Federal Reports

The VA Office of Inspector General (OIG) conducted a focused evaluation of the quality of care at the Louis A. Johnson VA Medical Center (Facility). 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 (EOC); Medication Management: Controlled Substances (CS) Inspection Program; Mental Health Care: 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. At the time of the OIG site visit, the leadership team had been working together for nine months. Facility leaders were generally engaged with patients; working to improve employee satisfaction scores; and appeared to support efforts related to patient safety, quality care, and other positive outcomes. However, the presence of organizational risk factors—lack of identification, tracking, and reporting of sentinel events and disclosure of adverse events—may contribute to future issues of noncompliance and/or lapses in patient safety unless corrective processes are implemented and monitored. The leadership team should continue to take actions to improve care and maintain performance of selected Strategic Analytics for Improvement and Learning (SAIL) Quality of Care and Efficiency metrics likely contributing to the current “4-Star” rating. The OIG noted findings in five of the clinical operations reviewed and issued nine recommendations that are attributable to the Director, Chief of Staff, Associate Director for Patient Care Services, 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 • Ongoing Professional Practice Evaluation processes (3) EOC • General safety • Emergency power testing and availability (4) Medication Management: CS Inspection Program • CS reconciliation • Verification of Orders (5) High-Risk Processes: Central Line-Associated Bloodstream Infections • Staff education

The OIG investigated allegations that a tribe had improperly removed funds from the bank account of a tribally controlled school funded by the Bureau of Indian Education (BIE). We investigated whether the tribe exceeded its authority in removing the funds and whether any of the funds had been stolen.We found that the tribe did not exceed its authority by removing the funds and that no funds had been stolen. We found that the tribe removed the funds as part of an effort to spend down a $3 million surplus that had accumulated in the school’s account over several years.

Professional Clinical Laboratory, Inc. (ProLab) generally did not comply with Medicare requirements for billing travel allowances. Specifically, of the 100 travel allowance claim lines in our stratified random sample, 35 claim lines complied with Medicare requirements and 65 claim lines did not (some lines had multiple deficiencies). ProLab did not (1) support prorated miles with documentation when multiple patients were served on a single trip, (2) resubmit claims when there was a retroactive change in the clinical laboratory fee schedule, and (3) have documentation to support specimen collections.

Ohio made capitation payments totaling $90.5 million on behalf of deceased beneficiaries. We confirmed that all beneficiaries associated with the 100 capitation payments in our stratified random sample were deceased. Ohio properly recovered 37 of these capitation payments. However, Ohio did not recover the remaining 63 capitation payments totaling $74,495 ($51,431 Federal share). On the basis of our sample results, we estimated that Ohio did not recover unallowable payments to Medicaid Managed Care Organizations totaling at least $51.3 million ($38 million Federal share) during our audit period.