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Global Health: USAID Planned for Emergency Responses in Accordance With Best Practices but Gaps Remain
We recommend that the Bureau for Global Health take the following actions: Establish procedures to facilitate the deployment of staff to the field when needed during a health emergency.
We recommend that the Bureau for Global Health take the following actions: Develop a timeline for finalizing all aspects of its Global Health Emergency Management System, including provisions for periodic testing of plans and for documenting and incorporating bureau-specific lessons learned.
We recommend that the Bureau for Management take the following actions: Develop a plan for the identification, recruitment and retention of skilled personnel to task forces in the event of a global health emergency, including contingency planning for a lack of available staff.
We recommend that the Bureau for Management take the following actions: Develop a plan to periodically test procedures in Automated Directives System, Chapter 112 through proactive exercises and evaluation activities and integrate lessons learned into the chapter.
COVID-19: Audit of Costs Incurred by World Vision (WV) from March 1, 2020 to March 31, 2022
Determine the allowability of $3,098,895 in questioned direct labor costs on pages 6-7 of the audit report and recover any amount that is unallowable.
Require World Vision to develop and implement policies and procedures to periodically record and review time worked and any proportional allocation of the costs for greater accuracy.
Require World Vision to develop and implement policies and procedures to establish a requirement to document the basis of the allocation percentages.
Require World Vision to develop and implement policies and procedures to ensure that management is verifying and documenting the percentage of labor hours that employees charged to awards.
Require World Vision to develop processes and establish controls to ensure each of World Vision offices are submitting the Value-Added-Tax reports by April 16 of the preceding year.
Require World Vision to establish controls to ensure each of its offices submit a separate annual report for each of its reporting responsibilities by the established deadline or obtain concurrence from USAID to utilize reports for multiple reporting requirements.
Determine the allowability of $144,372 in questioned direct costs on page 12 of the audit report and recover any amount that is unallowable.
Require World Vision to develop and implement policies and procedures to ensure adequate documentation (e.g., invoices, itemized receipts, and basis) is created and/or maintained to adequately support direct costs claimed.
Require World Vision to execute a record retention and audit response policy where documents are maintained and readily available in a timely manner to adequately support direct costs claimed, specifically considering the requirements of Code of Federal Regulations.
Audit of DoD Health Care Personnel Shortages During the Coronavirus Disease–2019 Pandemic
Rec. 1.a: The DoD OIG recommended that the Defense Health Agency Director, in consultation with the Defense Civilian Personnel Advisory Service develop and implement a plan to ensure a more competitive pay rate for nursing and other hard to fill medical positions in all Defense Health Agency regions.
Rec. 1.c: The DoD OIG recommended that the Defense Health Agency Director, in consultation with the Defense Civilian Personnel Advisory Service develop and implement a plan to establish qualification requirements for nursing and other hard to fill medical positions if it is determined that it would enhance the DoD's efforts to help recruit and retain health care personnel.
Rec. 3.a: The DoD OIG recommended that the Defense Health Agency Director revise Defense Health Agency Administrative Instruction 5136.03 to establish approval authority for any civilian personnel extensions outside the continental United States beyond a period of 7 years.
Rec. 3.b: The DoD OIG recommended that the Defense Health Agency Director establish maximum time frames to approve civilian personnel extensions outside of the continental United States and require monitoring of extension approval timelines.
Rec. 3.d: The DoD OIG recommended that the Defense Health Agency Director develop and implement a plan to apply strategies and incentives used by other Federal agencies to hire entry-level registered nurses if it is determined the strategies and incentives would enhance the DoD's recruitment efforts.
Audit of the Reliability of the DoD Coronavirus Disease–2019 Patient Health Data
(U) Rec. 1: The DoD OIG recommended that the Director of the Defense Health Agency work with the Program Executive Officer of the Program Executive Office, Defense Healthcare Management Systems to document and implement the process for identifying and collecting patient health data of DoD patients in the Military Health System in current and future registries within their purview in a written document, such as a standard operating procedure. The procedure should identify, at a minimum, the internal controls throughout the process, the relevant data sources, data fields, and diagnostic codes used in the computer scripts, and should be reviewed and approved when updates occur.
(U) Rec. 2: The DoD OIG recommended that the Senior Contracting Official of the U.S. Army Medical Research Acquisition Activity and the Chief of the Joint Trauma System work with the Joint Trauma System contracting officer's representative to revise the quality assurance surveillance plan. The plan should include an appropriate sampling methodology for selecting patient health records from the Coronavirus Disease-2019 Registry to verify that the contractor is achieving the contract-required accuracy rate for entering patient data, and submit the revised quality assurance surveillance plan to the contracting officer.
