Federal Reports

This Comprehensive Healthcare Inspection Program (CHIP) provides a focused evaluation of the quality of care delivered at the James H. Quillen VA Medical Center. The inspection covers leadership and organizational risks and key clinical and administrative processes associated with promoting quality care. At the time of the review, the areas of focus were Quality, Safety, and Value; Medical Staff Privileging; Environment of Care; Medication Management: Controlled Substances Inspections; Mental Health: Military Sexual Trauma Follow-Up and Staff Training; Geriatric Care: Antidepressant Use among the Elderly; Women’s Health: Abnormal Cervical Pathology Results Notification and Follow-Up; and High-Risk Processes: Emergency Department and Urgent Care Center Operations. The facility’s executive leadership team appeared stable, with three of the four positions permanently filled for over one year prior to the OIG’s on-site visit. Selected survey scores related to employees’ satisfaction and trust in the facility’s executive leaders were better than VHA averages. Patient experience survey data revealed that scores related to satisfaction with the facility were above VHA averages. The OIG’s review of the facility’s accreditation findings, sentinel events, disclosures, and patient safety indicator data did not identify any substantial organizational risk factors. The leadership team was knowledgeable within their scope of responsibility about selected Strategic Analytics for Improvement and Learning (SAIL) and community living center (CLC) metrics but should continue to take actions to sustain and improve performance of measures contributing to the SAIL “4-star” and CLC “2-star” quality ratings. The OIG issued five recommendations for improvement in the following areas: (1) Medication Management: Controlled Substances Inspections • Completion of inspections on day initiated • Reconciliation of dispensing and return of stock for one random day • Emergency drug cache inspections (2) Geriatric Care: Antidepressant Use among the Elderly • Patient/caregiver education on medications

DHS components did not always properly solicit, award, and manage contracts according to Federal and departmental regulations. In fiscal year 2016, DHS awarded $2.4 billion in contract actions that were valued at less than $300 million per action. For this audit, we reviewed $153.2 million of the $2.4 billion in contract actions that DHS awarded. We found that components did not document their oversight in the procurement files for 18 — about 62 percent — of the 29 contract files reviewed. This represented about $112.1 million of the $153.2 million contract actions awarded in fiscal year 2016. This occurred because components lacked a comprehensive contract management process for maintaining contract files, and reviews conducted by procurement personnel did not ensure that contract personnel performed the required procurement processes. As a result of these deficiencies, two contract files valued at $4.9 million could not be located. In one instance, DHS was unable to address contractor performance issues to recover about $1 million. Also of note, six procurement documents from four contracts valued at $9.4 million did not have authorized signatures, one contracting officer exceeded the warrant authority by $12,500, and two firm-fixed-price contracts totaling $2.3 million were not finalized. Furthermore, components lost procurement documents, mismanaged contracts, and did not adhere to contract policy requirements. These problems resulted in misspent funds and impaired the government’s ability to take action when contractors do not comply with the terms of the procurement.

OIG data analytics identified the Concord MPO recorded local travel reimbursement in Account Identifier Code (AIC) 538, Local Travel Transportation, totaling $26,834, or 79 percent of all local travel reimbursements in the Bay Valley District for the period April 1, 2018, through February 28, 2019. Local travel reimbursements at the Concord MPO were $9,805 at the end of the first quarter of fiscal year (FY) 2019 and $12,346 for two months of activity of Quarter (Q) 2, FY 2019, significantly higher than the prior quarters. The objective was to determine whether local travel reimbursements at the Concord MPO were appropriate and properly supported.

During a prior review, we determined that New York claimed Medicaid reimbursement for home and community-based services (HCBS) under a Medicaid waiver program that did not comply with Federal requirements.New York's Nursing Home Transition and Diversion (NHTD) is an HCBS waiver program. Our objective was to determine whether New York claimed Medicaid reimbursement for NHTD waiver program services in accordance with certain Federal and State requirements.