Federal Reports

We determined that while the Commission has a system in place to account for funds on a project-by-project basis and generally expended Public Assistance grant funds according to FEMA guidelines, the Commission needs additional assistance in developing long-term solutions for repetitive damages to county roads and managing its $5.4 million FEMA grant. We found that the Commission did not receive adequate guidance from FEMA and Alabama concerning Hazard Mitigation funding for long-term solutions to repetitive damages to roads; thus, potentially costing FEMA millions of dollars in the future; and project formulation, causing improperly written project scopes. Additionally, the Commission did not have proper procurement procedures to ensure that small businesses, minority-owned firms, and women’s business enterprises have an opportunity to bid on Federal contracts; and adequate procedures to ensure proper documentation is collected to support $24,000 in costs. The report contains five recommendations to the Regional Administrator, FEMA Region IV, to provide the Commission with additional guidance to properly manage its $5.4 million and save millions in the future. FEMA agreed with all recommendations.

This study continues OIG's body of work examining overpayments made by Medicare. Overpayments can be identified by a number of key players including providers and Medicare contractors. Recovering overpayments is critical to reducing improper payments in the Medicare program. Past OIG work found that overpayments referred by program safeguard contractors (PSCs) for collection did not result in significant recoveries to the Medicare program. As of 2012, CMS had transitioned the workload of most PSCs to six zone program integrity contractors (ZPICs). In 2016, CMS began transitioning the remaining PSCs and ZPICs to unified program integrity contractors (UPICs). OIG's work on both PSCs and ZPICs identified deficiencies in how contractors were tracking and reporting overpayment data. This study provides an update on the collection of ZPIC- and PSC-referred overpayments and identifies ongoing challenges that contractors face in tracking and collecting overpayments identified by ZPICs and PSCs.

The OIG reviewed allegations the Veterans Health Administration (VHA) inappropriately used Government purchase cards to procure commonly used prosthetics, instead of establishing contracts to leverage VHA’s purchasing power, and failed to ensure fair and reasonable prices. Furthermore, VHA allegedly did not report purchases in the Federal Procurement Data System (FPDS). We substantiated the allegation that for some prosthetic purchases above the micro-purchase limit, VHA did not leverage its purchasing power by establishing contracts and did not ensure fair and reasonable prices. This occurred because VHA controls did not ensure the Prosthetic and Sensory Aids Service (PSAS) sufficiently analyzed prosthetic purchases to identify commonly used prosthetics and the Procurement and Logistics Office (P&LO) did not adequately monitor Network Contracting Office procurement practices to ensure contracts were established. We estimated VHA may have paid higher prices for an estimated $256.7 million in prosthetics purchases during fiscal year (FY) 2015 by not establishing contracts.We did not substantiate the allegation that VHA failed to report prosthetic procurements in FPDS. However, we determined VA medical facility staff improperly procured prosthetics above the micro-purchase limit without authority. We estimated VHA made improper payments and unauthorized commitments totaling about $520.7 million in FY 2015. If VHA staff does not ensure P&LO and PSAS implement our recommendations and newly established controls, they increase risks for improper payments and unauthorized commitments totaling about $2.6 billion over a five-year period.We recommended the Acting Under Secretary for Health take additional actions to identify all commonly used prosthetics offering opportunities for leveraging VHA’s purchasing power and pursue appropriate contracts. We also recommended the Acting Under Secretary review FYs 2015 and 2016 prosthetics transactions to identify unauthorized commitments for ratification, conduct annual reviews, and consider holding cardholders and their approving officials accountable for unauthorized commitments, as appropriate.

CNCS-OIG received an allegation that a CNCS State Program Officer may have falsified documents when she awarded a VISTA grant.The investigation found no evidence that the employee falsified documents pertaining to the awarding of the VISTA grant; however, the employee failed to follow the VISTA Desk Reference guidelines when she failed to obtain the proper documents and verify the 501(c) (3) nonprofit status before awarding the VISTA grant.

