Federal Reports

Hospitals that cannot control the spread of emerging infectious diseases within their facilities risk spreading a disease such as COVID-19 to patients and staff. OIG therefore developed a plan to assess the Centers for Medicare & Medicaid Services’ (CMS’s) controls related to hospital preparedness for emerging infectious diseases.The objective of this audit was to determine whether CMS designed and implemented effective internal controls related to hospital preparedness for emerging infectious diseases such as COVID-19.

In prior audits of school-based administrative and health services costs that States allocated to Medicaid using random moment sampling (RMS), we identified significant overpayments. After conducting a risk assessment ofKentucky’s Medicaid AdministrativeClaiming program, we determined that Kentucky claimed significant Medicaid school-based administrative costs based on its RMS. We conducted this audit because of the significant amount claimed and our prior findings related to costs that States allocated to Medicaid using RMS.Our objective was to determine whether Kentucky claimed school-based Medicaid administrative costs in accordance with Federal requirements.

This report contains information about recommendations from the OIG's audits, evaluations, reviews, and other reports that the OIG had not closed as of the specified date because it had not determined that the Department of Justice had fully implemented them. The list omits information that the Department of Justice determined to be limited official use or classified, and therefore unsuitable for public release.The status of each recommendation was accurate as of the specified date and is subject to change. Specifically, a recommendation identified as not closed as of the specified date may subsequently have been closed.

The VA Office of Inspector General (OIG) conducted a review of 58 Veterans Health Administration (VHA) outpatient clinics’ emergency preparedness for the delivery of telemental health care as of November 1, 2019. The review focused on clinic-specific emergency procedures, emergency procedure roles and responsibilities, emergency contact information of staff, and patient safety reporting methods. The review excluded telemental health care provided to patients in their homes, which was a preferred setting for pandemic telemental health care, and non-VA clinic settings.OIG staff interviewed VHA leaders from the Office of Connected Care and the Office of Mental Health and Suicide Prevention, as well as facility telehealth coordinators and mental health service chiefs or representatives from 58 patient-clinic locations. OIG distributed questionnaires to 333 telepresenters and remote providers to evaluate knowledge of the patient-clinic locations’ emergency preparedness of those 187 staff-completed questionnaires.The OIG identified the following findings that could lead to delays in patient intervention and missed opportunities for patient safety:1. Missing telehealth emergency plans and procedures2. Emergency procedures not specific to telehealth care or the patient-clinic location3. Lack of a process for annual updates to telehealth emergency procedures4. Undefined emergency procedure roles and responsibilities for telehealth staff5. Missing or insufficient emergency contact information6. Lack of a process to verify and communicate emergency contact information7. Lack of a consistent process to designate the telehealth setting in patient safety reporting methodsThe OIG made five recommendations to VHA.

Through the Veterans Cemetery Grants Program, the National Cemetery Administration (NCA) offers grants to states, US territories, and tribes to help provide final resting places for eligible veterans and family members where VA’s national cemeteries cannot meet burial needs. Grants may be used to establish, expand, or improve veterans cemeteries.The VA Office of Inspector General (OIG) audited the program to assess NCA’s governance and oversight. The audit team also assessed whether critical noncompliance issues at two cemeteries in Hawaii were addressed.The OIG found grants program staff did not rank and award some cemetery grants as regulations required. After grants were awarded, program staff generally ensured cemeteries used grants for their intended purpose. However, NCA did not ensure cemeteries with grants met all national shrine standards for installation of permanent markers, maintenance, and safety. The audit team observed noncompliance issues at eight state cemeteries, including critical issues at the Hilo and Makawao cemeteries in Hawaii. As a result, NCA lacks assurance that veterans and family members buried in state veterans cemeteries have been appropriately honored with timely and accurate grave markings, burial locations, and maintenance.The OIG made 11 recommendations to the under secretary for memorial affairs to ensure state cemetery grants are prioritized and awarded in accordance with federal regulations. The OIG also recommended NCA continue to seek an increase in cemetery grant funding.NCA should also evaluate current headstone and niche cover contracts for timeliness and quality issues, require cemeteries to submit annual performance assessments, and provide remote training options for cemetery employees. The OIG also recommended NCA work with Hawaii’s government to correct longstanding problems at its eight state veterans cemeteries.

In 2019, Congress enacted the Payment Integrity Information Act (PIIA) to update required reporting on agencies’ improper payments. PIIA requires agencies to review and identify programs and activities that may be susceptible to significant improper payments, to estimate the rate and amount of improper payments in agency programs, and to report on their actions to reduce and recover those payments. The Inspector General of each agency assesses compliance with these requirements annually.Despite continuing work to improve its compliance with PIIA and preceding improper payment legislation, AmeriCorps remains non-compliant and did not meet four of the six PIIA requirements. Specifically, three of the four programs reported that more than ten percent of their payments were improper. AmeriCorps did not appropriately establish its published reduction targets, nor did it publish a complete and appropriate corrective action plan to reduce improper payments. Furthermore, AmeriCorps did not estimate reliably the amount and the rate of improper payments made in the AmeriCorps State and National Program, Foster Grandparent Program (FGP), Senior Companion Program (SCP), and Retired and Senior Volunteer Program (RSVP), due to AmeriCorps’ sampling methodology and statistical projections.AmeriCorps attributes the decreases in the improper payments rates to the implementation of an approved third-party vendor solution that grantees may use to perform required criminal history checks, previously the primary root cause of AmeriCorps’ improper payments. Although this corrective action reduced the improper payment rates in FY 2020, AmeriCorps continued to report improper payment rates equal to or above the ten percent threshold for the FGP, SCP, and RSVP programs.AmeriCorps agreed to implement our recommendations to update its improper payment standard operating procedures, strengthen supervision and oversight of the sample selection, testing, and statistical projection procedures, and develop and implement actions to reduce the improper payment rates below ten percent for FY 2021. AmeriCorps Management’s Response can be found in Appendix C of the report.

The purpose of this flash report is to apprise the U.S. Department of Education (Department) of the risk that the Puerto Rico Department of Education (Puerto Rico DOE) used Department program funds for payroll costs related to inactive employees1 from 2007 to 2020.We found that the Puerto Rico DOE may have charged up to $1.3 million in unallowable payroll costs to the Emergency Impact Aid program.