Federal Reports

Our objective was to evaluate service performance for First‑Class Single Piece (FCSP) letter mail nationally and in 17 selected districts. This report responds to a congressional request regarding concerns of low service performance in these districts in the last month leading up to the November 2020 general election. The OIG addressed issues on election mail service performance in a prior report. This audit focuses on overall service performance for FCSP letter mail in fiscal year (FY) 2020 through March 31, 2021.

Without internal controls to track ETF program performance, the EPA risks underreporting environmental and human health outcomes.

Joseph Kieffer, a marketer from Los Angeles, was sentenced on September 8, 2021, in U.S. District Court, Central District of California, to six months in prison, three years’ probation, a $10,000 fine, and he was ordered to pay restitution in the amount of $1,250,000 and a money judgment of forfeiture of $328,835. Kieffer previously pleaded guilty to paying kickbacks to marketers and some patients to obtain medically unnecessary compounded drugs, which allowed Fusion RX Compounding Pharmacy to bill health care providers for those drugs. Many of the prescription claims were reimbursed at rates much higher than average medications. The owner of Fusion Rx Compounding Pharmacy was also charged for his role in the scheme. Amtrak’s health insurance plan was fraudulently billed $17,000 as a result. Criminal judicial proceedings for other defendants are pending.

Since 1991, veterans who served in the Republic of Vietnam are presumed to have been exposed to herbicides such as Agent Orange. The Blue Water Navy Vietnam Veterans Act of 2019 extended this presumption to include veterans who served within 12 nautical miles of Vietnam. The objective of this OIG review was to determine whether Veterans Benefit Administration (VBA) employees (1) notified Navy veterans of their potential eligibility to receive medical benefits under the act; (2) correctly determined the eligibility of the veterans who filed claims for benefits; and (3) made accurate decisions on claims. The OIG found that VBA met the outreach requirements outlined in the act. VBA employees also generally determined Blue Water Navy veterans’ eligibility for benefits correctly. However, VBA has not established procedures for its employees to follow when the computer search tool they use to determine ship locations during claimant service dates returns unlikely results (for example, providing an inland location in a search for an aircraft carrier). In addition, VBA employees inaccurately decided approximately 46 percent of veterans’ claims (2,100 of 4,600) from April through June 2020, which led to about $37.2 million in improper payments to veterans ($25.2 million in overpayments and $12 million in underpayments) during that period. About 95 percent of these errors resulted from VBA employees deviating from policies governing disability-rating decisions. The OIG made three recommendations to the under secretary for benefits: (1) establish procedures to follow when the ship locator tool provides unlikely results based on deck log coordinates, (2) ensure VBA employees understand how to accurately decide and evaluate herbicide-related medical conditions, and (3) begin periodic local reviews of rating decisions involving such medical conditions to mitigate error trends identified.

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 Eastern Oklahoma VA Health Care System. The inspection covered key clinical and administrative processes that are associated with promoting quality care. It focused on Leadership and Organizational Risks; COVID-19 Pandemic Readiness and Response; Quality, Safety, and Value; Registered Nurse Credentialing; Medication Management: Remdesivir Use in VHA; 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 virtual review, all leadership positions were permanently filled. Survey data revealed opportunities to improve employee perceptions of leadership, reduce feelings of moral distress at work, and reduce fears of retaliation. Patient experience survey data highlighted a need to address outpatient care experiences. The OIG identified concerns with institutional disclosures for sentinel events. Leaders were generally knowledgeable within their scope of responsibilities 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 9 recommendations for improvement in 4 areas:(1) Leadership and Organizational Risks• Institutional disclosures for sentinel events(2) Quality, Safety, and Value• Designated systems redesign and improvement coordinator• Surgical work group attendance(3) Care Coordination• Inter-facility transfer form completion• Active medication list transmission(4) High-Risk Processes• Disruptive behavior committee meeting attendance• Patient notification of behavioral restriction order• Staff training