Federal Reports

The VA Office of Inspector General (OIG) examined whether the Veterans Health Administration (VHA) adequately governs its purchase and use of robotic surgical systems. Employees at VA medical facilities submit applications to the VHA Office of Healthcare Technology Management to purchase these systems. The office reviews applications and recommends them to the assistant deputy under secretary for health for administrative operations for final approval. The systems cost between $1.5 million and $2.2 million each, including parts and maintenance. The OIG found VHA did not consistently support its acquisition of robotic surgical systems as required by VA policy. Between June 2013 and September 2018, the office recommended approving 45 applications. Of these, 13 systems had incomplete information to support a justification. In addition, 10 systems did not have documented evidence of final approval before acquisition. VHA also did not have comprehensive data on robotic surgeries. VHA’s National Surgery Office reported about 2,300 fewer procedures than the manufacturer of the robotic systems had recorded during fiscal year 2018. The manufacturer’s data was based on information the robotic systems automatically captured for each procedure. VHA underreported the number of robotic surgical procedures because medical facility staff coded them inconsistently in VA’s electronic health information system. VHA concurred with all OIG recommendations, including that VHA provide clearer instructions for preparing and supporting applications for high-cost, high-tech medical equipment and ensure applications are reviewed and validated before they are recommended for final approval. VHA also agreed to evaluate the need and justification for the 10 surgical systems acquired without final approval. Finally, in response to OIG recommendations, VHA will develop guidance for coding robotic surgical procedures accurately and consistently and evaluate whether the National Surgery Office needs to obtain data from the system manufacturer to validate VHA data.

The VA Office of Inspector General (OIG) received wide-ranging allegations of misconduct in the operations of the Veterans Health Administration’s Consolidated Patient Account Center (CPAC) field offices, which function within the Office of Community Care and conduct medical billing functions for VA medical centers in designated regions. The OIG substantiated the following allegations: 1. CPAC management improperly used government funds to purchase food for CPAC employees in fiscal years 2015 and 2016 in connection with events held as part of VA’s Diversity and Inclusion initiative; 2. One CPAC violated VA policy for disposing of excess equipment when computer monitors were given to a local school without following established procedures; and 3. Some CPAC field offices violated VA policy requiring that destruction of temporary paper records be performed pursuant to a written contract. The OIG made two recommendations, with which VA concurred and took prompt corrective action. The OIG considers these recommendations closed. Allegations relating to improper travel, the misuse of funds for the purchase of daily planners and a wheelchair, and the improper use of purchase cards for armored car services were not substantiated.

The Federal Emergency Management Agency (FEMA) mismanaged the distribution of commodities in response to Hurricanes Irma and Maria in Puerto Rico. FEMA lost visibility of about 38 percent of its commodity shipments to Puerto Rico, worth an estimated $257 million. Commodities successfully delivered to Puerto Rico took an average of 69 days to reach their final destinations. Inadequate FEMA contractor oversight contributed to the lost visibility and delayed commodity shipments. FEMA did not use its Global Positioning System transponders to track commodity shipments, allowed the contractor to break inventory seals, and did not ensure documented proof of commodity deliveries. Given lost visibility and delayed shipments, FEMA cannot ensure it provided commodities to Puerto Rico disaster victims as needed to sustain life and alleviate suffering as part of its response and recovery mission. In addition, FEMA’s mismanagement of transportation contracts included multiple contracting violations and policy contraventions that ultimately led to contract overruns of about $179 million and at least $50 million of questioned costs. We made five recommendations that, if implemented, should improve FEMA’s management and oversight of its disaster response activities. FEMA concurred with four of the five recommendations. Recommendations 1 through 4 are considered open and resolved. Recommendation 5 is considered resolved and closed.

Previous Office of Inspector General (OIG) audits found that States had improperly paid Medicaid managed care entities capitation payments on behalf of deceased beneficiaries. We conducted a similar audit of the North Carolina Department of Health and Human Services, Division of Health Benefits, which administers the Medicaid program.Our objective was to determine whether North Carolina made capitation payments on behalf of deceased beneficiaries.