Federal Reports

The Fiscal Year 2022 Oversight Plan reflects the priority work that the OIG believes is necessary to keep the EPA, the CSB, and Congress fully informed about issues relating to the administration of Agency programs and operations. It is also important to note that our planning efforts are not static and that the projects included herein may be modified throughout the year as challenges and risks for the EPA and the CSB evolve and emerge.When originally issued on December 14, 2021, this document counted Audit of EPA’s Integrated Risk Information System Configuration-Management and Access-Control Compliance as an ongoing rather than a planned project. We updated the document on December 16, 2021, to accurately reflect the status of the project. This correction changed the number of planned projects for the EPA to 43 and ongoing projects for the EPA to 24.

The Office of Community Care, part of the Veterans Health Administration (VHA), manages programs that allow veterans to receive medical care from non VA providers. This audit evaluated whether VHA paid for non-VA acupuncture and chiropractic care that was not authorized or supported by medical documentation. The audit team also assessed whether VHA followed guidance for reauthorizing the care.The team found that VHA paid for care that was not authorized, including for more visits than allowed and for treatments not allowed by standards for care. For example, some acupuncturists billed for more than two rounds of needle insertions when only two rounds were allowed. VA’s automated system for processing claims did not prohibit unauthorized visits or unallowable treatments in claims submitted by non-VA providers.Further, VHA paid acupuncture and chiropractic claims that lacked appropriate supporting medical documentation. The unsupported payments persisted because VHA staff did not retroactively review documentation samples for deficiencies. The audit team estimated that improper payments for acupuncture and chiropractic care amounted to about $136.7 million during fiscal years 2018 and 2019.The audit team also found that VHA did not always follow guidance when reauthorizing acupuncture and chiropractic care. Not documenting assessments of prior treatments before authorizing additional care may interfere with veterans’ treatment.The OIG made six recommendations to the under secretary for health related to adding automated payment system controls, auditing the payment process, retrospectively auditing non-VA medical documentation, making continuing education material related to medical documentation available to non-VA providers, following the Office of Community Care’s Field Guidebook, and documenting clinical justification for non-VA care.

The OIG conducted this review to determine the risk of the Veterans Health Administration (VHA) improperly paying community care providers for evaluation and management services not supported by medical documentation.The review team found that some providers are billing VA at a significantly higher rate for high-level evaluation and management services than their peers in the same specialty. The team determined that in fiscal year (FY) 2020, more than 37,900 non-VA providers billed and were paid for significantly more high-level evaluation and management codes than were all providers in that specialty on average. These non-VA providers received about $39.1 million (13 percent) of the approximately $303.6 million paid for all non-VA evaluation and management services.Additionally, some providers billed separately for evaluation and management services during periods when the global surgery package was in effect. This package is supposed to cover all surgery-related services for a set period. The review team identified more than 45,600 providers who were paid about $37.8 million in FY 2020 for these evaluation and management services.Improper payments were not easy to detect because VHA staff did not retrospectively audit medical documentation as required. Additionally, the OIG found no evidence that VHA or contractors trained non VA providers on documenting evaluation and management services, similar to how VA providers are trained. The OIG determined VHA risked overpaying for evaluation and management services by about $19.9 million in FY 2020.The OIG made two recommendations to the under secretary for health related to (1) reviewing medical documentation for evaluation and management services billed by non-VA providers and then developing processes to act on the results of those reviews; and (2) ensuring non-VA providers receive current and future continuing education materials on proper medical documentation for evaluation and management services.

Semiannual Report to Congress: April 1, 2021, through September 30, 2021

During this semiannual reporting period, we issued two audit reports that included $51,408 in questioned costs and nine recommendations to improve Agency operations and award recipient’s stewardship of Federal funds. Through our audit follow-up process, we assisted the National Endowment for the Arts (NEA) staff and award recipients in clearing 47 recommendations based on corrective actions taken. In addition, we resolved a total of 29 hotline complaints. I applaud the NEA and Office of Inspector General (OIG) staff for pressing forward and working together when needed to avoid unreasonable and unnecessary work delays during the Pandemic. This enabled staff to continue delivering the missions of the Agency and OIG in a high quality and timely manner in spite of COVID-19, which required staff to continue working virtually during this period. The OIG has also initiated steps to monitor NEA’s progress to implement the President’s mandate to integrate diversity, equity, inclusion, and accessibility (DEIA) into all of its internal and external programs. The OIG applauds NEA’s initial steps to assess the level of DEIA in its program, and to add DEIA goals and strategies into its strategic plan. Recognizing the significance of this mandate and the level of effort it may take to implement the mandate, the OIG has added the DEIA mandate to the agency’s top management challenges. The value-added work that the OIG accomplished this semiannual period is due to my staff’s commitment to excellence, continued growth, and dedicated work effort; along with the support of the NEA Acting Chairman and her staff. I will continue to work with my staff, the Chairman, and her staff in promoting economy, efficiency, and effectiveness while helping to ensure integrity, excellence, and value in the delivery of NEA’s mission.