Federal Reports

In 2017, HHS declared the opioid epidemic in the United States a public health emergency. The misuse of and addiction to opioids-including prescription pain relievers, heroin, and synthetic opioids such as fentanyl-is a serious national crisis that affects public health as well as social and economic welfare. In 2018 alone, there were more than 46,000 opioid-related overdose deaths in the United States. As part of its efforts to combat the opioid crisis, the Health Resources and Services Administration (HRSA) awarded $200.5 million in Access Increases in Mental Health and Substance Abuse Services (AIMS) grants to health centers nation-wide. OIG audited HRSA's oversight of AIMS supplemental grant funding as part of our oversight on the integrity and proper stewardship of Federal funds used to combat the opioid crisis.

For a covered outpatient drug to be eligible for Federal reimbursement under the Medicaid program's drug rebate requirements, manufacturers must pay rebates to the States for the drugs. However, previous OIG audits found that States did not always bill and collect all rebates due for drugs administered by physicians.

Medicare paid approximately $2.2 billion for psychotherapy services provided to Medicare beneficiaries nationwide during calendar years 2017 and 2018. Prior OIG audits and reviews found that Medicare had made millions of dollars in improper payments for mental health services, including psychotherapy services. Using data analysis techniques, we identified On-Site Psychological Services, P.C. (On-Site), at risk for noncompliance with Medicare billing requirements.

The Child Care and Development Block Grant Act (CCDBG Act) of 2014 added new requirements for States that receive funding from the Child Care and Development Fund (CCDF) to conduct comprehensive criminal background checks on staff members and prospective staff members of child care providers every 5 years. Criminal background check requirements apply to any staff member who is employed by a child care provider for compensation or whose activities involve the care or supervision of children or unsupervised access to children.

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The VA Office of Inspector General (OIG) issued a management advisory memorandum to the Veterans Benefits Administration (VBA) to request VBA examine a relatively small number of apparent overpayments by the Vocational Rehabilitation and Employment Program. The payments made to schools covered veterans’ tuition. The OIG analyzed the data on 1.8 million payments and determined that the program potentially made 360 errors from January 1, 2014, through December 30, 2019, totaling $554,998 in overpayments. The potential overpayments ranged from $18 to $237,762 and averaged $1,542. The OIG in alerting VBA did not determine if the program corrected or recovered the overpayments. The errors appeared to have resulted from program staff transposing numbers or adding one or more digits to the invoice amounts: • In February 2018, a program participant was invoiced $3,614 by a university in California, but program staff paid the university $6,314. Staff apparently transposed the three and the six in the invoice amount when entering it into the system for payment. • In October 2017, a program participant was invoiced $4,495 from another university in California, but program staff paid the university $44,950. Staff apparently added a zero to the invoice amount when entering it into the system. • In July 2016, a program participant was invoiced $238 from a Missouri university, but program staff paid the university $238,000. Staff apparently added three zeros to the invoice amount when entering it into the system. Due to the small percentage of errors, the OIG did not initiate an audit or investigation. However, it provided the potential errors to VBA to allow it to investigate and take actions when appropriate to recover any overpayments. The OIG asked VBA to provide updates for any actions it takes on the potential errors and the outcome of the actions.

The VA Office of Inspector General (OIG) conducted a healthcare inspection at the Atlanta VA Health Care System in Decatur, Georgia (facility), to review allegations and concerns of delays in care related to three patients’ non-VA community care (NVCC) consult appointments. The OIG confirmed these three patients experienced delays in the scheduling of their consults but did not identify an increase in risk of or an adverse clinical outcome for these patients.The OIG performed an expanded review of 221 consults and found that delays occurred. The OIG determined two patients had increased risks of an adverse clinical outcome due to delays in scheduling their appointments. Although the delays placed patients at increased risk, both patients received care and neither patient experienced an adverse clinical outcome. The OIG did not identify risks of or adverse clinical outcomes for the other patients. The facility had a backlog of open NVCC consults, and the OIG found deficiencies in processing, scheduling, and timeliness of these consults. Contributory factors also included, but were not limited to, inconsistent scheduling processes, inconsistent oversight, and deficiencies with third-party administrator scheduling oversight; shortages o f facility NVCC staff; and lack of training and supervision for facility NVCC scheduling staff. The facility did not consistently meet facility process requirements for scheduling audits and lacked a process to identify consults that were missing documentation after administrative closure. The OIG made six recommendations to the Facility Director related to consult performance measurements, backlog and monitoring of open NVCC consults, hiring and training of NVCC staff, patient case reviews, and NVCC policy.