Federal Reports

The VA Office of Inspector General (OIG) conducted a review to assess Veterans Health Administration’s (VHA) virtual primary care response to the COVID-19 pandemic, as well as the use of virtual care by primary care providers and their perceptions of VA Video Connect (VVC) between February 7 and June 16, 2020.The COVID-19 pandemic presented significant challenges to health care delivery worldwide. One strategy initiated by VHA, in accordance with the Centers for Disease Control and Prevention recommendation to social distance, included expanding the delivery of primary care via virtual care. In VHA, virtual care has had a long-standing presence as a modality of care. Virtual care options during the pandemic included video conferencing through VVC and third-party applications, such as Skype and FaceTime, as well as telephone appointments.The OIG found face-to-face primary care encounters decreased by 75 percent and virtual encounters increased, with contact by telephone representing 81 percent of all primary care encounters during the review period. Additionally, primary care providers reported via questionnaire that VVC training and support were lacking for veterans, as was technology equipment and internet connectivity. Providers also identified challenging scheduling processes related to virtual appointment scheduling as a concern.The OIG made two recommendations to the Under Secretary for Health related to access, equipment, and VVC application training and support.

This management advisory memo identifies potential risks associated with the Veterans Health Administration’s (VHA) efforts to expedite adding new staff to meet increased demand caused by the COVID-19 pandemic. The VA Office of Inspector General (OIG) recognizes the tremendous pressure to quickly hire staff to meet unprecedented needs. To achieve VHA’s goal of bringing all new employees on duty within three days of making a tentative offer, VHA has modified or deferred tasks such as fingerprinting, background investigations, drug testing, credentialing, and preplacement physicals.The potential risks identified by the OIG may threaten VHA’s ability to safeguard veterans’ sensitive information and ensure its workforce is suitable for serving patients at VA medical facilities. The OIG organized these potential risks into three categories: (1) employees who do not have a completed fingerprint-based criminal history check may gain access to sensitive information and controlled substances; (2) delays in processing fingerprints add to a backlog of investigations; and (3) onboarding tasks are deferred—such as drug testing and credentialing—that are not being centrally monitored to ensure completion.Because these risks, if realized, could damage the trust veterans have in VA keeping their information secure and meeting employee suitability standards, this memorandum raises issues for VHA to consider in determining whether vulnerabilities and related processes warrant further review. These include possible changes to centralize governance of deferred actions to improve oversight.

The VA Office of Inspector General (OIG) conducted an inspection in response to allegations that significant failures related to the management of view alert notifications placed patients at risk. Unaddressed view alerts do not necessarily correlate to unmanaged clinical results or administrative consults; however, they will continue to accumulate until they are addressed.The OIG conducted reviews of patients with unaddressed view alerts and referred a total of 33 patients who had clinical or treatment issues that had not been adequately managed by the system for follow-up. The OIG reviewed the system’s action plans and found all plans to be acceptable.The OIG did not substantiate that at least 12 providers had each accumulated more than 5,000 view alerts, or that the system excluded teleradiologists from the requirement to communicate abnormal and critical test results to ordering providers or their designees. However, the OIG confirmed that nine providers each had more than 5,000 view alerts at some point between July 23 and December 2, 2019.The OIG substantiated that of the patients reviewed, some patient care was being compromised because abnormal laboratory and imaging results were either not managed or not managed within the required timeframe. Some patients were at risk for delayed cancer diagnoses because of the lack of timely provider follow-up. The OIG also found that the ordering providers did not consistently take appropriate actions to edit and resubmit canceled consults.The OIG determined that system leaders did not give providers clear instructions or adequate training on the prioritization of view alerts for review and disposition, documentation of actions when clearing unaddressed view alerts, and designation of surrogates.The OIG made one recommendation to the Under Secretary for Health, one recommendation to the VA Southeast Network Director, and nine recommendations to the System Director.

The OIG found several potential partnership opportunities that would allow the Postal Service to play a role in health and wellness. These include assisting in the recovery from current or future national health emergencies, disseminating information about available healthcare services, and helping facilitate access to those services. Such initiatives would prove extremely valuable to the nation.

Statistics on employee integrity investigation cases closed during the semiannual reporting period for FY 2017, as well as summaries of the cases.

OIG issues an Immediate Release and Advisory alerting Lifeline, Emergency Broadband Benefit, and Affordable Connectivity Program providers and consumers to improper and abusive enrollment practices that are part of some providers’ online enrollment processes.

We determined that the Federal Emergency Management Agency’s (FEMA) process for recovering disallowed grant funds could be improved. First, FEMA justified allowing most of the costs we questioned for noncompliance with procurement regulations without addressing the procurement deficiencies. Second, although staff in FEMA regional offices generally followed internal guidance when recovering disallowed grant costs, they did not track debt collections by the FEMA Finance Center because FEMA guidance does not require them to do so. Finally, FEMA did not update its internal guidance to comply with revised time limits of the statute of limitations in the Robert T. Stafford Disaster Relief and Emergency Assistance Act. We made five recommendations for FEMA to address identified deficiencies and revise its guidance. FEMA concurred with all five of our recommendations.