Federal Reports

This report responds to a request from U.S. Representative Lizzie Fletcher, 7th Congressional District of Texas, to evaluate select mail delivery and customer service operations and determine if internal controls are effective at the Ashford West and Westbury Stations in Houston, TX. Representative Fletcher’s June 2021 request specifically mentioned lost mail and the removal of drive-up collection boxes.The two stations are in the Postal Service’s Texas 2 District in the Southern Area and have a combined 116 city routes. Staffing at the stations includes 130 full-time city carriers, 58 part-time city carriers, 15 full-time clerks, and 4 part-time clerks.

Our initial objective for this management advisory report was to assess the extent to which the company is evaluating the risks associated with operating service on tracks on the Del Mar bluffs. Because a service disruption in San Clemente in September 2021 involved similar issues along the same route and occurred during our work, we also performed a limited review of company actions in response to that event.We found that the company met its regulatory obligations in response to Del Mar, San Diego, bluff failures along the Pacific Surfliner route by complying with speed restrictions and track outages enforced by the host railroad. Additionally, the company proactively responded to reports of unsafe track conditions in San Clemente, California, by suspending rail service until it could complete an internal review and seek its own assurances that it was safe to resume operations.The company, however, is not participating in regional stakeholder working groups focused on understanding and planning both short- and long-term mitigation options to address events like the Del Mar bluff failures. Going forward, Amtrak should consider designating company personnel to participate in ongoing discussions with stakeholders. 

On December 5, 2021, the National Railroad Passenger Corporation (Amtrak) responded to our investigative report titled, Opportunities to improve Controls to Detect and Reduce eVoucher and Ticket Fraud. Our report focused on investigations that involved the use of fraudulent company eVouchers and tickets that were not detected by the company, causing significant financial losses. We identified internal control weaknesses and other vulnerabilities that exacerbated the company’s fraud risk.The company’s response recognized multiple challenges with the eVoucher program, and it subsequently conducted a detailed analysis to identify existing practices that led to the greatest risk and loss to the company. As a result, the company made two improvements in an effort to remedy the issue. First, the company announced that the expiration date of the original eVoucher will be enforced. Previously, when an eVoucher was modified or partially used, the remaining balance was issued as a new eVoucher with a new expiration date. The enhancement ensures that the expiration date of the original eVoucher is applied to any subsequent eVouchers and is valid for one year from the issuance of the original eVoucher. Second, the company is prohibiting any name changes or transfers of an eVoucher and only the named original purchaser of Amtrak travel can use and retain the value of the eVoucher, eliminating potential sales to third parties.

Facet-joint denervation is a procedure that physicians use to treat neck or back pain caused by arthritis in or injury to the facet joints in the spine. To address inappropriate billing for and overuse of spinal facet-joint denervation for pain management, the Medicare Administrative Contractors (MACs) developed two limitations of coverage. One of the coverage limitations, in place in 11 of the 12 MAC jurisdictions, allowed physicians to be reimbursed, during a 12-month period, for a maximum of 2 facet-joint denervation sessions per beneficiary for each covered spinal region: (1) the lumbar region (lumbar spine) and (2) the cervical and thoracic regions (cervical/thoracic spine). The other coverage limitation allowed physicians to be reimbursed for a maximum of 4 or 10 facet joints per denervation session, depending on the MAC jurisdiction. A prior Office of Inspector General (OIG) audit found that MACs that limited coverage to five facet-joint injection sessions related to the lumbar and cervical/thoracic spines during a rolling year had improperly paid physicians $748,555 for sessions that exceeded this coverage limitation from January 1, 2017, through May 31, 2019. Therefore, we conducted this audit to determine whether Medicare made improper payments from January 1, 2019, through August 31, 2020 (audit period), for selected facet-joint denervation sessions in the MAC jurisdictions that had coverage limitations.