Federal Reports

This Office of Inspector General (OIG) Comprehensive Healthcare Inspection Program report provides a focused evaluation of the quality of care delivered in the inpatient and outpatient settings of the Edward Hines, Jr. VA Hospital and multiple outpatient clinics in Illinois. The inspection covers key clinical and administrative processes that are associated with promoting quality care. This inspection focused on Leadership and Organizational Risks; Quality, Safety, and Value; Medical Staff Privileging; Environment of Care; Medication Management: Long-Term Opioid Therapy for Pain; Mental Health: Suicide Prevention Program; Care Coordination: Life-Sustaining Treatment Decisions; Women’s Health: Comprehensive Care; and High-Risk Processes: Reusable Medical Equipment. The executive leadership team had worked together for five months at the time of the OIG site visit. The medical center director position had been vacant for five months; the Associate Director had served as acting Director since October 2019. Selected patient experience survey scores generally reflected similar or higher ratings than the VHA average; however, female veterans reported less positive specialty care experiences than female patients nationally. The OIG determined that opportunities exist to improve the institutional disclosure process and considered the vacant director position a vulnerability. Executive leaders were generally knowledgeable within their scopes of responsibilities about data used in Strategic Analytics for Improvement and Learning quality measures and should continue to take actions to sustain and improve performance. The OIG issued 23 recommendations for improvement in six areas: (1) Quality, Safety, and Value • Committee processes • Peer review processes • Utilization management processes (2) Medical Staff Privileging • Professional practice evaluations • Provider exit review processes (3) Environment of Care • Expired supplies • Environmental cleanliness (4) Medication Management • Pain screening • Behavior risk assessment • Urine drug testing • Informed consent • Patient follow-up (5) Mental Health • Staff training (6) High-Risk Processes • Bioburden testing • Traffic restriction • Climate control • Staff training • Competency assessments

Overtime pay is a premium that eligible employees receive when they perform work in excess of eight paid hours in a day, or 40 paid hours in a week. Per union contracts, regular overtime is paid at one and one-half times an employee’s hourly rate to non-exempt employees, while penalty overtime is paid at double an employee’s hourly rate under specific conditions. Employees must be paid for all overtime work they perform, even if that time was not authorized. Unauthorized overtime occurs when an employee’s clock time exceeds eight hours in a day or 40 hours in a week without prior authorization from a manager. Our objective was to assess Postal Service controls over managing overtime.

We audited Task Order No. 140G0218F0251 and Contract No. G16PC00016 between Quantum Spatial, Incorporated (QSI) and the U.S. Geological Survey (USGS) to determine whether (1) QSI complied with all applicable Federal regulations and terms and conditions of the task order and the governing contract, (2) the USGS complied with all applicable Federal regulations, USGS policies and procedures, and award terms and conditions when awarding and monitoring the contract and the task order, and (3) the USGS negotiated a fair and reasonable price for services rendered under the task order. We reviewed supporting documentation and compliance from the beginning of the solicitation phase in October 2014 through December 2018.We found that QSI and the USGS did not always comply with applicable regulations, policies, and contract terms and conditions. Specifically:• QSI submitted invoices that were mathematically incorrect.• QSI submitted invoices that did not include contract line item numbers as required.• The USGS did not include a required clause in the contract.• The USGS did not document the contract negotiations properly.In addition, we found that the USGS negotiated a fair and reasonable price for the task order.We make two recommendations regarding invoice review and three recommendations regarding contract administration to help the USGS improve its contract oversight and maintain complete and comprehensive documentation. Based on the USGS’ response to our draft report, we consider all five recommendations to be resolved but not implemented.

We audited the costs claimed by the State of Kansas, Department of Wildlife, Parks and Tourism (Department), under grants awarded by the U.S. Fish and Wildlife Service (FWS) through the Wildlife and Sport Fish Restoration Program. The audit included claims totaling $49.3 million on 69 grants that were open during the State fiscal years that ended June 30, 2017, and June 30, 2018. The audit also covered the Department’s compliance with applicable laws, regulations, and FWS guidelines, including those related to the collection and use of hunting and fishing license revenues and the reporting of program income.We found that the Department generally ensured that grant funds and hunting and fishing license revenue were used for allowable fish and wildlife activities and complied with applicable laws and regulations, FWS guidelines, and grant agreements. We noted, however, issues with indirect costs, subawards, and equipment management. We questioned $139,087 ($103,191 Federal share) as ineligible. We recorded a potential diversion of $30,728 in license revenue. We also found control deficiencies with the Department’s subaward reporting policies, and we repeated a finding on real property.The FWS concurred with our six recommendations and repeat recommendations and will work with the Department to implement corrective actions.