Federal Reports

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.

What We Looked AtThe Payment Integrity Information Act of 2019 (PIIA) requires agencies to identify, report, and reduce improper payments in programs susceptible to significant improper payments. For fiscal year 2021, the Department of Transportation (DOT) tested three programs with total expenditures over $49 billion and estimated that about 1.41 percent were improper payments. PIIA also requires inspectors general to report annually on their agencies' compliance. Accordingly, our audit objective was to determine whether DOT complied in 2021 with PIIA's requirements.What We FoundDOT is in compliance with PIIA requirements. For fiscal year 2021, DOT reported improper payment estimates for three susceptible programs. The payment integrity information in DOT's 2021 Agency Financial Report and data posted to the Payment Accuracy website were accurate and complete. A clerical error related to payment recapture data for two programs occurred but did not impact DOT's compliance with PIIA. DOT conducted four risk assessments for programs and reported one program, the Federal Transit Administration's (FTA) Coronavirus Aid, Relief, and Economic Security Act program, susceptible to significant improper payments. DOT published improper and unknown payment amounts and estimated future rates on the Payment Accuracy website. However, we found issues with the universe population identification procedures for the Federal Aviation Administration's and FTA's Bipartisan Budget Act of 2018 activities. The Federal Highway Administration's (FHWA) Highway Planning and Construction Program did not meet its reduction target of .80 percent and reported estimated improper payments about $697 million. The total estimate did not impact FHWA's compliance with PIIA. For fiscal year 2021, DOT reported an improper and unknown payment estimate of less than 10 percent. FHWA improved its corrective action plan by focusing on root causes of improper and unknown payments and prioritized these actions.RecommendationsDOT concurred with our three recommendations to help improve its reporting processes for improper payments. We consider these recommendations resolved but open pending completion of planned actions.