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Brought to you by the Council of the Inspectors General on Integrity and Efficiency
Federal Reports
Report Date
Agency Reviewed / Investigated
Report Title
Type
Location
Committee for Purchase From People Who Are Blind or Severely Disabled (AbilityOne Program)
FY2020 and 2021 Risk Assessment of the Commission’s Government Charge Card
The U.S. AbilityOne Commission’s (Commission) charge card programs for fiscal years (FY) 2020 and 2021, as required by the Government Charge Card Abuse Prevention Act of 2012 (Charge Card Act) conducted by RMA Associates, LLC (RMA), an independent public accountant firm.
To report internal control weaknesses, noncompliance issues, and unallowable costs identified in the single audit to the Social Security Administration (SSA) for resolution action.
In April 2021, the U.S. Postal Service announced that, due to declining mail volume, it would relocate or remove unnecessary letter and flat sorting equipment as appropriate from 18 selected facilities to make space for package processing.Our objective was to review the Postal Service’s plan to transfer processing operations from 18 mail processing facilities to analyze adherence to established policy and identify any associated risks and opportunities. For this audit, we obtained implementation plans, reviewed Postal Service handbooks, interviewed Postal Service managers, and performed site observations.
This Office of Inspector General (OIG) Comprehensive Healthcare Inspection Program report provides a focused evaluation of the quality of care delivered in the inpatient and outpatient settings of the VA Finger Lakes Healthcare System, which includes two medical center campuses—Bath and Canandaigua—and multiple outpatient clinics in New York and Pennsylvania. The inspection covered key clinical and administrative processes that are associated with promoting quality care. This inspection focused on Leadership and Organizational Risks; COVID-19 Pandemic Readiness and Response; Quality, Safety, and Value; Registered Nurse Credentialing; Medication Management: Remdesivir Use in VHA; Mental Health: Emergency Department and Urgent Care Center Suicide Risk Screening and Evaluation; Care Coordination: Inter-facility Transfers; and High-Risk Processes: Management of Disruptive and Violent Behavior.At the time of the inspection, system leaders had worked together for approximately three months. The OIG reviewed employee satisfaction survey results and concluded that averages from selected leadership questions were similar to or lower than VHA averages. Patient experience survey data showed that patients were generally satisfied with their outpatient care but less happy with their inpatient care than VHA patients nationally. The OIG’s review of the healthcare system’s accreditation findings, sentinel events, and disclosures did not identify any substantial organizational risk factors. However, the OIG identified a vulnerability in staffing challenges at the Canandaigua VA Medical Center. System leaders were knowledgeable within their scope of responsibilities about selected VHA data used in Strategic Analytics for Improvement and Learning models, and should continue taking actions to sustain and improve performance.The OIG issued six recommendations for improvement in three areas:(1) Mental Health• Suicide safety plan training(2) Care Coordination• Patient transfer monitoring and evaluation• Advance directive sent to receiving facility• Nurse-to-nurse communication(3) High-Risk Processes• Disruptive behavior committee meeting attendance• Staff training
Objective: to evaluate the effectiveness of the Social Security Administration’s controls over the recording of death information on the Numident database for deceased beneficiaries.
At the request of the Tennessee Valley Authority's (TVA) Supply Chain, we examined the cost proposal submitted by a company for transmission construction services. Our examination objective was to determine if the cost proposal was fairly stated for a planned 5-year, $50 million contract.In our opinion, the company's cost proposal was overstated. Specifically, we found the proposed general liability insurance markup rate was overstated compared to recent actual costs. We estimated TVA could avoid about $118,000 over the planned $50 million contract by negotiating a reduction to the general liability insurance markup rates to more accurately reflect the company's recent actual costs. (Summary Only)