Federal Reports

The VA Office of Inspector General (OIG) conducted this review to determine whether VA complied with the requirements of the Payment Integrity Information Act of 2019 (PIIA) for fiscal year (FY) 2021. The PIIA, enacted in March 2020, requires federal agencies to identify and review all programs and activities they administer that may be susceptible to significant improper payments based on Office of Management and Budget (OMB) guidance. In addition, PIIA requires inspectors general to review each of their agency’s improper payment reporting and issue an annual report.Agencies found to be noncompliant with PIIA and OMB guidance are required to perform additional reporting to OMB, Congress, and the Comptroller General depending on the number of years the OIG found them noncompliant. FY 2021 is considered the first year for any program considered noncompliant when applying those additional reporting requirements.In FY 2021, VA reported improper and unknown payment estimates totaling $5.12 billion for seven programs and activities. Of that amount, about $1.97 billion (around 39 percent) represented a monetary loss, and the remaining approximately $3.14 billion (about 61 percent) was considered either a nonmonetary loss or unknown payment that cannot be recovered. Though VA had an overall decrease in total improper payments and unknown payments, the overall monetary loss more than doubled from $892 million in FY 2020 to $1.97 billion.VA satisfied nine of the 10 requirements under the PIIA; however, it is not considered to be compliant because it failed to report an improper and unknown payment rate of less than 10 percent for four VA programs and activities that had estimates in the accompanying materials to their financial statements.The OIG recommended the under secretary for health reduce improper and unknown payments to below 10 percent for the noncompliant programs.

OIG reviewed USDA’s compliance with improper payment and high-dollar overpayment requirements for FY 2021.

The Office of Inspector General (OIG) conducted a healthcare inspection to assess concerns regarding facility providers’ failures to communicate, act on, and document a patient’s abnormal test results. The OIG also evaluated the facility’s quality management processes in response to identified deficiencies in the patient’s care.The OIG identified multiple providers’ failures to communicate, act on, and document abnormal test results from July 2019 until April 2021, when the patient was diagnosed with metastatic prostate cancer. In July 2019, a vascular surgeon failed to communicate and act on an abnormal CT scan, which noted a potentially malignant lesion in the prostate gland. In September 2020, a nurse practitioner failed to adequately address the patient’s urologic complaints during telephone triage call. In fall 2020, a primary care provider failed to communicate test results to the patient and to act on an abnormal PSA test result by not performing follow-up tests or consulting a urologist. In March 2021, the primary care provider failed to correctly enter bone scan orders in the electronic health record. A technologist attempted to correct this error; however, a facility registered nurse with no knowledge of the patient was entered as the ordering provider. Consequently, the results, which showed possible metastatic bone disease, were not sent to a provider. In April 2021, the patient’s new primary care provider became aware of the bone scan findings and communicated the results to the patient.The OIG concluded that the failures contributed to a delay in the diagnosis of prostate cancer. Additionally, the OIG found that facility leaders did not initiate peer reviews within three days and facility staff did not submit patient safety reports as required.The OIG made seven recommendations to the facility director related to communication of abnormal test results, entering imaging orders, urology consults, and quality reviews.

This audit report shows Kearney noted two of the 10 FCC programs,the Universal Service Fund (USF) Lifeline (LL) program and the USF High Cost (HC) program,were not compliant with at least one PIIA criteria. Overall, Kearney’s audit report includes six findings along with 17 recommendations.

The EPA needs to implement appropriate control measures to better identify and reduce the risk of its improper payments.

Audit of case handling efforts to reduce charge filing to disposition time for FY 2019 and FY 2020 as compared to FY 2018.