Federal Reports

Sound financial management practices at VA facilities are critical to ensure funds are used appropriately, effectively, and efficiently. For that reason, the VA Office of Inspector General (OIG) conducted a review to examine whether VA’s Maryland Health Care System appropriately managed purchases and payments for medical equipment and supplies. Fiscal oversight of purchase cards and internal controls governing the use of overtime were also reviewed.The OIG found ineffective processes, internal control weaknesses, and inadequate oversight in five areas:1. The healthcare system and the Enterprise Equipment Request (EER) portal need improved controls for approving equipment purchases.2. Healthcare system staff and the prime vendor should prepare timely and accurate planning information to ensure adequate supplies are on hand to fill orders.3. Even though no inaccurate inventory payments were identified, VA’s inventory system needs controls to ensure correct recording of supply units and costs.4. The healthcare system purchase card program requires closer monitoring to ensure purchases are authorized and supported by documentation.5. The healthcare system should strengthen its overtime payment controls to ensure supervisors verify overtime hours were completed before approving timecards for payment.VA concurred with all eight OIG recommendations. The OIG team also identified more than $5 million in questioned costs related to identified issues such as undocumented or unapproved purchases.

Veterans may apply for an annual clothing allowance benefit if they have a service-connected disability and use a prosthetic or orthopedic appliance or use a prescription skin medication that damages clothing. For fiscal year 2019, about 92,000 veterans received about $98 million in payments. The VA Office of Inspector General (OIG) determined whether entitled veterans received their annual clothing allowance benefit.The Veterans Benefits Administration (VBA) jointly administers the benefit with the Veterans Health Administration (VHA). VHA is responsible for administering and awarding benefits. VBA’s role is to inform veterans of potential entitlement, budget for the benefit, and provide data management and information technology support.VA generally ensured entitled veterans received their annual clothing allowance benefit. However, the OIG found that the VHA handbook needs detailed guidance on administering the benefit, including the roles, responsibilities, and functions of all staff involved.The OIG also found that some veterans may no longer meet entitlement requirements. Although most veterans are required to apply each year for benefits, those given “recurring status” are automatically renewed. To prevent overpayment errors, recurring status was eliminated in August 2012. If those cases were reevaluated, an estimated 31,200 veterans may not qualify based on changes in device design or technology. Reevaluation could save about $129.7 million over the next five years.The OIG recommended the under secretary for health revise the VHA clothing allowance handbook to include detailed procedures for determining and monitoring benefit entitlement. The OIG also recommended the under secretary, in collaboration with VBA, reevaluate veterans’ entitlement to recurring clothing allowance benefits.

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 VA Northern Indiana Health Care System, which includes a campus in Fort Wayne and Marion, and multiple outpatient clinics in Indiana. 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.The leaders had worked together for nine months at the time of the OIG’s virtual review. Employee survey data indicated that leaders had created a positive workplace environment where employees felt safe bringing forth issues and concerns. Patient experience surveys highlighted opportunities to improve satisfaction in the inpatient and outpatient settings. The OIG’s review of the system’s accreditation findings, sentinel events, and disclosures did not identify any substantial organizational risk factors. However, the healthcare system had disclosed 114 adverse events to patients and their families. Leaders were generally knowledgeable about selected data used in Strategic Analytics for Improvement and Learning models and should continue to sustain and improve performance.The OIG issued 20 recommendations for improvement in five areas:(1) Medical Staff Privileging• Ongoing professional practice evaluations• Provider exit review forms• State licensing board reporting(2) Medication Management• Aberrant behavior risk assessments• Urine drug testing• Informed consent(3) Mental Health• Follow-up visits• Suicide prevention safety plans• Suicide prevention training(4) Women’s Health• Gynecological care coverage• Women veterans health committee attendance(5) High-Risk Processes• Annual risk analysis• Daily cleaning schedule• Staff training and continuing education• Competency assessments

The Office of the Inspector General conducted a review of the Commercial Energy Solutions Fuels and Hedging (F&H) organization to identify factors that could impact F&H’s organizational effectiveness. During the course of our evaluation, we identified behaviors that had a positive impact on F&H. These included relationships with team members and most management. However, we also identified a behavioral risk related to relationships with a manager in one group. In addition, we identified risks to operations that could hinder F&H’s effectiveness. These risks were related to inaccurate coal burn forecasts and interactions with business partners.

We audited costs claimed by the Utah Department of Natural Resources, Division of Wildlife Resources (Division) under grants awarded by the U.S. Fish and Wildlife Service (FWS) through the Wildlife and Sport Fish Restoration Program. We conducted this audit to determine whether the Division used grant funds and State hunting and fishing license revenue for allowable fish and wildlife activities and complied with applicable laws and regulations, FWS guidelines, and grant agreements. The audit period included claims totaling $66.1 million on 76 grants that were open during the State fiscal years that ended June 30, 2018, and June 30, 2019.We found that the State generally ensured that grant funds and hunting and fishing license revenue were used for allowable fish and wildlife activities and complied with applicable laws and regulations, FWS guidelines, and grant agreements. We noted, however, issues with subawards. We found control deficiencies with the Division’s subrecipient determination, subaward reporting, and subaward agreement elements.The FWS concurred with the six recommendations and will work with the Division to implement corrective actions.