designated $10.9 billion for the Federal Transit Administration's (FTA) new Public Transportation Emergency Relief Program. We assessed (1) FTA's progress in allocating, obligating, and disbursing its Hurricane Sandy funding and (2) any weaknesses in these processes that we identified.What We FoundThrough December 31, 2020, FTA allocated and obligated approximately $10 billion--most of its Hurricane Sandy appropriation--but only disbursed about $4.3 billion. The pace was influenced by a number of factors, including but not limited to project construction planning and execution and the complexity of competitive resilience projects. As a result, over 8 years after the storm, more than half of the funds remain to be spent. We also found that FTA inconsistently tracks and reports Hurricane Sandy funding data or does not fully comply with Federal guidance. The Agency has allocation data in a variety of sources, but--as FTA does not have procedures to accurately communicate allocated amounts over time--the data from these sources do not align. Thus, FTA cannot use these data to determine whether obligation amounts for specific recipients and purposes stayed within the allocated amounts in FTA's official documentation. Finally, FTA has not complied with a directive from the Office of Management and Budget to make DRAA obligation data readily identifiable on the USAspending.gov website. Overall, the weaknesses we identified reduced transparency for internal users, decision makers, and the public into FTA's use of Hurricane Sandy funds.Our RecommendationsWe made two recommendations to improve FTA's tracking and reporting on its use of Hurricane Sandy funds. FTA concurred with both recommendations and proposed appropriate actions and completion dates. Accordingly, we consider both recommendations as resolved but open pending completion of the planned actions.

The OIG conducted this healthcare inspection after receiving information from the facility that an audiologist had provided poor care and billed for unrendered services. The inspection focused on actions the Audiology Supervisor, Service Chief, and Chief of Staff (audiology leaders) took in response to the audiologist’s poor clinical care. A facility fact-finding review revealed the audiologist provided poor care to eight of 43 patients reviewed, including misinforming patients who needed hearing aids that hearing aids were not needed.Although the audiology leaders reported the fact-finding results to the OIG, they failed to evaluate whether patients needed clinical follow-up; determine whether additional patients were affected by the audiologist’s poor care; evaluate whether clinical disclosures were required for the affected patients; and communicate the fact-finding results to the Facility Director, who was therefore unable to initiate the process to determine the necessity of a large scale disclosure.The instances of poor care were also not reported to the Patient Safety Manager who was, as a result, unable to assess the adverse events to determine if patient safety interventions were indicated.The OIG also found that performance monitoring of facility audiologists was not conducted as required. Annual competency assessments and annual performance appraisals were not consistently completed and did not contain adequate performance standards.Audiology leaders failed to consider whether the audiologist’s actions warranted a report to the state licensing board due to a lack of understanding of the requirements for reporting and, therefore, the Facility Director was not informed of the need to initiate a state licensing board review.The OIG made 10 recommendations to the Facility Director related to ensuring patients affected by poor audiology care receive follow-up and disclosures as appropriate, overseeing audiologists, and ensuring audiology leaders’ compliance with policies regarding disclosure, adverse event reporting, and state licensing board reporting.

The purpose of the VA Fiduciary Program is to protect beneficiaries who are unable to manage their VA benefits as a result of injury, disease, advanced age, or because they are under age 18. The Veterans Benefits Administration’s (VBA) Pension and Fiduciary Service administers the program through six fiduciary offices called “hubs.” The OIG examined whether program staff properly addressed allegations of benefit payments being misused and then reimbursed beneficiaries as required.Program staff initiated inquiries into approximately 12,000 allegations of misuse from January 1, 2018, through September 30, 2019. The OIG team assessed staff actions for 40 misuse determinations and did not find systemic issues. However, the team found instances of significant wait times for program staff to determine misuse and negligence and to reimburse misused funds. For example, one beneficiary waited 19 months after an initial determination of misuse before staff completed a negligence determination.VA then reimbursed the beneficiary over $20,000 in misused funds. Another beneficiary waited 14 months after the misuse determination before staff reimbursed approximately $5,800. VBA should consider whether the average number of days taken to complete each type of misuse action is acceptable to meet oversight responsibilities and fulfill the stated mission of protecting vulnerable veterans and other beneficiaries.The team also found that VBA did not adequately monitor all follow-up actions on reported misuse. VBA was unaware of unprocessed negligence determinations from 2016 and 2017 that the team identified. Additionally, the team examined the workload management plans and systematic analysis of operations for the two fiduciary hubs visited, but none of the documents discussed or identified pending reimbursements.The OIG made two recommendations to VBA to ensure prompt completion of determinations and reimbursements after December 31, 2017.