Federal Reports

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The OIG initiated an inspection to assess allegations regarding quality of care concerns at the facility with a focus on a patient’s care who transferred from the facility’s Community Living Center to the Emergency Department. The patient died in the Emergency Department. The OIG found delays and deficits in the patient’s care in the Emergency Department. An Emergency Department registered nurse failed to initiate cardiac and oxygen saturation monitoring. Deficiencies were also identified in medical decision making, provision of care, and handoff communication by an Emergency Department physician. The OIG determined that deficits in the physician’s practices were not limited to this case and shared these concerns with facility leaders. The physician was placed on a summary suspension and a management review of the physician’s practice was conducted, resulting in identification of “significant recurrent concerns” with the physician’s management and documentation. The facility’s Clinical Executive Board revoked the physician’s privileges. The physician appealed the decision. The VA Disciplinary Appeals Board overturned the physician’s removal from service; however, the physician subsequently resigned. The OIG identified concerns related to the facility’s quality management processes; the facility established a new standard for initiating management reviews to address those concerns. The OIG did not substantiate that the Emergency Department registered nurse was involved in additional patient deaths or that Emergency Department night-shift staffing was inadequate. Implementation of Emergency Department standing orders was inconsistent, and facility staff incorrectly destroyed a focused professional practice evaluation. Thirteen recommendations were made related to provider training, policy concerning transitions of care, standing orders, monitoring of critically ill patients, peer review training, Peer Review Committee documentation, leaders’ responses to identification of care concerns, Emergency Department supplies, bar code medication administration compliance, and document management procedures.

When Congress established average sales price (ASP) as the basis for Medicare Part B drug reimbursement, it also provided a mechanism for monitoring market prices and limiting potentially excessive payment amounts.

We determined that the Colorado Department of Public Safety, Division of Homeland Security and Emergency Management’s technical assistance and monitoring of the City of Evans’ (City) procurement and project-related activities are effective and that FEMA’s corrective actions met the intent of our recommendation 2. We also determined that the City awarded contracts according to Federal regulations and FEMA guidelines. If Colorado’s technical assistance and monitoring continue, FEMA should have reasonable assurance the City will spend the remaining $7.17 million in grant funds for eligible disaster work according to Federal regulations.

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The OIG investigated allegations that Doris White, Cheyenne River Sioux Tribe, Eagle Butte, SD, stole trust income from her family members who had inherited income-generating land. The Bureau of Indian Affairs held the land in trust and the Office of the Special Trustee for American Indians (OST) administered the income.We substantiated the allegation. White admitted to us that her family members were not aware of the oil and gas royalty income generated by the land and that between 2005 and 2017, she stole nearly $1.4 million from their accounts. She intentionally concealed the lease income by hiding, and eventually destroying, the family members’ account statements. White said she used the stolen money on herself and her family members.White pleaded guilty in U.S. District Court for the District of South Dakota, Central Division, to one count of larceny, 18 U.S.C. §§ 661 and 1153, and was sentenced to 3 months in prison. She agreed to pay $1,398,713.83 in restitution to her family members.

A prior OIG audit found that New York made more than $7 million in unallowable Federal Medicaid payments to different managed care organizations (MCOs) for the same month for beneficiaries assigned more than one Medicaid identification (ID) number. A recent analysis of Medicaid data showed that New York continued to make these improper payments despite the improvements it made to its processes for identifying beneficiaries with multiple Medicaid ID numbers.

Adam Micek, a resident of Queens, New York, pleaded guilty in U.S. District Court, Eastern District of New York, on February 20, 2020, to conspiracy to commit wire fraud for his involvement in an Amtrak eVoucher scheme. Micek and his co-conspirators used stolen credit card information to make unauthorized purchases of Amtrak tickets and then cancelled or exchanged those tickets for eVouchers. Subsequently, they sold the fraudulently obtained eVouchers on the internet. Micek’s sentencing is pending.