Federal Reports

This audit report is one of a series of OIG reports that addresses the identification, reporting, and investigation of incidents of potential abuse and neglect of our Nation's most vulnerable populations, including children, the elderly, and individuals with developmental disabilities. OIG is committed to detecting and combating such abuse and neglect.

We contracted this audit with Cotton & Company LLP, which found FEMA did not ensure Collier County, Florida (the County) established and implemented policies, procedures, and practices to account for and expend Public Assistance (PA) program grant funds awarded in disaster areas in accordance with Federal regulations and FEMA guidance. Specifically, the County could not provide documentation to support $4,602 in force account costs claimed. Additionally, the subrecipient monitoring process needs improvement. The State has not evaluated the risk of subrecipients’ noncompliance with Federal requirements, obtained subrecipient audit reports, or developed plans for monitoring subrecipients. We made four recommendations that, when implemented, should improve Collier County, Florida’s management of FEMA PA funds. FEMA concurred with our four recommendations.

The Office of Inspector General (OIG) is initiating an audit of the Procurement List Addition Process, Procedures, and Practices. Our overall objective is to determine whether the Procurement List addition process is transparent and performed efficiently, effectively, and in compliance with applicable laws, regulations, and policies.

Four Chicago-based employees were terminated from employment on June 18, July 6, and July 9, 2020, and another retired on June 25, 2020, prior to her administrative hearing. The five former employees participated in a medical fraud scheme in violation of company policies.Our investigation found that the former employees provided a chiropractor, based in Dolton, Illinois, with their medical and personally identifiable information, typically their names and dates of birth or those of their dependents, in exchange for cash kickbacks. The chiropractor used the information to fraudulently bill Amtrak’s health insurance plan for services that were not provided. In addition, all five employees were uncooperative or lied to our agents during their interviews.

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 Harry S. Truman Memorial Veterans’ Hospital in Columbia, Missouri and multiple outpatient clinics. 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 two months prior to the OIG visit. Survey results revealed that employees were generally satisfied with executive leaders. Patient experience survey data, including both male and female satisfaction scores, indicated that patients were generally satisfied with their care. The OIG’s review of the system’s accreditation findings, sentinel events, and disclosures did not identify any substantial organizational risk factors. In addition, the executive leaders were knowledgeable within their scope of responsibilities about VHA data used by the Strategic Analytics for Improvement and Learning models. The OIG issued 14 recommendations for improvement across seven areas: (1) Quality, Safety, and Value • Utilization management processes • Root cause analysis processes (2) Medical Staff Privileging • Ongoing professional practice evaluations • Provider exit review forms (3) Medication Management • Behavior risk assessment • Urine drug testing • Informed consent • Follow-up after therapy initiation (4) Mental Health • Annual suicide prevention training (5) Care Coordination • Life sustaining treatment decisions progress notes • Multidisciplinary committee establishment (6) Women’s Health • Advisory Committee For Women Veterans membership (7) High-Risk Processes • Staff competency assessments

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 John J. Pershing VA Medical Center, Poplar Bluff, Missouri. The inspection covers key clinical and administrative processes 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 team had been working together as a group for two months, although several team members had been in their positions for more than a year. Employee satisfaction survey results revealed opportunities for the Associate Director for Patient Care Services and Associate Director to decrease staff’s feelings of moral distress in the workplace. Patients appeared satisfied with their care. The OIG did not identify any substantial organizational risk factors. The leaders were knowledgeable about Strategic Analytics for Improvement and Learning data and should continue to take actions to sustain and improve performance. The OIG issued 17 recommendations for improvement across six areas: (1) Quality, Safety, and Value • Utilization management data review (2) Medical Staff Privileging • Focused professional practice evaluations • Provider exit review forms (3) Medication Management • Aberrant behavior risk assessments • Concurrent therapy with benzodiazepines • Urine drug testing • Informed consent • Follow-up after therapy initiation • Pain Management Sub-Committee activities (4) Mental Health • Follow-up visits • Suicide prevention training (5) Women’s Health • Women’s health primary care providers • Women Veterans Health Committee membership (6) High-Risk Processes • Standard operating procedures • Annual risk analysis • Staff competency assessments

With certain exceptions, self-administered drugs are typically not covered under Medicare Part B. However, in a November 2017 report, OIG found that CMS and a Federal court interpret relevant statute to require the inclusion of versions of drugs not generally covered under Part B in limited circumstances when setting Medicare payment amounts. As a result, CMS included noncovered, self-administered versions of Orencia and Cimzia when determining payments for those two drugs. The inclusion of these noncovered versions caused Medicare and its beneficiaries to pay an extra $366 million from 2014 through 2016. OIG recommended that CMS seek a legislative change that would provide the agency with flexibility to determine when noncovered versions of a drug should be included in the calculation of the Part B payment amount. CMS did not concur with our recommendation and, to date, no action has been taken to close the payment loophole.