Federal Reports

We reviewed the oversight of opioid prescribing and the monitoring of opioid use in Washington State. This factsheet shows Washington State's responses to our questionnaire covering five categories related to its approach to addressing the opioid epidemic: policies and procedures, data analytics, outreach programs, and other efforts. The information in this factsheet, along with information from seven additional States, will be summarized in a report to the Centers for Medicare & Medicaid Services.

National Protection and Programs Directorate (NPPD) Chief of Staff requested a review to determine whether Federal Protective Service (FPS) inspectors’ positions were classified correctly for purposes of earning overtime under the Fair Labor Standards Act. Although properly classified as non-exempt, inspectors’ excessive use of overtime does raise significant concerns. Specifically, 11 of the 19 inspectors reviewed frequently worked multiple 17- to 21-hour shifts with no days off in between. This kind of extensive overtime allowed seven inspectors to earn more than the most senior executives in the Federal Government, with three earning more than the Vice President of the United States. Furthermore, FPS’ increasing use of overtime contributed to a projected budget shortfall for fiscal year 2018, potentially putting the FPS mission at risk. The inspectors were able to accumulate the extensive overtime because of poor internal controls, such as management not monitoring the use of overtime.

The VA Office of Inspector General (OIG) conducted an inspection to determine the validity of allegations that when a patient’s primary care provider left, the patient did not have another primary care provider assigned for over a year. The patient also allegedly experienced delays in scheduling dermatology care at the Joint Ambulatory Care Center (JACC) in Pensacola, Florida—a community based outpatient clinic of the Gulf Coast Veterans Health Care System in Biloxi, Mississippi. The OIG determined that a new primary care provider was assigned to the patient approximately nine months after the previous provider left the system. During the interim period, the patient remained assigned to a provider who was no longer employed at JACC. The patient experienced a scheduling delay of approximately three months for a dermatology consult. The delay occurred because the dermatologist had not followed Veterans Health Administration (VHA) requirements and had changed the appointment date beyond the date requested by the primary care provider. Although the patient received treatment and did not experience an adverse clinical outcome, the risk increased because of the delay. The OIG reviewed other JACC dermatology consults and found scheduling delays in 46 percent initiated during fiscal year 2017. The patients with delays did not experience adverse clinical outcomes, although the risk was increased for one patient. System staff reported insufficient scheduling personnel as one reason for delays. The OIG also determined that documented electronic health record communications between two providers did not meet VHA requirements and contained critical and derogatory comments. Four recommendations related to primary care provider assignment, scheduling dermatology appointments, reviewing staffing levels, and improper electronic health record documentation were made.