Federal Reports

This report provides the results of our review of the Centers for Disease Control and Prevention (CDC) detailed accounting submission, which includes the table of Drug Control Obligations, related disclosures, and management's assertions for the fiscal year ended September 30, 2017. We also reviewed the Performance Summary Report, which includes management's assertions and related performance information for the fiscal year ended September 30, 2017.

Carolinas Medical Center (the Hospital), located in Charlotte, North Carolina, complied with Medicare billing requirements for 157 of the 240 inpatient claims that we reviewed. However, the Hospital did not fully comply with Medicare billing requirements for the remaining 83 claims, resulting in net overpayments of $331,831 for the audit period. On the basis of our sample results, we estimated that the Hospital received overpayments of at least $1.7 million 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.

This report provides the results of our review of the Health Resources and Services Administration (HRSA) detailed accounting submission, which includes the Table of Drug Control Obligations, related disclosures, and management's assertions for the fiscal year ended September 30, 2017. We also reviewed the Performance Summary Report, which includes management's assertions and related performance information for the fiscal year ended September 30, 2017.

This report provides the results of our review of the Substance Abuse and Mental Health Services Administration (SAMHSA) detailed accounting submission, which includes the Table of Drug Control Obligations, related disclosures, and management's assertions for the fiscal year ended September 30, 2017. We also reviewed the Performance Summary Report, which includes management's assertions and related performance information for the fiscal year ended September 30, 2017.

This report provides the results of our review of the National Institutes of Health (NIH) detailed accounting submissions, which include the tables of Fiscal Year 2017 Actual Obligations, related disclosures, and management's assertions for the fiscal year ended September 30, 2017. We also reviewed the Performance Summary Report, which includes management's assertions and related performance information for the fiscal year ended September 30, 2017.

This report provides the results of our review of the Indian Health Service (IHS) detailed accounting submission, which includes the table of Drug Control Obligations, related disclosures, and management's assertions for the fiscal year ended September 30, 2017. We also reviewed the Performance Summary Report, which includes management's assertions and related performance information for the fiscal year ended September 30, 2017.

The VA Office of Inspector General (OIG) conducted a focused evaluation of the quality of care delivered at the Minneapolis VA 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 provided crime awareness briefings to 26 employees.The facility has generally stable executive leadership and active engagement with employees and patients to maintain high satisfaction scores. Organizational leadership supports patient safety, quality care, and other positive outcomes. The senior leadership team was knowledgeable of insightful and important metrics that reflect upon their leadership qualities and activities taken to improve or sustain performance of selected metrics. 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.OIG noted findings in the six areas of clinical operations reviewed and issued 18 recommendations. The identified areas with deficiencies are:(1) QSV• Implementation of Peer Review Committee actions• Completion of utilization management reviews and documentation of decisions• Annual patient safety report• Committee meeting minutes(2) Medication Management: Anticoagulation Therapy• Inclusion of required elements in facility policy• Quality assurance data• Staff competency assessments(3) Coordination of Care: Inter-Facility Transfers• Inclusion of required elements in facility policy• Documentation for inter-facility transfers(4) EOC• EOC rounds frequency and attendance• Mental health unit staff and Interdisciplinary Safety Inspection Team training (5) High-Risk Processes: Moderate Sedation• History and physical examination and pre-sedation assessment components• Provision and documentation of informed consent • Performance of timeouts(6) Long-Term Care: CNH Oversight • Oversight committee participation• Monthly cyclical clinical visits

We found that the California Department of Education's (CDE) system of internal control did not provide reasonable assurance that reported graduation rates were accurate and complete. Specifically, CDE did not oversee or monitor the local entities’ internal controls over the reliability of Cohort Graduation Rate (ACGR) data. Based on our testing, we determined that CDE’s reported ACGR for school year (SY) 2013–14 was not accurate and complete. Consequently, both CDE and the Department risk using inaccurate and incomplete data when describing and reporting on (1) CDE’s progress toward raising graduation rates; and (2) CDE’s graduation rate accountability as an academic indicator to measure student achievement and school performance.We also found that CDE did not calculate its ACGR in accordance with Federal requirements. Specifically, we found that CDE removed students from the cohort who transferred to programs that did not lead to a regular high school diploma and included students as graduates who did not earn a regular high school diploma. We concluded that correcting for these errors would have decreased CDE’s SY 2013–14 ACGR by about 2 percentage points. Additionally, CDE did not ensure that students in the SY 2013–14 cohort were first-time ninth graders in SY 2010–11, the first year of the SY 2013–14 cohort.

Quarterly Summary Memorandum for the Lead Inspector General, Department of Defense

In March 2016, the Nuclear Regulatory Commission (NRC) issued a Chilled Work Environment Letter to Watts Bar Nuclear Plant as a result of an investigation that concluded that a chilled work environment existed in the Operations Department because of a perception that operators were not free to raise safety concerns using all available avenues without a fear of retaliation. In response to the Chilled Work Environment Letter, TVA assessed the actions taken in response to a Confirmatory Order (CO) issued in 2009 and determined that not all of the actions had been implemented effectively. As a result of the ineffective implementation, we initiated a review of the process TVA used to address the 2009 CO.We concluded there was a weakness in the approach that TVA followed for addressing the 2009 CO. TVA did not have a formal process or procedure directly related to how a CO issued by the NRC should be addressed. TVA’s approach did not assign accountability or provide oversight to govern the implementation and continued execution for on-going actions. A potential contributing cause was TVA’s intent to address the underlying issue only and not to prevent recurrence.