Inadequate Oversight of VHA’s Home Oxygen Program

The Veterans Health Administration (VHA) uses contractors to provide oxygen services to veterans who need respiratory care in their homes. The OIG examined whether VHA’s oversight of the home oxygen program ensured (1) patients received reevaluation of their need for home oxygen and home visits were conducted as required, and (2) contractor performance was monitored and invoicing and payments were checked for accuracy. The OIG found that prescribing providers did not always reevaluate home oxygen patients timely and medical facility staff did not always conduct home visits for the required number of patients. As a result, VHA lacked an essential component for ensuring patient safety and high quality vendor service. In addition, contract monitoring by contracting officers and their representatives was inadequate, caused by a lack of oversight and differing interpretations of guidance. Payments, however, were generally processed accurately. During the audit, the team also found that VHA paid for services using expired contracts for two facilities: the Charlie Norwood VA Medical Center in Augusta, Georgia, and the Ralph H. Johnson VA Medical Center in Charleston, South Carolina. The OIG made six recommendations to the under secretary for health. These included implementing guidance for managing home oxygen consults, clarifying reevaluation timelines, updating responsibilities for home visit oversight, and requiring network contracting office oversight of contracting officers to ensure completion of evaluation and quality monitoring elements and to properly designate contracting officer’s representatives. The OIG also recommended clearly communicating the processes staff should use to achieve the contract monitoring requirements in the Federal Acquisition Regulation. Regarding the expired contracts, the OIG recommended reviewing the identified orders for home oxygen services that were paid without an awarded contract and submitting a request for ratification for any unauthorized commitments to VHA’s head of contracting activity.