Federal Reports

From January 1, 2015, through March 31, 2017 (audit period), Kelley Medical Equipment and Supply, LLC (Kelley Medical), which is located in Durant, Oklahoma, did not always comply with Medicare requirements when billing for selected orthotic braces (i.e., back, knee, and ankle-foot braces). For 24 of the 100 sampled beneficiaries, Kelley Medical complied with the requirements. However, for the remaining 76 beneficiaries, it did not comply with the requirements. Specifically, Kelley Medical billed for orthotic braces that were not medically necessary for 67 beneficiaries and could not provide medical records for 9 beneficiaries.

In the Spring of 2018, the Department of Justice and Department of Homeland Security (DHS) implemented a "zero-tolerance policy" for certain immigration offenses. As a result, DHS separated large numbers of alien families, with adults being held in Federal detention while their children were transferred to the care of the Office of Refugee Resettlement (ORR) within the Department of Health and Human Services (HHS). On June 26, 2018, in a class action lawsuit, Ms. L v. U.S. Immigration and Customs Enforcement (ICE), a Federal District Court ordered the Federal Government to identify and reunify separated families who met certain criteria. Given the potential impact of these actions on vulnerable children and ORR operations, the Office of Inspector General (OIG) conducted this review to determine the number and status of separated children (i.e., children separated from their parent or legal guardian by DHS) who have entered ORR care, including but not limited to the subset of separated children covered by Ms. L v. ICE.

In the Spring of 2018, the Department of Justice and Department of Homeland Security (DHS) implemented a "zero-tolerance policy" for certain immigration offenses. As a result, DHS separated large numbers of alien families, with adults being held in Federal detention while their children were transferred to the care of the Office of Refugee Resettlement (ORR) within the Department of Health and Human Services (HHS). On June 26, 2018, in a class action lawsuit, Ms. L v. U.S. Immigration and Customs Enforcement (ICE), a Federal District Court ordered the Federal Government to identify and reunify separated families who met certain criteria. Given the potential impact of these actions on vulnerable children and ORR operations, the Office of Inspector General (OIG) conducted this review to determine the number and status of separated children (i.e., children separated from their parent or legal guardian by DHS) who have entered ORR care, including but not limited to the subset of separated children covered by Ms. L v. ICE.

This healthcare inspection assessed allegations that over a multi-year period, providers at three facilities ordered or continued to order a high dose of an antidepressant medication amitriptyline for a patient who was not told about the risks of the high dose, and was experiencing some side effects associated with the medication. Additionally, when asked about attempts to reduce the dose of the patient’s medication, the VA Illiana Health Care System (system) in Danville, Illinois, provided Senator Joe Donnelly inaccurate information. The Office of Inspector General (OIG) substantiated VA providers did not explain to the patient that the amitriptyline dosing was higher than the drug labeling for outpatients or the risks of the high dosage during the period of care from 2012 through mid-2018. In 2012, a provider at the Orlando VA Medical Center (VAMC) in Florida ordered an electrocardiogram but did not inform the patient about an abnormality or discuss the potential that the high dose of amitriptyline contributed to the abnormality. At another VAMC in Indianapolis, Indiana, the ordering provider did not notify the patient that 2016 test results indicated a subtherapeutic level of amitriptyline. At the system, there was no follow-up to the patient’s expressed cardiac concerns due to a failed collaboration between the system’s treating psychiatrist and a primary care provider. Due to other potential causes, the OIG was unable to substantiate the patient experienced tachycardia or short-term memory loss because of taking amitriptyline. The system’s response to Senator Donnelly was not timely and included inaccurate information. The OIG made eight recommendations related to evaluations of the patient’s cardiac care, patient notification of electrocardiograms and blood tests, the strengthening of system processes for effective clinical consultation between providers and congressional inquiry responses, and an evaluation of system staff actions in preparation of the letter to Senator Donnelly.

Although the U.S. Department of Health and Human Services (HHS), Centers for Medicare & Medicaid Services (CMS), has made significant progress in the timely resolution of audit recommendations since our previous review (of Federal fiscal years (FYs) 2006 and 2007), CMS did not always resolve audit recommendations in a timely manner during FYs 2015 and 2016. Specifically, CMS resolved 1,231 of the 1,371 recommendations that were outstanding during FYs 2015 and 2016. However, it did not resolve 405 of the 1,231 recommendations (32.9 percent) within the required 6-month resolution period. In addition, as of September 30, 2016, CMS had not resolved 140 audit recommendations that were past due for resolution. Some of the past-due recommendations had associated dollar amounts that totaled $138.6 million; others were procedural in nature.

The unclassified version of the SAR covers the period from April 1, 2018, through September 30, 2018, and reflects what NSA OIG could release publicly about its work for that reporting period. The OIG issued 21 reports and oversight memoranda during that period, making 620 recommendations to assist the Agency in addressing the findings and deficiencies identified. NSA’s management agreed with all OIG recommendations made during this period. The Director of the NSA and Congress previously received the classified version of the SAR in accordance with the IG Act.