(U) Rec. 2: The DoD OIG recommended that the Senior Contracting Official of the U.S. Army Medical Research Acquisition Activity and the Chief of the Joint Trauma System work with the Joint Trauma System contracting officer's representative to revise the quality assurance surveillance plan. The plan should include an appropriate sampling methodology for selecting patient health records from the Coronavirus Disease-2019 Registry to verify that the contractor is achieving the contract-required accuracy rate for entering patient data, and submit the revised quality assurance surveillance plan to the contracting officer.
(U) Rec. 3.a: If the contractor did not meet the 90 percent accuracy requirement, the DoD OIG recommended that the Chief of the Joint Trauma System work with the Senior Contracting Official of the U.S. Army Medical Research Acquisition Activity to update the contractor's rating in the contractor's performance assessment reports for contract W81XWH-22-C-0151 and contract W81XWH-20-P-0197, when feasible.
(U) Rec. 3.b: If the contractor did not meet the 90 percent accuracy requirement, the DoD OIG recommended that the Chief of the Joint Trauma System work with the Senior Contracting Official of the U.S. Army Medical Research Acquisition Activity to recoup any of the $3.9 million in questioned costs paid for services that did not comply with the terms of contract W81XWH-20-P-0197, if feasible.
(U) Rec. 3.c: If the contractor did not meet the 90 percent accuracy requirement, the DoD OIG recommended that the Chief of the Joint Trauma System work with the Senior Contracting Official of the U.S. Army Medical Research Acquisition Activity to recoup any of the $2.3 million in questioned costs paid for services that did not comply with the terms of contract W81XWH-22-C-0151.
(U) Rec. 3.d: If the contractor did not meet the 90 percent accuracy requirement, the DoD OIG recommended that the Chief of the Joint Trauma System work with the Senior Contracting Official of the U.S. Army Medical Research Acquisition Activity to consider all available contract remedies for contract W81XWH-22-C-0151, including modifying and, if necessary, terminating and re-competing the contract, and take action to ensure that the Department receives full value for the funds it expends for contract W81XWH-22-C-0151.
(U) Rec. 3.e: If the contractor did not meet the 90 percent accuracy requirement, the DoD OIG recommended that the Chief of the Joint Trauma System work with the Senior Contracting Official of the U.S. Army Medical Research Acquisition Activity to delegate an official to review the concerns identified in this report, including the actions of the contracting officials, and take administrative actions, as necessary. The review should include a determination on whether the contractor's performance assessment reports were accurate and make updates as necessary.
(U) Rec. 3.e: If the contractor did not meet the 90 percent accuracy requirement, the DoD OIG recommended that the Chief of the Joint Trauma System work with the Senior Contracting Official of the U.S. Army Medical Research Acquisition Activity to delegate an official to review the concerns identified in this report, including the actions of the contracting officials, and take administrative actions, as necessary. The review should include a determination on whether the contractor's performance assessment reports were accurate and make updates as necessary.
(U) Rec. 4.a: The DoD OIG recommended that the Director of the Defense Health Agency work with the Chief of the Joint Trauma System establish and implement a process for selecting Coronavirus Disease-2019 events for entry into the Coronavirus Disease-2019 Registry to limit selection bias.
(U) Rec. 4.b: The DoD OIG recommended that the Director of the Defense Health Agency work with the Chief of the Joint Trauma System to include a bias disclosure notice on all reports generated from the Coronavirus Disease-2019 Registry until the Coronavirus Disease-2019 Registry data represent the population of DoD patients who had a Coronavirus Disease-2019 event.
(U) Rec. 5.a: The DoD OIG recommended that the Assistant Secretary of Defense (Health Affairs) establish and implement a policy for developing and populating patient registries that aligns with the Department of Health and Human Services best practices, "Agency for Healthcare Research and Quality, Registries for Evaluating Patient Outcomes: A User's Guide," current edition.
(U) Rec. 5.b: The DoD OIG recommended that the Assistant Secretary of Defense (Health Affairs) conduct a review of all patient registries in the Military Health System to verify the reliability of data in each registry and implement corrective actions, as necessary.
