Federal Reports

The VA Office of Inspector General (OIG) conducted a healthcare inspection to evaluate care of a patient who died in a behavioral health unit at the Gulf Coast Veterans Health Care System, Biloxi, Mississippi. The specific concern was the unit staff’s failure to initiate full resuscitation efforts when the patient was found unresponsive (event). Behavioral health unit registered nurses (RNs) did not fulfill the position responsibilities or ensure accurate documentation for the patient. Unit staff did not initiate appropriate resuscitation efforts after finding the patient unresponsive. The OIG was unable to determine whether initiating full resuscitation efforts would have been successful if employed at the time the patient was found unresponsive. An RN inappropriately determined the patient’s death; staff did not consistently track documentation of the behavioral health unit RNs’ basic life support competency and training; and emergency department providers did not document a discussion with the admitting behavioral health provider. The behavioral health unit’s emergency cart was unlocked and contained an expired tubing package. The OIG identified deficiencies in the facility’s response to the event that included the reporting requirements to the State Licensing Board and consideration of an institutional disclosure. Despite the claim that staff initiated resuscitation for the patient, the OIG did not find documentation of therapeutic measures on required forms and the designated committee did not review the event. The OIG made nine recommendations related to emergency/code blue procedures, pronouncement of death, health record documentation, and review processes.

Account Identifier Code (AIC) 553, Refund Postage and Fees, is used to record refunds of customers postage and fees paid for special services not received. OIG data analytics identified the Bellmawr Main Window as having the highest amount recorded to AIC 553 during fiscal year (FY) 2018 quarter (Q) 4, and FY 2019, Q1. The objective of this audit was to determine whether postage and fee refunds were valid, properly supported, and processed at the Bellmawr Main Window.

The DOL-OIG Highlights is a bimonthly publication summarizing selected OIG significant concerns and accomplishments.

In response to a congressional request, the VA Office of Inspector General (OIG) conducted this audit to determine whether processors of non-VA emergency care claims inappropriately denied or rejected the claims, and, if so, whether the cause was pressure to meet production standards. The OIG conducted an accuracy review of claims for emergency medical care obtained outside VA and found that 31 percent of denied or rejected non-VA emergency care claims—with an estimated billed amount of $716 million—were inappropriately processed from April 1 through September 30, 2017, creating the risk of undue financial burden to an estimated 60,800 veterans. The review revealed that some of those denied and rejected claims should have been approved. The OIG estimated from its sample that about 17,400 veterans—with related bills totaling approximately $53.3 million—were negatively affected. The remaining processing errors still created a risk that the claimants did not receive complete and accurate information regarding why their claim was not approved, and therefore could not effectively respond with necessary information to obtain claim approval and payment. The OIG concluded there was a significant risk that some of the errors identified in this audit resulted from pressure to meet production targets, insufficient quality assurance of claims processing accuracy, and incentives associated with meeting production targets. The OIG made 11 recommendations to improve the accuracy of non-VA emergency claims processing that included addressing the culture of prioritizing claims productivity over accuracy, improving performance evaluation standards and review processes, tying incentives to all performance standards rather than just production quantity, reevaluating inappropriately processed claims, and improving internal and external communication about claim status.

To determine whether the Social Security Administration (SSA) had taken appropriate actions for Old-Age, Survivors and Disability Insurance beneficiaries over age 70 whose benefits were suspended for address, whereabouts unknown, or failure to return the foreign enforcement questionnaire.

This report presents the results of our self-initiated audit of Mail Delivery Issues – Broadview Station, Atlanta, GA. The Broadview Station is in the Atlanta District of the Capital Metro Area. This audit was designed to provide U.S. Postal Service management with timely information on potential mail delivery risks at the Broadview Station. The objective of this audit was to assess mail delivery service on selected routes at the Broadview Station in Atlanta, GA.