Federal Reports

Previous Office of Inspector General (OIG) audits found that State Medicaid agencies had improperly paid capitation payments on behalf of beneficiaries with concurrent eligibility in another State. We conducted a similar audit of Minnesota’s Medicaid program.Our audit covered 7,706 August 2018 capitation payments, totaling $4.0 million, made on behalf of beneficiaries with concurrent eligibility in another State during our audit period, July 1 through September 30, 2018. We selected the middle month of our audit period to ensure that beneficiaries were eligible in the months before and after the August 2018 capitation payments. We selected a stratified random sample of 106 capitation payments, totaling $45,919 ($29,458 Federal share), and determined whether the beneficiaries were residing and receiving Medicaid benefits in Minnesota during the audit period.

The VA Office of Inspector General (OIG) conducted a healthcare inspection to assess responses by facility leaders to a Sterile Processing Services (SPS) employee’s failure to follow endoscope reprocessing procedures. During the review, the OIG also identified concerns related to actions taken by Veteran Health Administration (VHA) leaders.The OIG received three similar complaints alleging that a facility SPS employee (employee) improperly reprocessed endoscopes, placing patients at risk. The OIG requested facility leaders respond to the allegations and provide information regarding SPS procedures, staff compliance, corrective actions, and reports of patient harm.The facility response revealed that after becoming aware of the allegations, the Chief and Assistant Chief of SPS conducted an audit of endoscope reprocessing supplies and found discrepancies with the supply use documented by the employee. Further, facility and Veterans Integrated Service Network (VISN) investigations substantiated that the employee did not follow facility reprocessing procedures and falsely documented compliance.The OIG determined that the Facility Director did not develop and implement an adequate plan to monitor the employee’s compliance with SPS procedures following reinstatement to SPS duty, particularly given concerns regarding the employee’s integrity and compliance.Because multiple patients were potentially affected, facility and VISN leaders notified the VHA Clinical Episode Review Team (CERT) for review and disposition. The CERT concluded there was minimal risk to patients and that a large-scale disclosure was not warranted; however, the OIG found that the CERT’s determination may have been based on an inaccurate understanding of the reprocessing equipment’s capabilities.The OIG made one recommendation to the Facility Director regarding oversight of the employee’s performance.The OIG made one recommendation to the Under Secretary for Health regarding the CERT’s review of OIG-provided information to determine if it altered the determination of patient risk or the need for a large-scale disclosure.

The VA Office of Inspector General (OIG) conducted a review to assess aspects of the care provided to a patient who was struck and killed by a motor vehicle following elopement from a community living center (CLC).The patient suffered from paranoid schizophrenia and was involuntarily civilly committed to the CLC. The OIG had concerns regarding the appropriateness of CLC admission and elopement prevention.The OIG determined that the patient’s admission to the CLC was inappropriate as indicated by the CLC’s own screening process. The OIG determined that interventions implemented by staff were inadequate to mitigate the patient’s risk for elopement. The patient eloped multiple times and facility staff failed to provide individualized, progressive, mental health-driven interventions to prevent the patient from eloping. The OIG also found that facility staff assigned to care for the patient were inadequately trained in mental health care, and patient safety reports were not completed as required.On the day of the patient’s death, the OIG found that facility staff did not follow missing patient procedures after the patient eloped. Facility staff failed to detect that the patient was missing for nearly three hours and once the patient was noted as missing, facility staff failed to follow policy to locate the patient. In addition, the OIG found that facility leaders did not ensure the facility had a missing patient prevention policy or that staff completed annual missing patient training. The OIG expressed concern that the CLC may not have been utilized as intended, given the lack of mental health standards applicable to CLCs and the complex mental health needs of this patient. The OIG made 12 recommendations to the Veterans Integrated Service Network and Facility Directors regarding reviews of the patient’s care, the use of the CLC, and staff training.

The Office of Inspector General (OIG) is issuing this Evaluation report to notify Small Business Administration (SBA) officials of significant matters regarding its handling of complaints of identity theft in the Coronavirus Disease 2019 (COVID-19) Economic Injury Disaster Loan (EIDL) program.We recommend the Administrator to direct the Associate Administrator for the Office of Disaster Assistance, the Chief Financial Officer for the Office of Performance Management and Chief Financial Officer, and the Associate Administrator for the Office of Capital Access to:1. Develop a process to maintain and track all identity theft complaints.2. Develop a process to provide status updates to each complainant alleging identity theft.3. Complete and formalize a process to restore identity theft victims to their condition prior to the fraud. The process should include steps to stop the loan billing statements, prevent delinquency collections, release them from loan liability and UCC liens.4. Develop a process to remove any fraudulent loans and related UCC filing fees from its financial records.5. Review over 150,000 returned billing statements and resolve any that involve identity theft, then refer fraudulent loans to OIG.While management stated they partially agreed with all of the recommendations, management’s formal comments state they took actions to address each of them.