VA Office of Inspector General Releases Phoenix Consult Mismanagement Report
OIG review finds that the Phoenix VA Health Care System inappropriately discontinued consults for some patients in 2015.
Mr. Chairman and Members of the Committee, thank you for the opportunity to discuss the work of the VA Office of Inspector General (OIG) and how the OIG provides effective oversight of VA programs and operations through independent audits, inspections, and investigations. The OIG seeks to prevent and detect fraud, waste, and abuse, and make meaningful recommendations to drive economy, efficiency, and effectiveness throughout VA programs and operations. Our goal is to undertake impactful work that will assist VA in providing the appropriate and timely services and benefits that veterans so deservedly earned, and ensuring the proper expenditure of taxpayer funds.
Veterans Affairs Employees Charged with Stealing and Selling Prescription Drugs
Three U.S. Department of Veterans Affairs employees charged with conspiring to steal prescription medications, including opioids, from the VA John L. McClellan Memorial Veterans Hospital.
Audit of VA's Financial Statements for Fiscal Years 2016 and 2015
We contracted with an independent public accounting firm to audit VA’s FY 2016 financial statements as required by the Chief Financial Officers Act of 1990. VA received an unmodified opinion meaning that its financial statements were materially accurate. The contractor identified six material weaknesses: IT security controls; education benefits accrued liability; control environment surrounding the compensation, pension, and burial actuarial estimates; community care obligations, reconciliations, and accrued expenses; financial reporting; and CFO organizational structure for VA and VHA. The contractor further identified two significant deficiencies: procurement, undelivered orders, accrued expenses, and reconciliations; and loan guaranty liability estimate. It also reported VA’s substantial noncompliance with applicable Federal financial management systems requirements and the United States Standard General Ledger at the transaction level under the Federal Financial Management Improvement Act (FFMIA). It noted improvements were needed in complying with the Federal Managers’ Financial Integrity Act. The contractor cited instances of noncompliance with section 5315, title 38, United States Code, pertaining to the charging of interest and administrative costs; noncompliance with section 3733, title 38, United States Code, pertaining to the vendee loan program and six violations of the Antideficiency Act identified by VA.
OIG Monthly Highlights
Read about our top reports and investigations in December 2016 OIG REPORTS Review of Antimicrobial Stewardship Programs in Veterans Health Administration Facilities As directed by the Senate Appropriations Committee report to accompany H.R. 2029, Military Construction, Department of Veterans Affairs, and Related Agencies Appropriation Bill 2016, and at the request of Senator Dianne Feinstein, the Office of Inspector General (OIG) reviewed Veterans Health Administration (VHA) implementation of Antimicrobial Stewardship Programs (ASPs). The majority of VHA facilities had established ASPs; however, OIG identified variations with program implementation. A large majority of facilities had written policies and designated ASP champions; however, over one third did not timely complete program evaluation, and facilities reported less than 50 percent compliance with staff education on appropriate use of antibiotics. VHA made efforts to collect and analyze data on antibiotic use and resistance but did not endorse one standard data collection tool for inter-facility comparisons and consistency of data collection and reporting. Additionally, facilities did not consistently generate clinical outcome reports on antibiotic usage. Therefore, VHA cannot effectively measure positive or negative national trends on antibiotic use to guide improvement efforts. With standardization, individual facility and system-wide trends can be analyzed. Further, in order to achieve optimal ASPs, facility leaders need to provide dedicated staff, administrative support, and essential tools to develop and maintain such programs. OIG recommended that the Under Secretary for Health implement procedures to ensure that facilities comply with VHA Directive 1031 requirements, including the completion of annual evaluations, designation of provider and pharmacy champions, staff education, and the provision of adequate dedicated staffing and resources; require VHA facilities to track and generate clinical outcome reports on antibiotic use; and consider implementing standardized tools and definitions for antimicrobial stewardship data and a uniform reporting system to permit analysis of comparable information over time.
Audit of VBA’s Automated Burial Payments
In October 2014, OIG received an allegation that VBA’s automated burial benefits system was authorizing improper burial payments. We evaluated the effectiveness of VBA controls ensuring proper automated burial payments. VBA controls ensured that the majority of automated burial payments were made to living spouses for deceased veterans in accordance with the CFR. However, controls did not consistently ensure proper automated burial payments. We found VBA improperly authorized 4,525 of 16,406 automated burial payments (about $2.8 million) from August 2014 through January 2015, including payments to spouses who weren’t on veterans’ records at the date of death or who were deceased, multiple payments, and payments to veterans who were still living. This occurred because VBA lacked controls, policies, procedures, and sufficient quality assurance reviews. If VBA does not implement adequate controls, we estimated VBA will continue authorizing improper automated burial payments of about $5.6 million annually and approximately $28 million over the next five years. VBA improperly discontinued 68 living veterans’ monthly disability benefit payments totaling $190,267 because VBA had erroneously recorded the veterans as deceased, possibly causing financial hardship to veterans and their families. We recommended the Principal Deputy Under Secretary for Benefits, Performing the Duties of Under Secretary for Benefits, review the improper payments identified during our audit, take appropriate corrective actions when warranted and strengthen burial payment controls. We also recommended he initiate actions to ensure policies and procedures are consistent with CFR and perform quality assurance reviews. The Principal Deputy Under Secretary for Benefits concurred with four of five recommendations and provided acceptable corrective actions plans, but didn’t agree to enforce the requirement that proof of death be submitted prior to the release of automated burial payments. He also provided additional comments, which we addressed in this report.
Audit of Hurricane Sandy Major Construction Relief Funds for VA New York Harbor Healthcare System
We performed this audit to determine if the VA New York Harbor Healthcare System (NYHHS) received the goods, services, and deliverables VA paid for in accordance with Public Law 113-2, Disaster Relief Appropriations Act, 2013 (the Act), for Hurricane Sandy recovery. We found that the goods, services, and deliverables paid for through March 2016, with funds designated for Hurricane Sandy major construction, were received by NYHHS in accordance with the Act. Because NYHHS received the goods, services, and deliverables paid for by the Disaster Relief Appropriations Act, 2013 through March 2016 in accordance with Public Law 113-2, we made no recommendations.