Federal Reports

During the course of the audit, we determined that FEMA provided hotel rooms to about 90,000 households (nearly 227,000 survivors) after the 2017 California wildfires and Hurricanes Harvey, Irma, and Maria. However, FEMA did not oversee and manage the Transitional Sheltering Assistance (TSA) program to ensure it operated efficiently and effectively to meet all disaster survivors’ needs. Specifically, FEMA officials did not accurately validate taxes charged for hotel rooms and did not ensure that CLC maintained accurate records to ensure taxes charged were reasonable and allocable; paid for unoccupied rooms; and did not transition survivors from TSA hotels to interim or permanent housing timely. This occurred because FEMA officials did not establish a dedicated program office with staff and standard operating procedures for the TSA program. These deficiencies hindered FEMA from conducting appropriate reviews of the hotel costs and payments, and from adequately coordinating with the states to prepare pre-disaster housing strategies. As a result, FEMA paid more than $55.8 million in unverified taxes, disbursed indeterminate amounts for unoccupied rooms, and left over 146,000 disaster survivors in hotels for more than the recommended 30 days. We made two recommendations that when implemented, will improve FEMA’s oversight and pre-disaster planning of transitional sheltering. FEMA concurred with both recommendations and the recommendations are resolved and open.

This audit assessed the Veterans Health Administration’s (VHA) oversight of the issuance of prosthetic supplies and devices to veterans. VA’s Prosthetic and Sensory Aids Service (PSAS) is the world’s largest provider of prosthetic devices and sensory aids. Prosthetics include not only artificial limbs, but any device that supports or replaces a body part or function such as wheelchairs and pacemakers. Sensory aids include hearing aids, optical prescriptions, low vision and mobility aids, or speech and communication aids. The cost of PSAS services increased from over $2.9 billion in fiscal year (FY) 2016 to nearly $3.5 billion in FY 2019.The VA Office of Inspector General (OIG) found weaknesses in VHA oversight contributed to PSAS staff cloning (copying) consults improperly that also affected its ability to track fulfillment times. Consequently, VHA improperly issued an estimated $15.8 million in prosthetic supplies in 2017. However, 94 percent of transactions related to deceased veterans were proper. The remaining 6 percent were improper, but the OIG did not identify evidence of fraud with respect to these errors. VHA also maintained adequate oversight of duplicate supply issuance.The OIG made four recommendations with which VHA concurred to improve oversight of the clone consult function. Specifically, the OIG called on VHA to ensure PSAS business practice guidelines include requirements for conducting and documenting reviews of cloned and pending consults; staff develop a process to verify that consults include accessory and consumable supplies for prosthetic items before issuance; establishes field consistency requirements for program reviews and evaluations, and complies with existing policy for reviewing program assessments and evaluations, and communicate the results to the regional prosthetic representatives.

The VA Office of Inspector General (OIG) conducted an inspection at the request of Representative Carol Miller in response to allegations related to timeliness and quality of care in the Emergency Department and scheduling concerns in the Oncology Clinic of a patient at the Beckley VA Medical Center (facility) in West Virginia.The OIG did not substantiate that the patient received untimely or poor-quality care in the facility’s Emergency Department. On six occasions over four months in 2019, the patient presented to the Emergency Department, was assessed, treated for the presenting complaints, and received coordinated care between the primary care provider and other providers. On two occasions, there was no documented evidence that the primary care provider communicated abnormal and critical laboratory test results with the patient. While it appears that the failure to document communication of test results did not negatively affect this patient’s care, the lack of timely follow-up of abnormal test results could contribute to poor patient outcomes.The OIG found deficits in an oncologist’s use of scheduling orders and adherence to the Primary Care and Oncology Service Agreement wait times. Although the oncologist agreed to see the patient earlier than a scheduled appointment, it was not until a second oncology e-consult was entered that an earlier appointment was scheduled. The OIG was unable to determine whether compliance with the return-to-clinic policy would have altered the patient’s course.The OIG found that facility leaders performed comprehensive reviews of the patient’s care. The OIG made two recommendations to the Facility Director related to primary care providers’ communication and documentation of laboratory results and the oncologist’s compliance with scheduling and ordering policies.

The OIG investigated an allegation of a financial conflict of interest involving a U.S. Geological Survey (USGS) employee and a family member. The complaint alleged that the USGS employee assigned to a USGS unit at a State university submitted and managed multiple research work orders (RWOs) from the USGS from which the family member was paid as a co-principal. (RWOs are funding agreements between USGS and a cooperating university.)We substantiated that the USGS employee’s actions on the RWOs and the requisition regarding the family member constituted a financial conflict of interest. The employee submitted proposals for USGS RWOs at the State university where he was assigned, listing the family member as an employee in various roles under the agreements, and did so, in part, to ensure the family member’s salary of over $187,000. The family member also assisted the employee with the proposals, including developing budgets for payments.The U.S. Attorney’s office filed a civil false claims suit against the employee in lieu of criminal prosecution. The employee agreed to a settlement, which required the employee to pay $50,000. The employee’s family member is now employed at the State university with a salary paid by Federal and State grants.