Federal Reports

What We Looked AtTitle XI of the Merchant Marine Act of 1936 established the Maritime Administration’s (MARAD) Federal Ship Financing Program (Title XI), which provides loan guarantees to private companies for ship construction and shipyard modernization. The Fiscal Year 2019 John S. McCain National Defense Authorization Act requires us to audit MARAD’s policies and procedures for reviewing and approving loan guarantee applications. Our audit objectives were to assess (1) the completeness of the program’s policy for application reviews and (2) the program’s adherence to the policy in its application reviews. What We FoundMARAD’s Title XI policy manual does not fully cover 13 of 28 regulatory requirements that address program eligibility and applications. A MARAD official acknowledged that the manual does not cover all requirements but pointed out that missing requirements are not frequently relevant to application reviews. However, lack of inclusion of all requirements creates a risk that the program will omit attention to relevant requirements, and in turn, diminish the reliability of information the program uses to assess applicants’ eligibility and creditworthiness.MARAD lacks adequate procedures to ensure that staff fully comply with requirements. The program also takes longer to process applications than the 9-month statutory review period, and the program’s controls are inadequate to ensure staff comply with policy requirements. According to the Government Accountability Office, management must enforce accountability for the entity’s internal control, including through supervisory feedback. However, the program supervisor reviews applications for completeness on an ad-hoc basis. The lack of internal controls could inhibit assessments of applicants’ eligibility and creditworthiness. RecommendationsWe made three recommendations, and MARAD concurred with all three.

The Administration for Children and Families (ACF), within HHS, requested that we audit Sharon Baptist Head Start (Sharon Baptist) after ACF identified instances of noncompliance with Federal requirements in a January 2014 monitoring review.Our objective was to determine whether Sharon Baptist complied with Federal requirements applicable to related party-rent and related-party receivable transactions.

The VA Office of Inspector General (OIG) reviewed the accessibility of dermatology, orthopedics, and urology specialty care for patients in the 17 Veterans Health Administration (VHA) community-based outpatient clinics (CBOCs) classified as highly rural. The OIG also reviewed accessibility, barriers, and the availability and utilization of resources for the time frame March 1, 2018 (or from the date the CBOC became highly rural), through February 28, 2019. VHA utilized clinical consults, electronic consults (eConsults), telehealth, and community care to provide specialty care at the highly rural CBOCs. Sites in this review mostly utilized referrals to their parent facility and community specialty providers. These sites rarely used telehealth, inter-facility consults, and eConsults. Staff identified limited access to community providers as the top barrier in the selected specialties. The OIG identified discrepancies regarding site operating days and hours among the available listing locations for clinic operations. Of the five highly rural CBOCs located in a non VA community hospital or health care center, not all community resources available at the sites were used. The OIG completed a review of the environment of care at the 16 sites visited and found they generally met the standards reviewed. Four recommendations were made to the Under Secretary for Health related to assessing specialty care needs including internet bandwidth and telehealth equipment, ensuring validation of the VHA Site Tracking system, ensuring the maintenance of accurate and current information on VA websites, and assessing whether highly rural CBOCs located in non-VA health care centers fully utilized resources in the facilities. Following the conclusion of this review, VHA implemented the Office of Emergency Management coronavirus disease 2019 Response Plan. Four of the 17 highly rural CBOCs closed and 13 listed pre-pandemic operations on their websites.

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 Tomah VA Medical Center and multiple outpatient clinics in Wisconsin. 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 consisted of the acting Medical Center Director, Chief of Staff, acting Associate Director for Patient Care Services (ADPCS), and acting Associate Director. Survey scores related to employees’ satisfaction with the medical center leaders were generally similar to or better than the VHA averages; however, opportunities exist for the ADPCS to decrease staff’s feelings of moral distress in the workplace. Patient experience survey data reflected higher care ratings than the VHA averages in the outpatient setting, while inpatient results appeared to highlight opportunities for improvement. The OIG’s review of the medical center’s accreditation findings, sentinel events, and disclosures did not identify any substantial organizational risk factors. The executive leadership team was generally knowledgeable within their scope of responsibility about selected VHA data used by the Strategic Analytic for Improvement and Learning models and should continue to take actions to sustain and improve performance. The OIG issued four recommendations for improvement in three areas: (1) Mental Health • Annual suicide prevention refresher training (2) Women’s Health • Community-based outpatient clinic women’s health primary care providers • Women Veterans Health Committee membership (3) High-Risk Processes • Annual risk analysis

On April 9 and April 16, 2020, we received requests from U.S. Senators Tammy Baldwin and Ron Johnson and U.S. Representatives Gwen Moore and Bryan Steil to investigate reports of absentee ballots not delivered in a timely manner for the Wisconsin primary election held Tuesday, April 7, 2020. This management alert responds to the congressional requests and presents our results and recommendations to address the issues identified in this report.