OIG conducted a healthcare inspection to assess allegations made regarding the management of outpatient post-traumatic stress disorder (PTSD) consults by the PTSD Clinical Team (PCT) at Battle Creek VA Medical Center (facility), Battle Creek, MI.Specifically the complainant alleged:• Between May and July 2016, consults were improperly designated as complete although a PCT provider had not evaluated the patient.• A mental health provider used computer-based and written psychological testing as a substitution for evaluations.• Staff psychologists were unproductive.We substantiated that some PCT consults were improperly identified as completed between May 1 and July 30, 2016. We substantiated that four of the five identified patients had PCT consults inappropriately designated as complete roughly between May 1 and July 30, 2016. In spring 2016, PCT managers changed their assessment process to include multiple clinic visits rather than a single one. The change caused confusion relating to when a consult was considered complete. We reviewed the care of all patients who received a PCT consult between January 1 and March 31, 2016, before the process change, and between May 1 and July 30, 2016, after the process change. We found 37 of the 111 (33 percent) consults were marked as completed prior to the assessment process with a provider. However, we did not find any of the patients suffered adverse clinical impact. We confirmed that PCT managers decided to return the PCT consult process to its previous operation prior to our site visit in August 2016. In that the consult scheduling process was corrected and we found no adverse impact to patients, we made no recommendation. We did not substantiate a mental health provider used computer-based and written psychological testing as a substitution for an evaluation or that psychologists had nonproductive work hours during the new scheduling process.We made no recommendations.

In November 2015, Congress referred to OIG an allegation that Veterans Integrated Service Network (VISN) 23 may have misused medical funding when procuring information technology (IT) equipment and that purchase orders and contracts appeared to bundle IT hardware and software together with medical equipment while classifying them exclusively as medical equipment. We sought to determine whether appropriate funds were used and procedures were followed for 30 purchase orders and associated contracts. We did not substantiate the allegation and determined the 30 orders (about $57.9 million) and contracts were for IT hardware, software, and services dedicated to patient care. We found all 30 purchase orders were appropriately funded with medical appropriations but that VISN 23 improperly funded 1 purchase for patient WiFi and cable television services (about $245,000) by using the wrong type of medical appropriation. VISN 23 used Medical Support and Compliance funds instead of Medical Services funds because VA’s Office of Information Technology (OIT) guidance on what VISN 23 was allowed to fund with IT appropriations was outdated, unclear, and incomplete. The Office of General Counsel’s (OGC’s) determination that funding patient WiFi using Medical Services funds was acceptable was not communicated to the Veterans Health Administration’s Chief Financial Officer (CFO). We recommended the VISN 23 Director consult with OGC and take corrective actions and also ensure that appropriate funds are used for future IT procurements following the most recent VA policy and OGC guidance. The Director should work with the CFO to determine if an Antideficiency Act violation occurred and take appropriate action. We recommended the Acting Assistant Secretary for OIT update the 2016 IT/Non-IT Policy to address the dissemination of decisions and issues that may be systemic across VA. The Director concurred with Recommendations 1 and 2 and reported corrective actions were completed. We will close them once documentation is received. The Acting Assistant Secretary concurred with Recommendation 3. The corrective action plan is acceptable and we will follow up on its implementation.

OIG evaluated quality of care at the VA Eastern Colorado Health Care System. This included reviews of processes that affect patient care outcomes—Quality, Safety, and Value (QSV); Environment of Care; Medication Management; Coordination of Care; Diagnostic Care; Moderate Sedation; Community Nursing Home Oversight; Management of Disruptive/Violent Behavior; and Mental Health (MH) Residential Rehabilitation Treatment Program (RRTP). OIG followed up on recommendations from the previous Combined Assessment Program and Community Based Outpatient Clinic and Primary Care Clinic reviews and provided crime awareness briefings to 138 employees.OIG identified certain system weaknesses in the QSV Committee; credentialing and privileging; utilization management; patient safety; general safety; environmental cleanliness; reusable medical equipment processes; anticoagulation policies/processes; transfer processes and documentation; point-of-care testing follow-up; moderate sedation data collection and reporting; management of disruptive/violent behavior; RRTP security; and nurse staffing.As a result of the findings, OIG could not gain reasonable assurance that the facility: 1. Has effective QSV program oversight, policies, and practices2. Maintains safety by conducting fire drills and maintains clean horizontal surfaces, ventilation grills, floors, and patient nourishment kitchens 3. Reprocesses reusable medical equipment per manufacturer instructions and ensures employee competency4. Has a comprehensive anticoagulation therapy management program5. Has safe inter-facility transfer processes6. Ensures clinicians take action regarding glucose point-of-care testing results7. Uses data to improve moderate sedation care8. Has a comprehensive program for managing disruptive/violent behavior 9. Secures the MH RRTP 10. Uses the nurse staffing methodology and conducts annual reassessmentsOIG made recommendations in the following eight areas: (1) QSV, (2) Environment of Care, (3) Medication Management, (4) Coordination of Care, (5) Diagnostic Care, (6) Moderate Sedation, (7) Management of Disruptive/Violent Behavior, and (8) MH RRTP. OIG made a repeat recommendation in Nurse Staffing.