Federal Reports

Homeland Security Presidential Directive (HSPD) 12 requires that Federal agencies implement a government-wide standard for secure, reliable identification for their employees and contractors to access facilities and systems. ur objective was to assess DHS’ progress in implementing and managing the HSPD-12 program since our prior audits in 2007 and 2010. The Department of Homeland Security has not made much progress in implementing and managing requirements of the HSPD-12 program department-wide. Many of the same issues we previously reported in 2007 and 2010 pose challenges today.

When Arizona billed manufacturers for rebates for pharmacy and physician-administered drugs, it did so correctly. However, Arizona did not bill for and collect from manufacturers estimated rebates of $36.7 million ($25.6 million Federal share) for physician-administered drugs. For drugs that were eligible for rebates, Arizona did not bill for estimated rebates of $18.3 million (Federal share) for single-source and top-20 multiple-source physician-administered drugs. For drugs that may have been eligible for rebates, Arizona did not bill for estimated rebates of $7.3 million (Federal share) for other physician-administered drugs. Arizona did not always bill for and collect from manufacturers rebates because it did not have a system edit to ensure that National Drug Codes (NDCs) or valid NDCs were submitted for physician-administered drugs before October 1, 2012. Even after Arizona implemented the edit on October 1, 2012, this edit did not ensure that NDCs or valid NDCs were captured for all physician-administered drugs.

Audit Report

The OIG reviews decision analysis reports (DARs) in advance of Investment Review Committee (IRC) meetings to determine whether the requested investments are reasonable business decisions and are in the best interest of the U.S. Postal Service.In FY 2017, the OIG evaluated 64 DARs totaling $2.9 billion that required the Postal Service Headquarters Finance team’s validation and subsequent IRC approval or disapproval. We provided our individual reviews to DAR sponsors and the IRC considered these reviews during its approval process. Six of the 64 investment requests that we reviewed (totaling $1.42 billion) were subsequently canceled prior to receiving the Postmaster General’s approval.We determined that all DARs reviewed in FY 2017 were reasonable business decisions or in the best interest of the Postal Service; however, we identified concerns for eight DARs that totaled $218.8 million.

The Federal Emergency Management Agency (FEMA) estimated that the City of Cedar Falls, Iowa (City), had sustained approximately $893,000 in damage caused by severe storms and flooding from September 21 through October 3, 2016. We audited early in the grant process to identify areas in which the City may need additional technical assistance or monitoring to ensure compliance with Federal procurement requirements. Except for procurement, the City’s policies, procedures, and business practices appear to be adequate to account for and expend FEMA grant funds according to Federal regulations and FEMA policies. Specifically, the City’s procurement policies did not provide sufficient opportunities for disadvantaged firms to compete for contracts, or prevent awarding contracts to debarred or suspended contractors. After we discussed these issues, City officials moved quickly to modify procurement policies to comply with Federal requirements.

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The VA Office of Inspector General (OIG) conducted a focused evaluation of the quality of care delivered at the VA Northern California 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 (QSV); Medication Management: Anticoagulation Therapy; Coordination of Care: Inter-Facility Transfers; Environment of Care (EOC); High-Risk Processes: Moderate Sedation; and Long-Term Care: Community Nursing Home (CNH) Oversight. OIG also provided crime awareness briefings to 404 employees. The facility has generally stable executive leadership to support patient safety, quality care, and other positive outcomes; however, leaders should continue to take actions to improve outpatient satisfaction scores. OIG’s review of accreditation organization findings, sentinel events, disclosures, Patient Safety Indicator data, and Strategic Analytics for Improvement and Learning (SAIL) results did not identify any substantial organizational risk factors. Although the senior leadership team was knowledgeable about selected SAIL metrics, the leaders should continue to take actions to improve performance of the Quality of Care and Efficiency metrics likely contributing to the current 2-star SAIL rating. OIG noted findings in the six areas of clinical operations reviewed and issued 13 recommendations that are attributable to the Chief of Staff and Associate Directors. The identified areas with deficiencies are: (1) QSV • Peer review process • Review of Ongoing Professional Practice Evaluation data (2) Medication Management: Anticoagulation Therapy • Anticoagulation management policy • Laboratory testing • Employee competency assessments (3) Coordination of Care: Inter-Facility Transfers • Patient transfer documentation (4) EOC • EOC rounds attendance • Security surveillance television system testing • Locked mental health unit employee and Interdisciplinary Safety Inspection Team training  (5) High-Risk Processes: Moderate Sedation • Assessments of previous history/experience with sedation • Timeout checklist (6) Long-Term Care: CNH Oversight • Annual reviews • Monthly clinical visits