Federal Reports

Prior Office of Inspector General audits of State Medicaid agencies that used random moment timestudies (RMTSs) to allocate costs for school-based administrative (SBA) costs determined that States did not always correctly claim Federal Medicaid reimbursement for SBA services. Nebraska, whose SBA costs we have not previously audited, uses RMTSs to allocate those costs.

We determined that children brought to Port Isabel on July 15, 2018, waited extended periods, and in many cases overnight, to be reunited with their parents. U.S. Immigration and Customs Enforcement (ICE) was not prepared to promptly reunify all children who arrived at Port Isabel on the first day of attempted mass reunifications. ICE and U.S. Health and Human Services had fundamentally different understandings about the timing and pace of reunifications, and ICE personnel at Port Isabel underestimated the resources necessary to promptly out-process the parents of arriving children. As a result, some children waited in vehicles at Port Isabel, while others waited in unused detention cells, though all children were in climate-controlled environments and had continuous access to food, water, and restrooms. As the mass reunifications continued, ICE personnel responded to processing and space issues, which generally resulted in shorter wait times for children who arrived at Port Isabel closer to the court’s July 26, 2018 deadline. The report contains no recommendations.

ICE’s Homeland Security Investigations (HSI) is effectively contributing to the Federal Bureau of Investigation’s (FBI) Joint Terrorism Task Force (JTTF) counterterrorism efforts by leveraging its authorities, experience, skills, and staffing. However, existing agreements and guidance on HSI’s participation in the JTTF and its terrorism financing investigations are outdated. Additionally, we determined existing agreements and policy impose restrictions that delay and hinder sharing and access to information in the JTTF. We recommended DHS JTTF contributors evaluate and update agreements governing JTTF participation as needed. HSI should renegotiate and update the 2003 agreement on terrorism financing, as well as update its related guidance accordingly. We also recommended DHS coordinate with Department of Justice and Department of State, as well as within the DHS, to develop agreements to allow for the more direct sharing of critical investigative information. We made five recommendations that aim to improve counterterrorism efforts and information sharing. DHS concurred with two recommendations and non-concurred with three.

At the request of the Tennessee Valley Authority's (TVA) Supply Chain, we examined the cost proposal submitted by a company for engineering, design, and construction support services. Our examination objective was to determine if the company's cost proposal was fairly stated for a planned 5-year, $90 million contract.In our opinion, the company's cost proposal was overstated. Specifically, we found the methodology the company used to calculate its proposed labor markup rates was not reflective of the divisions that would be performing the anticipated scopes of work. We estimated TVA could avoid about $5.17 million over the planned $90 million contract by negotiating reductions to the labor markup rates to more accurately reflect the costs from the company divisions who would be performing work under the potential contract.(Summary Only)

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This Office of Inspector General (OIG) Comprehensive Healthcare Inspection Program (CHIP) report provides a focused evaluation of the quality of care delivered in the inpatient and outpatient settings of the Jesse Brown VA Medical Center and multiple outpatient clinics in Illinois and Indiana. The inspection covers key clinical and administrative processes that are associated with promoting quality care. For this inspection, the areas of focus were 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 medical center’s executive leadership team had one vacancy in its five key positions. The Medical Center Director had served in an acting capacity for two weeks, and the chief of staff position had been filled for three months. Survey results indicated opportunities to improve employee satisfaction. Patient survey results indicated overall satisfaction. The OIG did not identify any substantial organizational risk factors. Executive leaders were generally knowledgeable about Strategic Analytics for Improvement and Learning measures and actions taken during the previous 12 months to maintain or improve performance. The OIG issued 22 recommendations for improvement in seven areas: (1) Quality, Safety, and Value • Utilization management processes (2) Medical Staff Privileging • Professional practice evaluations • Provider exit reviews • State licensing board reporting (3) Medication Management • Behavior risk assessments • Concurrent medication therapy • Urine drug testing • Informed consent • Patient follow-up • Pain Committee (4) Mental Health • Patient follow-up • Suicide safety plans • Suicide prevention training (5) Care Coordination • Multidisciplinary committee (6) Women’s Health • Women’s health primary care providers • Women Veterans Health Committee (7) High-Risk Processes • Standard operating procedures • Annual risk analysis • Competency assessments