Federal Reports

Due to concerns identified during Evaluation 2020-15743, Sequoyah Nuclear Plant Radiation Protection’s Organizational Effectiveness (report issued December 10, 2020), we performed an evaluation of TVA Nuclear’s handling of potentially contaminated liquids at its nuclear sites. The scope of our evaluation was limited to TVA Nuclear’s process for releasing liquids from Radiologically Controlled Areas (RCA) for unrestricted use. We determined potentially contaminated liquids were released from RCAs at each nuclear site. This occurred because all applicable analyses were not performed on some liquids prior to release. In addition, we identified opportunities for improvement related to (1) TVA Nuclear’s processes for tritium analysis prior to the release of liquids for unrestricted use and (2) documentation issues at each nuclear site, including the incomplete submittal of records, incomplete maintenance processes, and inaccurate logs.

The objective was to determine whether the Social Security Administration (1) transferred overpayments from terminated Supplemental Security Income records to current records for recovery and (2) took corrective action to recover the Supplemental Security Income overpayments we identified in our 2009 audit.

Semiannual Report to Congress

The OIG assessed allegations that a patient’s care was delayed and mismanaged in the facility’s Emergency Department resulting in the patient’s death, and facility leaders ignored complaints of inadequate Emergency Department nurse staffing levels. Initially, the OIG had concerns regarding the impact of the pandemic on the scheduling and quality of the patient’s hemicolectomy surgery completed 15 days prior to the patient’s death; however, no deficiencies were identified.Between postoperative days 10 and 15, facility surgical staff instructed the patient several times, via phone, to seek urgent medical attention to address not eating, abdominal distension, and vomiting. The patient presented to non-VA hospitals twice and to the facility’s Emergency Department on the third occasion, where the patient was triaged as an Emergency Severity Index (ESI) 3, evaluated by a nurse practitioner, and returned to the waiting room. A short time later, the patient, yelled “I cannot breathe,” fell out of a chair, became unresponsive, and died later that day.The OIG substantiated that the patient’s Emergency Department care was deficient and mismanaged, which may have resulted in a delay in care. The OIG found the clinicians who triaged the patient failed to consider all reasonable causes of the patient’s shortness of breath, communicate with the patient’s surgeon, and assign an ESI 2.The facility did not have a policy that prohibited ESI 2 patients from remaining in the waiting room, which conflicted with guidance from the Emergency Nurses Association.The OIG did not substantiate inadequate levels of nursing staff in the Emergency Department during the week of the patient’s death or that facility leaders received complaints.The OIG made two recommendations to the Facility Director related to ESI 2 patients not remaining in the waiting room and review of identified concerns related to the patient’s pre-code Emergency Department care.

Medicare administrative contractors nationwide paid approximately $885 million for selected polysomnography (a type of sleep study) services provided to Medicare beneficiaries during January 1, 2017, through December 31, 2018 (audit period). Previous OIG audits of polysomnography services found that Medicare paid for some services that did not meet Medicare requirements. These audits identified payments for services with inappropriate diagnosis codes, without the required supporting documentation, and to providers that exhibited questionable billing patterns. After analyzing Medicare claim data, we selected for audit University of Michigan Health System (University of Michigan), a hospital provider located in Ann Arbor, Michigan.Our objective was to determine whether Medicare claims that University of Michigan submitted for polysomnography services complied with Medicare requirements.

Joshua Pearson, a marketer from St. George, Utah, was sentenced on June 3, 2021, in U.S. District Court, Central District of California, to three years probation, six months home confinement, and was ordered to forfeit $1,250,000. Pearson previously pleaded guilty to receipt of illegal kickbacks related to a health care fraud scheme after our joint investigation found that he received kickbacks from Sheridan Medical for patient referrals for compounded drugs—drugs that were medically unnecessary. A marketer from Sheridan Medical and the owner of Fusion Rx Compounding Pharmacy, both in Los Angeles, were also charged for their role in the scheme. Amtrak’s health insurance plan was fraudulently billed $17,000 as a result of the scheme. Criminal judicial proceedings for the other defendants are pending.