Audit of DoD Actions Taken to Implement Cybersecurity Protections Over Remote Access Software in the Coronavirus Disease–2019 Telework Environment
(U) Rec. A.1: The DoD OIG recommended that the Director of the U.S. Southern Command - Joint Interagency Task Force South Command, Control, Communications, Computers, Cyber and Intelligence direct its network administrators to scan the VMware Horizon main virtual desktop for malware in accordance with the McAfee Endpoint Security Technical Implementation Guide, develop compensating controls, or formally accept the risk of not scanning the main virtual desktop.
(U) Rec. A.2.a: The DoD OIG recommended that the Chief Information Officer of the Department of the Air Force revise its policy to align with the Windows 10 Security Technical Implementation Guide requirement for disabling inactive user accounts after no more than 35 days.
(U) Rec. A.2.b: The DoD OIG recommended that the Chief Information Officer of the Department of the Air Force direct network and system administrators to disable inactive user accounts after no more than 35 days of inactivity in accordance with the Windows 10 Security Technical Implementation Guide, develop compensating controls, or formally accept the risk of not disabling the inactive user accounts.
(U) Rec. A.3: The DoD OIG recommended that the Chief Information Officer of the Naval Surface Warfare Center - Panama City Division direct network and system administrators to disable inactive user accounts after no more than 35 days of inactivity in accordance with the Windows 10 Security Technical Implementation Guide, develop compensating controls, or formally accept the risk of not disabling the inactive user accounts.
(U) Rec. A.4.a: The DoD OIG recommended that the Chief Information Officer of the Defense Intelligence Agency revise its policy to align with the Windows 10 Security Technical Implementation Guide requirement for disabling inactive users after no more than 35 days.
(U) Rec. A.4.b: The DoD OIG recommended that the Chief Information Officer of the Defense Intelligence Agency direct network and system administrators to disable inactive user accounts after no more than 35 days of inactivity in accordance with the Windows 10 Security Technical Implementation Guide, develop compensating controls, or formally accept the risk of not disabling the inactive user accounts.
(U) Rec. A.5.a: The DoD OIG recommended that the Director of the Marine Corps Information Command, Control, Communications, and Computers revise the organization's policy to align with the Windows 10 Security Technical Implementation Guide requirement for disabling inactive users after no more than 35 days.
(U) Rec. A.5.b: The DoD OIG recommended that the Director of the Marine Corps Information Command, Control, Communications, and Computers direct network and system administrators to disable inactive user accounts after no more than 35 days of inactivity in accordance with the Windows 10 Security Technical Implementation Guide, develop compensating controls, or formally accept the risk of not disabling the inactive user accounts.
(U) Rec. A.6: The DoD OIG recommended that the Director of the Defense Information Systems Agency Joint Service Provider direct network and system administrators to disable inactive user accounts after no more than 35 days of inactivity in accordance with the Windows 10 Security Technical Implementation Guide, develop compensating controls, or formally accept the risk of not disabling the inactive user accounts.
(U) Rec. B.1: The DoD OIG recommended that the Director of the Defense Information Systems Agency Joint Service Provider direct network and system administrators to revise the vulnerability management program to include mitigation timeframes for all vulnerabilities and develop plans of actions and milestones for all vulnerabilities that cannot be mitigated in a timely manner.
Evaluation of Department of Defense Military Medical Treatment Facility Challenges During the Coronavirus Disease-2019 (COVID-19) Pandemic in Fiscal Year 2021
(U) Rec. A.1.c: The DoD OIG recommended that the Director of the Defense Health Agency, in conjunction with the Secretaries of the Military Departments, establish a working group to address the staffing challenges identified by Military Medical Treatment Facilities during this evaluation. The working group should establish milestones to establish a central authority with the knowledge of the Services' requests for individual and large group deployments of medical staff coming out of Military Medical Treatment Facilities and the associated risks to health care delivery.
(U) Rec. A.1.d: The DoD OIG recommended that the Director of the Defense Health Agency, in conjunction with the Secretaries of the Military Departments, establish a working group to address the staffing challenges identified by Military Medical Treatment Facilities during this evaluation. The working group should establish milestones to assess the ability of Military Medical Treatment Facilities to rapidly receive augmentation of medical staff from the Reserve Components.
