Federal Reports

The objective of our ongoing inspection is to evaluate FNS’ oversight of TEFAP—this report provides interim results on whether FNS identified risks related to the safeand efficient distribution of USDA-food assistance to States during the COVID-19pandemic.

Since our FY 2020 evaluation, the Office of Intelligence and Analysis (I&A) has continued to provide effective oversight of the department-wide intelligence system and has implemented programs to monitor ongoing security practices. We determined that DHS' information security program for Top Secret/Sensitive Compartmented Information intelligence systems is effective this year as the Department achieved “Level 4 – Managed and Measurable” in three of five cybersecurity functions, based on current reporting instructions for intelligence systems. However, we identified deficiencies in DHS’ protect and recover functions. We made three recommendations to I&A to address the deficiencies identified, and I&A concurred with all three recommendations.

We identified deficiencies in E-Verify’s processes for confirming identity during employment verification. E-Verify’s photo matching process is not fully automated, but rather, relies on employers to confirm individuals’ identities by manually reviewing photos. We attribute these deficiencies to USCIS not developing or evaluating the plans and internal controls needed to improve its processes and detect, track, and investigate system errors. Until USCIS addresses E-Verify’s deficiencies, it cannot ensure the system provides accurate employment eligibility results. We made 10 recommendations to improve E-Verify’s accuracy, internal controls, and workload capabilities. USCIS concurred with all 10 recommendations.

The VA Office of Inspector General (OIG) conducted a healthcare inspection at the request of Chairman Mark Takano, and Representatives Julia Brownley, Chris Pappas, and Mike Levin, members of the House Committee on Veterans’ Affairs, to evaluate allegations related to a lack of care coordination for patients receiving ketamine for treatment-resistant depression (depression that has failed to respond after multiple treatments) in the community after authorizations for the care lapsed in September 2019 at the VA San Diego Healthcare System (facility) in California.The OIG substantiated that the facility ended authorizations for community care for patients receiving ketamine, a medication used for treatment-resistant depression, in October 2019 and again in March 2020. The discontinuation negatively affected 35 patients during the two time frames. While distress related to uncertainties about continuing ketamine treatment were identified as a contributory stressor, the OIG did not substantiate that discontinuation of community care resulted in a patient’s death by suicide as the community provider continued to offer ketamine treatment to that patient. The OIG also identified deficiencies in facility processes.The OIG concluded that risks for negative patient outcomes increased due to• communication and care coordination deficits,• terminating community care authorizations,• accelerating timelines for care transition,• uncertainties from changing treatment for complex patientsThe OIG made two recommendations to the Under Secretary for Health regarding community care providers’ review of VA’s protocol for ordering ketamine and research related to the use of ketamine for treatment-resistant depression. Four recommendations were made to the Facility Director related to community care processes for coordination of non-VA care and ensuring coordinated, clinically informed plans for transitioning remaining patients to care at the facility.

The VA Office of Inspector General (OIG) conducted an inspection at the Fayetteville VA Medical Center in North Carolina to determine the validity of allegations that facility staff failed to coordinate appropriate care for a patient seeking community living center (CLC) placement and respite care, and did not provide medications for the patient while at a community assisted living center.The OIG did not substantiate that the facility failed to coordinate placement for a patient seeking CLC care. The facility evaluated the submitted consults in a manner consistent with policy, and disapproved CLC placement when the patient’s functional status did not warrant placement. In the fall of 2020, the patient was approved for community nursing home placement.However, the facility failed to coordinate respite services for the patient. Community health staff did not properly determine the patient’s eligibility, and an interdisciplinary assessment was not completed to determine the patient’s eligibility as required.The OIG did not substantiate that the facility failed to provide medications for the patient while at a community assisted living center; however, when the patient needed to be seen by a community optometrist to obtain glaucoma medications, a community care optometry consult was not initiated.The OIG also identified that the psychiatrist used the involuntary commitment process in a manner that was inconsistent with the state’s established parameters, and failed to adequately assess and document the patient’s capacity to make informed decisions and determine whether the patient had a healthcare agent. In addition, the patient’s primary care providers and psychiatrist missed an opportunity to coordinate specialty care needs for the patient.The OIG made seven recommendations related to the evaluation, assessment of, and staff training for respite services; the psychiatrist’s use of involuntary commitment; patient decision-making capacity; identification of healthcare agents; and initiation of specialty care consults.