Federal Reports

Adequate access to treatment is vital in addressing the escalating rates of addiction and mortality related to opioid misuse and abuse. Medication-assisted treatment (MAT) couples medication (such as buprenorphine, methadone, or naltrexone) with counseling and behavioral therapies to treat opioid use disorder. Since 2000, Congress has enacted several measures to increase the availability of MAT, including the creation and expansion of the Buprenorphine Waiver Program (waiver program). The waiver program allows physicians and certain other qualified providers to prescribe buprenorphine to patients in office settings rather than limiting this service to specialized opioid treatment programs. Despite these efforts, studies still show that only a small percentage of Americans who need treatment actually receive it.

Previous OIG audits found that States had improperly paid Medicaid managed care organizations (MCOs) capitation payments on behalf of deceased beneficiaries. We conducted a similar audit of the Indiana Family and Social Services Administration, which administers the Medicaid program.

This Comprehensive Healthcare Inspection Program provides a focused evaluation of the leadership performance and oversight by the Veterans Integrated Service Network (VISN) 1: VA New England Healthcare System, covering leadership and organizational risks and key processes associated with promoting quality care. For this inspection, the areas of focus were Quality, Safety, and Value; Medical Staff Privileging; Environment of Care; and Medication Management: Controlled Substances Inspections. The OIG conducted this unannounced visit while concurrent inspections of the following VISN 1 facilities were also performed: VA Central Western Massachusetts Healthcare System, Leeds, MA; Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA; and Manchester VA Medical Center, NH. The VISN 1 leadership team appeared relatively stable. Employee satisfaction scores were generally better than VHA averages. However, opportunities appear to exist for the network director to improve employee satisfaction; the deputy network director to model servant leadership; and the network director, deputy network director, and chief medical officer to reduce employee moral distress at work. Patient experience results were above VHA averages. VISN 1 leaders supported efforts to provide accessible and inclusive care for women veterans, and access metrics and clinician vacancies did not identify any significant organizational risks. Leaders appeared knowledgeable about efforts taken to reduce veteran suicide as well as selected Strategic Analytics for Improvement and Learning and community living center performance metrics; but should continue to support facility actions to improve care provided throughout VISN 1. The OIG issued 12 recommendations for improvement: (1) Quality, Safety, and Value • Acute inpatient stay reviews • Utilization management data reviews • Minimum of eight root cause analyses (2) Medical Staff Privileging • Focused and ongoing professional practice evaluation processes (3) Environment of Care • VISN comprehensive environment of care program • VISN emergency management committee processes (4) Medication Management: Controlled Substances Inspections • Quarterly trend report reviews

What We Looked AtWe queried and downloaded 84 single audit reports prepared by non-Federal auditors and submitted to the Federal Audit Clearinghouse between September 1, 2019 and December 31, 2019, to identify significant findings related to programs directly funded by the Department of Transportation (DOT). What We FoundWe found that reports contained a range of findings that affected DOT programs. The auditors reported significant noncompliance with Federal guidelines related to 19 grantees that require prompt action from DOT’s Operating Administrations (OA). The auditors also identified questioned costs totaling $1,135,453 for six grantees. RecommendationsWe recommend that DOT coordinate with the impacted OAs to develop a corrective action plan to resolve and close the findings identified in this report. We also recommend that DOT determine the allowability of the questioned transactions and recover $1,135,453, if applicable.