Federal Reports

The VA Office of Inspector General (OIG) conducted this review to determine whether Veterans Benefits Administration (VBA) decision makers accurately completed disability evaluations for veterans’ service-connected heart disease. The OIG estimated VBA decision makers incorrectly evaluated about 12 percent of claims for heart disease between November 1, 2018, and April 30, 2019. Of those, about 870 resulted in improper payments totaling at least $5.6 million. VBA decision makers inappropriately evaluated heart disease using information from disability benefits questionnaires filled out either by VA or contracted medical providers. Decision makers also made other inaccurate decisions on claims. The OIG determined that the disability benefits questionnaire format contributed to the inappropriate evaluations of veterans’ heart conditions. The system-generated instructions for the questionnaire prompted unclear medical statements. VBA decision makers did not consistently ask for the clarification they needed to make accurate disability determinations. The OIG made three recommendations for improving the handling of disability benefits questionnaires for heart diseases to ensure they are properly filled out with unambiguous and consistent information. The OIG made no recommendation on the inaccurate claims decisions because the review team did not identify a common trend or pattern for these errors.

The VA Office of Inspector General (OIG) assessed an allegation that providers permitted an individual with no legal authority to make medical decisions on behalf of a patient. The patient had a three-week medical and mental health hospitalization with repeated episodes of confusion, agitation, and combative behavior. The patient was transferred to hospice care and died five days later. The OIG substantiated the patient’s neighbor had no legal authority but made medical decisions. The OIG noted clinical and patient rights deficiencies and reviewed facility leaders’ evaluation of the deficiencies in the patient’s care. Facility staff did not take the required appropriate steps to identify and confirm the eligibility of this surrogate. Staff searched the patient’s belongings and records, but they did not review other VA records. Three days after the patient’s death, administrative staff located a family member from VA benefits records. The OIG determined that records did not contain sufficient documentation of physicians’ clinical assessments to support diagnoses and treatment decisions. Clinical communication and collaboration were inconsistent, insufficient, and negatively impacted the patient’s continuity and quality of care. Providers did not consistently document medication monitoring and oversight activities to ensure safe patient care. The OIG concluded the patient’s transfer to hospice was completed without fully pursuing other diagnoses and treatment options and staff did not ensure the patient’s rights were upheld regarding involuntary admission and behavioral restraints. Facility leaders did not complete a thorough quality of care review to understand the reasons for the patient’s atypical hospital course and outcome. The OIG made 15 recommendations to the Facility Director related to the patient’s decisional capacity, surrogate identification, medical assessments, medication management, and hospice admission. Other areas of focus included patient rights, quality management processes, and institutional disclosure.

A majority of U.S. customers are concerned about the environmental impact of deliveries and many factor in these concerns when choosing a delivery company.To respond to customers’ expectations the Postal Service — like competitors and international posts — could consider offering optional carbon compensation offsets for its letters and parcels, as well as reusable packaging solutions.

The objective for this management advisory report was to monitor and assess how the company is using CARES Act funds and the controls it has in place to accurately account for and report on them.The company experienced a sharp drop in ridership and passenger revenues in March 2020 as a result of the coronavirus pandemic. The company’s response included aggressive cost-cutting actions such as cancelling some of its train service and reducing management pay and retirement benefits. Despite these actions, the company projected that revenues would still not cover its reduced costs and requested assistance from Congress. Congress responded by providing the company with $1.018 billion through the Coronavirus Aid, Relief, and Economic Security Act (CARES Act) to “prevent, prepare for, and respond to” the coronavirus pandemic.On April 16, 2020, we began an audit to monitor and assess how the company is using CARES Act funds and the controls it has in place to accurately account for and report on them. So far, the company’s initial steps to use, account for, and report on the CARES Act funds are encouraging. By its actions, the company appears committed to providing transparency and demonstrating fiscal responsibility over its use of these funds. We identified three areas where additional focus could reduce risks. Going forward, a focus on providing more transparent data on how changes in service will affect state costs will help states as they develop their own budgets. In addition, a more-timely verification of pandemic-related expenses will help demonstrate that the company is being a responsible steward of taxpayer dollars. This is especially important considering that the company has requested $1.475 billion in supplemental funding for FY 2021 to mitigate expected shortfalls in passenger revenue. Finally, ensuring that adequate controls are in place to safeguard scarce pandemic-related materials and equipment throughout all links in the supply chain will ensure that these products are available to support the safety and health of the company’s workers and the traveling public.

Prior OIG audits identified Medicare overpayments to hospitals that did not comply with Medicare's post-acute-care transfer policy (transfer policy). CMS generally concurred with our recommendations, but subsequent analysis that we conducted indicated that CMS's system edits were still not properly designed and that hospitals may be using condition codes to bypass CMS's system edits to receive higher reimbursements for inpatients transferred to home health services.

What We Looked AtWe queried and downloaded 95 single audit reports prepared by non-Federal auditors and submitted to the Federal Audit Clearinghouse between April 1, 2020 and June 30, 2020, to identify significant findings related to programs directly funded by the Department of Transportation (DOT). What We FoundWe found that reports contained a range of findings that impacted DOT programs. The auditors reported significant noncompliance with Federal guidelines related to 21 grantees that require prompt action from DOT’s Operating Administrations (OA). The auditors also identified questioned costs totaling $3,440,165 for 10 grantees. RecommendationsWe recommend that DOT coordinate with the impacted OAs to develop a corrective action plan to resolve and close the findings identified in this report. We also recommend that DOT determine the allowability of the questioned transactions and recover $3,440,165, if applicable.