Federal Reports

EAC OIG, through the independent public accounting firm of Brown & Company, CPAs, audited EAC's financial statements for fiscal year 2018. The purpose of this letter is to convey a control weakness that did not rise to the level of a significant deficiency or material weakness.

The VA Office of Inspector General (OIG) conducted a focused evaluation of the quality of care delivered at the San Francisco VA Health Care System. The review covered key clinical and administrative processes associated with promoting quality care—Leadership and Organizational Risks; Quality, Safety, and Value (QSV); Credentialing and Privileging; Environment of Care; Medication Management: Controlled Substances Inspection Program; Mental Health: Posttraumatic Stress Disorder Care; Long-term Care: Geriatric Evaluations; Women’s Health: Mammography Results and Follow-up; and High-risk Processes: Central Line-associated Bloodstream Infections. Apart from the Director, the executive leaders were relatively new to their positions. The OIG noted the Facility leaders’ efforts to address nursing challenges, engage employees, and continue efforts to improve employee satisfaction. Patients were generally satisfied with the care provided. Organizational leadership appeared to support patient safety and quality care. However, organizational risk factors, such as potential underreporting of adverse events and lack of an integrated and functional senior level QSV framework, may contribute to future issues of noncompliance and/or lapses in patient safety. The leaders should continue to take actions to improve care and performance of selected Quality of Care and Efficiency metrics likely contributing to the current “3-Star” rating. The OIG noted findings in five of the clinical operations reviewed and issued 12 recommendations that are attributable to the Director, Chief of Staff, and Associate Director. The identified areas with deficiencies are: (1) QSV • Physician Utilization Management Advisors’ documentation of decisions • Interdisciplinary review of utilization management data (2) Credentialing and Privileging • Focused Professional Practice Evaluation process (3) Environment of Care • Environment cleanliness • Protection of patient health information • Documentation of response time during panic alarm testing • Annual review of comprehensive emergency management plan (4) Medication Management: Controlled Substances Inspection Program • Annual physical security survey • Order verification • Monthly inspections (5) Long-term Care: Geriatric Evaluations • Program evaluation

The VA Office of Inspector General (OIG) contracted with the independent public accounting firm, CliftonLarsonAllen LLP (CLA), to audit VA’s financial statements as of September 30, 2018 and 2017, and for the fiscal years (FY) then ended. This audit is an annual requirement of the Chief Financial Officers Act. CLA provided an unmodified opinion on VA’s financial statements for FYs 2018 and 2017. With respect to internal control, CLA identified five material weaknesses: (1) community care obligations, reconciliations, and accrued expenses; (2) financial systems and reporting; (3) information technology security controls; (4) compensation, pension, burial, and education actuarial estimates; and (5) entity level controls including chief financial officer organizational structure. CLA further identified two significant deficiencies: (1) loan guarantee liability; and (2) procurement, undelivered orders, accrued expenses, and reconciliations. CLA also reported VA’s substantial noncompliance with federal financial management systems requirements and the United States Standard General Ledger at the transaction level under the Federal Financial Management Improvement Act. CLA noted improvements were needed to fully comply with the intent of the Federal Managers’ Financial Integrity Act. They cited instances of noncompliance with Title 38 United States Code §5315 pertaining to the charging of interest and administrative costs and Title 38 United States Code §3733 pertaining to the vendee loan program. They noted VA reported one violation of the Antideficiency Act and was in the process of reporting a second one. VA identified five other violations carried forward from prior years that are under further discussion. They also noted noncompliance with the Improper Payments Elimination and Recovery Act for FY 2017, as reported by the OIG. CLA made recommendations for addressing each of the material weaknesses and significant deficiencies. CLA is responsible for its audit report dated November 26, 2018, and the conclusions expressed in it.

The VA Office of Inspector General (OIG) conducted a focused evaluation of the quality of care delivered in the inpatient and outpatient settings of the William S. Middleton Memorial Veterans Hospital. The review covered key clinical and administrative processes associated with promoting quality care—Leadership and Organizational Risks; Quality, Safety, and Value; Credentialing and Privileging; Environment of Care; Medication Management: Controlled Substances (CS) Inspection Program; Mental Health: Posttraumatic Stress Disorder; Long-term Care: Geriatric Evaluations; Women’s Health: Mammography Results; and High-risk Processes: Central Line-associated Bloodstream Infections. The Facility had stable executive leadership and active engagement with employees and patients. The OIG reviewed accreditation agency findings, adverse events, Patient Safety Indicator data, and Strategic Analytics for Improvement and Learning results and did not identify any substantial organizational risk factors. The OIG noted findings in two of the eight areas reviewed and issued four recommendations attributable to the Director and the Chief of Staff. The identified areas with deficiencies are: (1) Credentialing and Privileging • Focused and Ongoing Professional Practice Evaluation processes (2) Medication Management: CS Inspection Program • CS Inspectors free of conflicts of interest • Reconciliation of CS return to stock • Verification of drugs held for destruction