Federal Reports

Amtrak Express is a shipping program by which individuals can pay to ship packages and pallets on Amtrak trains between more than 100 locations. Our prior work helped identify security vulnerabilities with the program, including a drug-trafficking organization that used it to ship hundreds of packages of illegal drugs on trains from 2010 to 2016. This report evaluates the effectiveness of the program’s security controls and operations.We found that security weaknesses in Amtrak Express continue to place employees, passengers, and the company’s brand at risk, and operational inefficiencies continue to contribute to train delays among other impacts.To address the findings in our report, we recommended the company implement security controls to mitigate risks. Additionally, we recommended the company improve its paper-based, manual process, including investing in electronic tools to reduce operational inefficiencies that contribute to train delays and have other impacts.

Our objective was to determine whether the Fiscal Year (FY) 2014 personnel and indirect costs the Michigan Disability Determination Services (MI-DDS) claimed for reimbursement from the Social Security Administration (SSA) were allowable.

The VA Office of Inspector General (OIG) conducted a healthcare inspection to determine the validity of allegations regarding a hospitalist’s interactions with a patient and family when obtaining consent for do-not-resuscitate (DNR) status and determining discharge plans at the facility. The OIG was unable to determine whether the patient had decision-making capacity to consent to a DNR status when the hospitalist discussed life-sustaining treatment. The hospitalist followed policy when determining the patient’s decision-making capacity. The OIG did not substantiate that the facility failed to evaluate, plan, and coordinate the patient’s discharge. The discharge plan addressed the patient’s medications, nutrition needs, and aspiration precautions. The patient’s shortened hospital stay did not afford the Palliative Care Consult Team the opportunity to educate the patient and family about home-hospice services. After discharge, the family requested, and the patient received, home-hospice services and a nasogastric tube. The OIG was unable to determine whether the hospitalist demonstrated inappropriate and unprofessional behavior with the patient and family due to differing recollections of the interaction. While on-site, the OIG learned of three other patients for whom facility staff expressed concerns with the way the hospitalist presented prognoses and end-of-life treatment options to patients and families. The OIG team evaluated the three additional patient cases focusing on the hospitalist’s determination of patients’ DNR status. The hospitalist’s interactions lacked evidence of discussions of patients’ preferences and quality of life, which likely led to the patients’ and families’ requests to reverse DNR orders. The OIG determined that the facility had processes to provide oversight of physician behavior. The OIG made no recommendations.