Federal Reports

OIG conducted a healthcare inspection in response to complaints regarding consults at the Central Texas Veterans Health Care System (system), Temple, TX. The complainant provided 14 examples of patients at the Olin E. Teague Veterans’ Medical Center (facility) for whom he/she believed Physical Medicine and Rehabilitation Services (PMRS) consults were not scheduled timely and appointments were delayed as a result. We substantiated the allegation that 12 of the 14 patients experienced delays in scheduling consult appointments and in receiving care. Although patients experienced delays in PMRS consults, primary care teams continued to manage patients. We found the problem of delayed consult appointments was a systemic problem within PMRS. Some of the facility’s PMRS consult procedures did not comply with system policy and could have contributed to the delay in appointment scheduling. Multiple provider and managerial positions were filled by temporary personnel, and an absence of a fully staffed department affected the functioning of the service and contributed to the delays. Facility managers were aware of these problems and attempted to correct them by forming a Consult Management Committee to review consult data, and by requesting another Veterans Health Administration (VHA) facility review PMRS. Although facility managers provided Advanced Medical Support Assistants who scheduled appointments with additional scheduling training, they continued to be confused about scheduling procedures and did not meet scheduling competency evaluation requirements. We recommended that the Facility Director ensure that (a) consult clinical reviews and appointment scheduling for patients are conducted in compliance with VHA directives and policies, (b) PMRS have sufficient staffing to arrange for timely consults and appointments within the service, and (c) facility staff who schedule PMRS patient appointments receive annual scheduling competencies to ensure understanding of the correct process for compliance with VHA directives and staff are monitored for compliance.

In March 2017, OIG evaluated the Denver, CO, VA Regional Office (VARO) to determine how well Veterans Service Center (VSC) staff processed veterans’ disability claims, how timely and accurately they processed proposed rating reductions, how accurately they entered claims-related information, and how well they responded to special controlled correspondence. VSC staff generally processed the disability claims we reviewed correctly. OIG reviewed 30 veterans’ traumatic brain injury claims and found staff accurately processed 28. Additionally, OIG reviewed 30 veterans’ special monthly compensation (SMC) or ancillary benefit claims and found staff correctly processed 26. One error affected a veteran’s benefits and resulted in eight improper monthly underpayments totaling approximately $17,400. Systemic trends among these errors were not identified, so no recommendation for improvement was made. VSC staff generally processed rating reductions accurately, but needed to prioritize workloads to ensure timely action. OIG reviewed 30 reduction cases and found staff delayed or incorrectly processed 14. Delays were due to prioritization of other workloads by VARO management. Delays and errors resulted in approximately $51,400 in overpayments and $1,100 in underpayments. OIG reviewed 30 newly established cases and found staff did not correctly input claim information into the electronic systems at the time of claims establishment for 19, due to staff inexperience and ineffective oversight. VSC staff generally processed special correspondence timely and accurately. OIG reviewed 30 special correspondence and found one was processed untimely and four were processed inaccurately. Systemic trends were not identified among the errors, so no recommendation for improvement was made in this area. OIG recommended the VARO Director implement a plan to complete proposed rating reductions at end of due process, and implement a plan to have claims processing staff receive training on claims establishment procedures to improve oversight. The VARO Director concurred with our recommendations, and planned actions are responsive.

A large majority of Americans say they believe self-driving cars will be used for delivery and transportation within the next 10 years, but they are split over whether they like the idea — many are concerned about the concept’s safety. The more people know about self-driving vehicles, the more they tend to like the idea and believe in its potential safety benefits. USPS may be able to enhance its brand by implementing self-driving technology, but the public lacks faith that USPS could successfully deploy the concept.

This is our final audit report conducted to review Minority Business Development Agency (MBDA) grant programs as part of our annual risk-based audit plan. Our audit objective was to review the adequacy of MBDA’s management of its cooperative agreements. Specifically, for the MBDA Business Center (MBC) program, we (1) evaluated controls over application review and award approval processes; (2) reviewed processes for monitoring performance and compliance with programmatic requirements for MBC awards; and (3) determined whether performance accomplishments reported by MBCs are supported and verified.

State Medicaid agencies (Medicaid agencies) are required to suspend payments for health care items and services when there is a credible allegation of fraud against the provider, unless "good cause" exists not to suspend payment. Using payment suspensions, when appropriate, is important to protect Medicaid funds: payment suspensions based on credible allegations of fraud can swiftly stop the flow of Medicaid dollars to providers defrauding Medicaid. A payment suspension can remain in place throughout the law enforcement investigation and potential prosecution of the health care fraud case.