Federal Reports

The Veterans Health Administration (VHA) is the nation’s largest care provider for chronic hepatitis C virus infection, with rates about three times the national average. Direct-acting antivirals (DAA) can cure chronic hepatitis C, and Congress appropriated over $3 billion between fiscal years 2015–2017 to provide such treatment for infected veterans. The VA Office of Inspector General (OIG) conducted this review to assess VHA facilities’ care of patients with chronic hepatitis C. In one study population, the OIG found that 8,813 (55 percent) of 15,940 patients who tested positive for chronic hepatitis C did not receive DAA treatment. VHA providers documented acceptable reasons for nontreatment for 85.5 percent of these patients. Acceptable reasons included when the patient received treatment outside VHA, deferred or declined treatment, or did not respond to contact attempts by VHA. Other patients did not receive treatment for reasons that were unidentifiable (11.6 percent) or indeterminate (2.9 percent) to the OIG, hindering its ability to evaluate providers’ plans to offer these patients treatment or specialty care referrals. The OIG also found that 9.6 percent of patients who completed DAA treatment did not receive posttreatment testing to confirm they were cured, although the OIG was unable to determine the reasons why testing was not done. In a second study population of 5,467 patients, the OIG assessed whether those who tested positive for hepatitis C antibodies received further confirmatory testing for chronic hepatitis C infection as required. An estimated 99.1 percent of these patients had confirmatory testing completed. The OIG made two recommendations to the VHA Executive in Charge to ensure patients with chronic hepatitis C have provider treatment considerations documented and that providers obtain and document posttreatment follow-up testing in the patients’ medical record in alignment with VA National Viral Hepatitis Program Guidelines.

On November 30, 2018, the VA Office of Inspector General (OIG) received a request from 12 senators and one congressman to investigate allegations that VA planned to withhold retroactive payments for missed or underpaid monthly housing stipends for students under the Harry W. Colmery Veterans Education Assistance Act, also known as the Forever GI Bill. This Issue Statement discloses the information that the OIG provided to those members of Congress with some additional context. During December 2018 and January 2019, OIG staff conducted interviews with VA and contract personnel involved in the Forever GI Bill implementation efforts. The OIG also reviewed internal VA documents and the results of an independent assessment conducted by the MITRE corporation. The OIG found that the Veteran’s Benefits Administration (VBA) failed to modify their electronic systems by the required date to make accurate housing allowance payments under sections 107 and 501. These sections fundamentally redesign how VBA pays monthly housing allowances to veterans using the Post-9/11 Educational Assistance Program. VA lacked an accountable official to oversee the project during most of the effort. This resulted in unclear communication and inadequately defined expectations of the VA offices and contractors involved. In November 2018, the VA Secretary named the Under Secretary for Benefits as the official responsible for implementing the Forever GI Bill. The OIG conducted this review in accordance with the Council of the Inspectors General on Integrity and Efficiency’s Quality Standard for Inspection and Evaluation, except for the advance reporting standards. Due to the nature of the objective to respond to congressional inquiries and disclose that information to the VA and the public, not distributing a draft to VA did not have an effect on this Issue Statement and there are no recommendations requesting VA’s response.

We conducted this review to determine whether the Department of Health and Human Services (HHS) had addressed known vulnerabilities in its oversight of the Small Business Innovation Research (SBIR) program to ensure that program funds were being spent appropriately. In 2014, we reported vulnerabilities within HHS's SBIR program and made four recommendations to improve HHS's oversight. HHS implemented two recommendations from our 2014 report prior to this review. However, HHS had not formally notified OIG of any actions to implement the two outstanding recommendations-with which HHS had concurred-regarding awardee eligibility and duplicative funding. Since implementation of the SBIR program in 1982, HHS has obligated or awarded nearly $13 billion in awards to small businesses pursuing innovative research ideas.