Federal Reports

The VA Office of Inspector General (OIG) conducted this audit to determine whether appeals of non-VA care claims decisions were effectively managed and processed. An earlier audit identified a significant risk that the Office of Community Care’s Payment Operations and Management (POM) directorate was not effectively managing Veterans Health Administration (VHA) appeals. When POM does not effectively identify and process claimants’ appeals, veterans are at risk of becoming financially liable for wrongfully denied non-VA care claims. The audit focused on POM’s management of appeals before the Veterans Appeals Improvement and Modernization Act of 2017 took effect on February 19, 2019, as well as VHA’s readiness to implement the act’s appeals process. Before the act took effect, claimants could only send appeals of denied claims to POM for initial review. Now, veterans can choose to appeal for either a higher review or supplemental claim decision, or veterans or providers can send appeals directly to the Board of Veterans’ Appeals. The OIG found significant deficiencies with POM’s management of appeals of non-VA care claims decisions. Unprocessed and unaccounted-for appeals were stored in cabinets, boxes, and bins at facilities. Office of Community Care leaders lacked effective oversight of its appeals function, and POM leaders had not clearly defined the appeals manager’s roles and responsibilities. The audit team concluded VHA and the POM directorate failed to effectively oversee appeals management and processing before and after implementation of the new law. VHA did not effectively prepare for the new appeals process and faces significant challenges in identifying and processing appeals. The OIG made eight recommendations to improve appeals management, including identifying and processing existing appeals, ensuring incoming appeals go to facilities that will process them, providing staff clear policies and procedures, and ensuring appropriate access and use of the appeals system of record for employees.

The Office of Inspector General contracted with the independent certified public accounting firm of Harper, Rains, Knight & Company, P.A. (HRK) to conduct a performance audit of the U.S.Equal Employment Opportunity Commission's (EEOC) compliance with the Digital Accountability and Transparency Act of 2014 (DATA Act) financial and award data submissionsfor the first quarter of fiscal year 2019.

Based on our data analysis for fiscal year (FY) 2019, Quarter (Q) 3, we identified the Far Rockaway MPO and Park Station had local purchases and payments totaling $10,583. The local purchases for miscellaneous services for the Far Rockaway MPO and Park Station were 70 percent of the overall amount of local purchases for miscellaneous services in the Triboro District for the same timeframe. In addition, this amount was the third highest in the nation. The Far Rockaway Park Station Manager was the former Far Rockway MPO Postmaster and the manager for all eight local purchases and payments.Our objective was to determine whether local purchases and payments made at the Far Rockaway MPO and Park Station were valid and properly supported and processed.

Major Management Challenges Facing the Railroad Retirement Board

This Comprehensive Healthcare Inspection Program provides a focused evaluation of the quality of care delivered at the Charlie Norwood VA Medical Center, covering leadership, organizational risks, and key processes associated with promoting quality care. Focused areas were Quality, Safety, and Value; Medical Staff Privileging; Environment of Care; Medication Management: Controlled Substances Inspections; Mental Health: Military Sexual Trauma Care; Geriatric Care: Antidepressant Use among the Elderly; Women’s Health: Abnormal Cervical Pathology Results; and High-Risk Processes: Emergency Department/Urgent Care Center Operations. The facility’s leaders had been working together since December 2018, have opportunities to improve employee satisfaction and patient experiences, and supported efforts related to safety and quality care. However, the OIG had concerns regarding surgical procedure sentinel events and the lack of a process to capture, track, and trend patient safety indicator data. The leaders were aware of Strategic Analytics for Improvement and Learning (SAIL) metrics but should take actions to improve performance contributing to the facility’s SAIL “2-star” quality ratings. The OIG issued 24 recommendations for improvement: (1) Quality, Safety, and Value • Timely completion, improvement action implementation, and quarterly review of peer reviews • Interdisciplinary utilization management data reviews (2) Medical Staff Privileging • Focused and ongoing professional practice evaluation processes (3) Environment of Care • General safety and cleanliness • Inventory of assets and resources • Review of comprehensive emergency operations plan (4) Medication Management • Leadership oversight of controlled substances summary of findings and trends • Inspectors’ annual competency assessments • Monthly physical inventories • Reconciliation of dispensing and return of stock • Verification of orders, drugs held for destruction, prescription pads, hard copy prescriptions, and 72-hour inventory (5) Mental Health • Military sexual trauma training (6) Women’s Health • Women Veterans Health Committee membership and meetings • Cervical cancer screening data tracking/follow-up • Patient notification of abnormal results (7) Emergency Departments and Urgent Care Center Operations • Backup call schedule

The Southgate, MI, Post Office is in the Detroit District of the Great Lakes Area. Employees use Account Identifier Code (AIC) 526, Refund Spoiled/Unused Customer Meter Stamps, to record refunds of spoiled/unused postage meter stamps from customer postage meters. OIG data analytics identified the Southgate, MI, Post Office with $125,012, or a 324 percent increase, in refunds from April 1 through August 31, 2019, compared to April 1 to August 31, 2018.The spoiled and unused customer meter stamp refunds for the Southgate Post Office were 61 percent of the overall amount of refunds in the Detroit District for the same timeframe. This percentage ranked the highest in the Detroit District. Our objective was to determine whether meter refunds were properly issued, supported, and processed.

Except for identified questioned costs, reported DHS Purchase and Travel Card transactions for FY 2017 were appropriate and complied with relevant laws and regulations. The auditor, CohnReznick LLP, identified 17 control deficiencies within DHS Purchase and Travel Card Programs related to maintenance of purchase documentation, application of required procurement policies, price reasonableness determinations, price quotes/competitive bids, required sourcing, tax exemptions, and split purchases. The DHS Travel Card Program deficiencies related to maintenance of travel documentation, allowability of transactions per regulations, credit balance refunds, the prudent traveler standard, and improper use of a travel card. The auditor identified $43,508 in questioned costs for FY 2017 and made 12 recommendations. When implemented, these recommendations should ensure that Purchase and Travel Card transactions are appropriate and comply with relevant laws and regulations. The Office of the Chief Financial Officer concurred with six recommendations and non-concurred with six recommendations.

From fiscal years 2015 through 2018, in the midst of a growing opioid epidemic, U.S. Customs and Border Protection (CBP), U.S. Immigration and Customs Enforcement, Transportation Security Administration, and U.S. Secret Service appropriately disciplined employees whose drug test results indicated illegal opioid use, based on their employee standards of conduct and tables of offenses and penalties. Additionally, during the same time period, components have either implemented or are taking steps to evaluate whether employees using prescription opioids can effectively conduct their duties. For example, components have established policies prohibiting the use of prescription opioids that may impact an employee’s ability to work, in addition to requiring employees to report such prescription opioid use. They have also implemented or are in the process of implementing measures to evaluate the fitness for duty of employees using prescription opioids. These policies establish consistent standards components can use to ensure they are allowing employees to use legally-prescribed opioids, while also ensuring their workforce is capable of effectively performing their duties. We made two recommendations to improve components’ oversight of illegal and prescription opioid use by employees. CBP and Secret Service concurred with the recommendations, which are both resolved and open.