Federal Reports

The OIG conducted a review of VA’s planned launch of a new electronic health record (EHR) system at the Mann-Grandstaff VA Medical Center in Spokane, Washington. The facility was scheduled to be the first facility to implement the new EHR system on March 28, 2020, which VA postponed on February 10 to an unspecified date. The review focused on the EHR’s initial capabilities and the potential impact on patients’ access to care. The OIG found that facility leaders are planning for a 30 percent decrease in productivity as the system is tested and learned. Although the Office of Electronic Health Record Modernization (OEHRM) made efforts to evaluate and address productivity, facility leaders were not provided written guidance to address patients’ access to care during this less productive time. Facility leaders hired just more than 48 of 108 positions needed to support roll out and addressed access to primary care, but had a backlog of 21,155 community care consults (referrals) as of January 9, 2020. The OEHRM determined in July 2019 that not all new EHR capabilities would be available for the March go-live date. The OIG determined that facility staff would enact as many as 84 mitigations for 62 systems identified as moderate or high risk to address gaps at the go-live date. In particular, work-arounds were needed to address the removal of an online prescription refill capability—presenting patient safety risks. The OIG determined that going live with decreased capabilities that require mitigation strategies risks patient safety beyond that inherent in an EHR deployment. The OIG made four recommendations regarding productivity and capabilities to the Under Secretary for Health and OEHRM, two recommendations to the Veterans Integrated Service Network Director on facility support, and two recommendations to the Facility Director related to community care consults and timely medication refills.

VA faces tremendous challenges modernizing its electronic health records system and connecting it to a similarly implemented Department of Defense (DoD) system to create a comprehensive, lifetime health record for service members. The VA Office of Inspector General (OIG) examined whether infrastructure-readiness activities were on schedule to support the modernization initiative, starting with the system’s initially scheduled deployment on March 28, 2020, at the Mann-Grandstaff VA Medical Center (VAMC) in Spokane, Washington. The OIG found that critical physical and information technology infrastructure upgrades had not been completed at Mann-Grandstaff and associated facilities six months before the specified system deployment date, as guidance suggested. Even as recently as January 8, 2020, some infrastructure updates had yet to be completed, jeopardizing the then planned March 28 deployment. In April 2020, VA postponed going live without specifying a new date. The lack of important upgrades jeopardizes VA’s ability to properly deploy the new system and increases risks of delays to the overall schedule. Some needed infrastructure upgrades were not projected to be completed until months after going live. Infrastructure upgrades were not completed at Mann-Grandstaff on time primarily because VA had not completed initial comprehensive site assessments, developed specifications for infrastructure with appropriate monitoring mechanisms, and lacked adequate staffing. VA committed to the March 28 date without having the necessary information on the state of the medical center’s infrastructure. The OIG also found security vulnerabilities with some of the physical infrastructure at the Mann-Grandstaff VAMC. Damage to that infrastructure from unauthorized access could lead to loss of connectivity. The OIG made eight recommendations, including establishing an infrastructure-readiness schedule for future deployment sites that incorporates lessons learned from DoD’s experience and ensures projected milestones are realistic and achievable. The OIG also recommended ensuring the physical security of electronic health records infrastructure.

What We Looked AtThe Improper Payments Elimination and Recovery Act (IPERA) requires Federal agencies to report improper payment estimates for all programs identified as susceptible to significant improper payments. It requires agencies to limit improper payments to less than 10 percent of their total program payments, publish their results in the Agency Financial Report (AFR), and comply with regulations the Office of Management and Budget (OMB) developed to implement the act. IPERA also requires inspectors general to submit reports on IPERA compliance to their agency heads. For fiscal year 2019, the Department of Transportation (DOT) reported approximately $45 billion in payments in programs or activities susceptible to significant improper payments. DOT estimated that $396 million of those payments were improper payments. We reviewed DOT’s improper payment testing results for fiscal year 2019 to determine whether DOT complied with IPERA’s requirements as implemented by OMB. What We FoundDOT complied with IPERA and included all required reporting elements in its 2019 AFR. Specifically, DOT reported improper payment estimates for the Federal Highway Administration’s (FHWA) Highway Planning and Construction program (HPC)—the only program the Department identified as susceptible to significant improper payments. In addition, the payment integrity information in the AFR was accurate and complete. Furthermore, DOT reported an improper payment rate of less than 10 percent and published corrective action plans for FHWA HPC. However, the corrective action plan has not helped one HPC grantee prevent improper payments for the last 3 years. In fiscal year 2019, FHWA projected the amount of improper payments to be approximately $169 million for this grantee only and categorized these funds as monetary losses or overpayments. The lack of an effective corrective action for this HPC grantee jeopardizes DOT’s efforts to prevent improper payments and remain compliant with IPERA. Our RecommendationsDOT concurred with both of our recommendations and provided an appropriate action and completion dates. Accordingly, we consider all recommendations as resolved but open pending completion of the planned actions.

The U.S. Department of Housing and Urban Development (HUD), Office of Inspector General (OIG) conducted this study to assess what information servicers of mortgage loans insured by Federal Housing Administration (FHA) are providing to borrowers regarding forbearance options available under the Coronavirus Aid, Relief, and Economic Security Act (CARES Act).

UPDATE: AUD-MERO-20-26 was issued in April 2020, with redactions. OIG later determined that the redactions were appropriate but that the Freedom of Information Act (FOIA) exemptions associated with the redactions should be modified. The report linked to this webpage was updated to reflect the appropriate FOIA exemptions.