Federal Reports

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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 VA Palo Alto Health Care System (Facility). 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 Inspection Program; Mental Health Care: Post-Traumatic 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.The Facility had generally stable executive leadership and active engagement with employees and patients to maintain high satisfaction scores. Organizational leadership supported patient safety, quality care, and other positive outcomes. The OIG’s review of accreditation organization findings, sentinel events, disclosures, Patient Safety Indicator data, and Strategic Analytics for Improvement and Learning results did not identify any substantial organizational risk factors. However, the OIG is concerned with the lack of Patient Safety Indicator data review and action. The senior leadership team should also continue to take actions to improve care and performance of selected Quality of Care and Efficiency metrics likely contributing to the “2-Star” rating.The OIG noted findings in four of the eight areas of clinical operations reviewed and issued eight recommendations that are attributable to the Director, Chief of Staff, and Associate Director. The identified areas with deficiencies are:(1) Quality, Safety, and Value• Documentation of Physician Utilization Management Advisor decisions• Reporting and documentation of patient incidents• Completion of annual Patient Safety Reports(2) Environment of Care• Attendance of Environment of Care rounds• Panic alarm testing at community based outpatient clinics(3) Medication Management: Controlled Substances Inspection Program• Controlled substances (CS) monthly inspections• CS reconciliation(4) Long-term Care: Geriatric Evaluations• Program oversight

We found that the Federal Emergency Management Agency (FEMA) overpaid its employees because it mistakenly believed the Department’s payroll provider had an automated control to prevent payments over the annual cap, and because it did not follow its own premium pay policy. We also found that FEMA has no effective policy or practice to determine the Fair Labor Standards Act status of FEMA employees during disaster deployments, which also contributed to this issue. Since discovering the overpayments, FEMA has been working to calculate how many people were overpaid, but it cannot finish that analysis until it addresses a number of outstanding questions.

At the request of the Tennessee Valley Authority's (TVA) Supply Chain, we examined the cost proposal submitted by a company for civil projects and coal combustion residual program management work at TVA's steam electric power plants. Our examination objective was to determine if a company's cost proposal was fairly stated for a planned <br> $50 million contract.In our opinion, the company's cost proposal was overstated. Specifically, we found:The company's proposed costs for a Cumberland Fossil Plant project included overstated (1) overhead/general and administrative rates, (2) equipment costs, (3) labor burden rates, and (4) temporary living allowance costs. In addition, the company's Cumberland Fossil Plant proposal included (1) a fee rate that exceeded the maximum allowable fee rate in TVA's request for proposal and (2) understated bond costs.</li> The company's proposed rate attachments included (1) noncraft wage ranges that did not reflect the company's current wage ranges, (2) incorrect and missing labor billing rates, (3) excessive time and material rates, and (4) excessive equipment rental rates.</li>We estimated TVA could avoid $5.57 million on the planned $50 million contract by (1) negotiating appropriate reductions to the company's proposed overhead/general and administrative rates, equipment costs, labor burden rates, and temporary living allowance costs; (2) limiting the company's fee rate to the request for proposal's maximum allowable rate; and (3) negotiating appropriate revisions to the company's bond costs to reflect its actual bond costs. In addition, we suggest TVA negotiate revisions to the company's contract rate attachments to correct errors and more accurately reflect the company's actual wage ranges and costs.(Summary Only)

WakeMed Raleigh Campus (the Hospital), located in Raleigh, NC, complied with Medicare billing requirements for 187 of the 263 inpatient claims that we reviewed. However, the Hospital did not fully comply with Medicare billing requirements for the remaining 76 claims, resulting in net overpayments of approximately $250,000 for the audit period. On the basis of our sample results, we estimated that the Hospital received overpayments of at least $697,000 for the audit period. These errors occurred primarily because the Hospital did not have adequate controls to prevent the incorrect billing of Medicare claims within the selected risk areas that contained errors.