Federal Reports

Provider-preventable conditions (PPCs) are certain reasonably preventable conditions caused by medical accidents or errors in a healthcare setting. In 2011, the Centers for Medicare & Medicaid Services (CMS) issued Federal regulations prohibiting Federal Medicaid payments for services related to PPCs. The goal of the regulations is to improve quality of care by prohibiting payments for medical errors. Prior OIG audits of nine States found that none of them fully complied with Federal requirements. Based on the information we compiled during those audits, we conducted this audit to identify actions that CMS could take to help States' compliance and to augment States' efforts to improve the quality of care provided to Medicaid beneficiaries.

The objective for this report was to assess the effectiveness of the company’s current efforts to better manage its vehicle fleet, including any efforts made by the company to respond to our prior observations. We found that the company has addressed some weaknesses in its management of its vehicle fleet, including improving safety by installing dashboard cameras in almost three-quarters of the fleet, and taking steps to right-size the fleet in response to prior reports by reducing it by approximately 100 vehicles. The company has not, however, addressed other longstanding weaknesses, including mitigating remaining safety risks; ensuring that it needs all the vehicles it has; and responding to misuse of fuel purchase cards, overdue maintenance, and past-due inspections.As a result, the company continues to face increased safety and liability risks and incurs excess costs. For example, the company will face financial risks for injuries or damages caused by high-risk drivers until comprehensive and regular driver’s license screenings and driving record checks are put in place. Additionally, we identified $91,000 in inappropriate fuel card purchases and costs resulting from a lack of required vehicle maintenance in fiscal year 2019. We also estimate the company could avoid annual lease costs of as much as $872,000 with stronger controls over vehicle justifications and re-justifications. To address the findings in our report, we recommend that the Procurement department take several actions, including requiring more timely coaching and enforcement actions for drivers with safety violations, periodically checking drivers’ license status and driving histories, requiring the use of more comprehensive criteria to justify obtaining new vehicles and keeping existing ones, and addressing fuel purchase card misuse as well as delayed maintenance and required safety inspections.

Our objective was to report internal control weaknesses, noncompliance issues, and unallowable costs identified in the single audit to the Social Security Administration (SSA) for resolution action.

What We Looked AtWe performed a quality control review (QCR) on the single audit that RSM US LLP performed for the City of Corpus Christi's (City) fiscal year that ended September 30, 2018. During this period, the City expended approximately $9.2 million from U.S. Department of Transportation (DOT) grant programs. RSM determined that DOT's major program was the Airport Improvement Program.Our QCR objectives were to determine (1) whether the audit work complied with the Single Audit Act of 1984, as amended, and the Office of Management and Budget's Uniform Guidance, and the extent to which we could rely on the auditors' work on DOT's major program; and (2) whether the City's reporting package complied with the reporting requirements of the Uniform Guidance.What We FoundRSM's audit work complied with the requirements of the Single Audit Act, the Uniform Guidance, and DOT's major program. We found nothing to indicate that RSM's opinion on DOT's major program was inappropriate or unreliable. However, we identified a deficiency in the City's reporting package that will require corrective action in future audits.

VA contracts for Medical Disability Examinations from non-VA medical sources on behalf of veterans and active military members. One of the companies VA contracts with to conduct these exams is QTC Medical Services (QTC). The VA Office of Inspector General (OIG) and independent auditors have previously conducted reviews of QTC’s contracts, which identified significant questioned costs largely due to differences in Medicare billing rates and use of proprietary Medicare codes. Later reviews performed by independent auditors found additional deficiencies in subsequent QTC contracts. The OIG review could not determine if or how these were resolved with QTC. This OIG review was conducted to ensure corrective measures to address prior identified issues were sustained and to follow up on recent billing practices. The review team focused on one of four contracts that VA awarded to QTC effective November 28, 2018, because the four contracts were identical except for geographical coverage. The OIG team sampled two months of billings totaling more than $12 million under the selected contract. This review focused on two issues found to be of concern in previous reviews: 1. Contract overbilling; 2. National Correct Coding Initiative (NCCI) edits to prevent duplicate billing. The review resulted in no negative findings or recommendations. The OIG review team concluded that QTC adequately followed billing requirements for the contract and did not materially overbill VA for services rendered through February 28, 2019. VA’s Office of Acquisition, Logistics, and Construction commented in its review of the report, “OALC appreciates this follow-up review. It demonstrates that our corrective actions were successful and fully integrated into VA practices….”

A Customer Service Representative in Joliet, Illinois, was terminated from employment on March 16, 2020, following an administrative hearing for violating company policy. Our investigation found that the employee inappropriately used leave granted under the Family Medical Leave Act to engage in outside employment. Additionally, the employee was dishonest with our agents when we interviewed him during this investigation.