Audit of Entitlements for Activated Army National Guard and Air National Guard Members Supporting the Coronavirus Disease–2019 Mission
Rec. 1.a: The DoD OIG recommended that the Under Secretary of Defense (Comptroller)/Chief Financial Officer, DoD, in coordination with the Under Secretary of Defense for Personnel and Readiness, update the DoD Financial Management Regulation, volume 7A, "Military Pay Policy - Active Duty and Reserve Pay," chapter 27, "Family Separation Allowance" to clearly state that the permanent duty station of a Reserve Component member on temporary duty status is the member's primary residence for the purpose of determining Family Separation Allowance entitlement.
Rec. 1.b: The DoD OIG recommended that the Under Secretary of Defense (Comptroller)/Chief Financial Officer, DoD, in coordination with the Under Secretary of Defense for Personnel and Readiness, update the DoD Financial Management Regulation, volume 7A, "Military Pay Policy - Active Duty and Reserve Pay," chapter 27, "Family Separation Allowance" to clarify that Family Separation Allowance entitlement determination is based on the commuting distance between the member's primary residence and their temporary duty location.
Rec. 2.e: The DoD OIG recommended that the Chief, National Guard Bureau, in coordination with the Director of the Army National Guard and the Director of the Air National Guard, develop and implement policies and procedures to establish formal dissemination and communication procedures for National Guard Bureau policies related to entitlements provided to the Army National Guard and Air National Guard, including the policies in the preceding recommendations. The procedures should require: 1) creation of a central location where policies and procedures will be kept for easy access by all states, territories, and the District; and 2) confirmation of receipt from all of the states, territories, and the District when procedures are communicated or obtained.
Rec. 2.b: The DoD OIG recommended that the Chief, National Guard Bureau, in coordination with the Director of the Army National Guard and the Director of the Air National Guard, develop and implement policies and procedures to outline the process and frequency of recertification for Basic Allowance for Housing entitlement that Army National Guard and Air National Guard officials will use to verify and fully document the dependency status of members to provide clarification to the DoD Financial Management Regulation, volume 7A, chapter 26. These procedures should include: * how recertifications will be completed; * which members will complete a recertification; and * how Army National Guard and Air National Guard officials will provide oversight to ensure that information is complete and accurate.
Rec. 2.c: The DoD OIG recommended that the Chief, National Guard Bureau, in coordination with the Director of the Army National Guard and the Director of the Air National Guard, develop and implement policies and procedures to require Army National Guard and Air National Guard officials to review and document the status of a military member married to another military member regardless of which Military Service, Reserve or Active Component, or Army National Guard or Air National Guard unit the member's spouse belongs to, and identify which member will claim any applicable dependents.
Rec. 2.d: The DoD OIG recommended that the Chief, National Guard Bureau, in coordination with the Director of the Army National Guard and the Director of the Air National Guard, develop and implement policies and procedures to specify the methods for confirming eligibility and paying Family Separation Allowance for Army National Guard and Air National Guard members, in accordance with the DoD Financial Management Regulation, volume 7A, chapter 27, and include the: * timeliness of payments; * determination of Family Separation Allowance eligibility for back to back orders; * members assigned to their normal duty locations; and * requirement to track members to know when they return to their primary residence.
Rec. 2.e: The DoD OIG recommended that the Chief, National Guard Bureau, in coordination with the Director of the Army National Guard and the Director of the Air National Guard, develop and implement policies and procedures to establish formal dissemination and communication procedures for National Guard Bureau policies related to entitlements provided to the Army National Guard and Air National Guard, including the policies in the preceding recommendations. The procedures should require: 1) creation of a central location where policies and procedures will be kept for easy access by all states, territories, and the District; and 2) confirmation of receipt from all of the states, territories, and the District when procedures are communicated or obtained.
Rec. 3: The DoD OIG recommended that the Chief, National Guard Bureau, in coordination with the Director of the Army National Guard and the Director of the Air National Guard, develop and implement additional internal control procedures for the review of transactions manually submitted by the Army National Guard and Air National Guard to the payment system prior to payment to ensure the completeness and accuracy of transactions.
Management Advisory Regarding Results from Research for Future Audits and Evaluations Related to the Effects of the 2019 Novel Coronavirus on DoD Operations
Rec. 1: The DoD OIG recommended that the Under Secretary of Defense (Comptroller)/Chief Financial Officer, DoD work with DoD Components to implement procedures to ensure award amounts funded under the Coronavirus Aid, Relief, and Economic Security Act are appropriately recorded and reported with the accurate Disaster Emergency Fund Codes through the respective reporting systems.
Rec. 2: The DoD OIG recommended that the Under Secretary of Defense (Comptroller)/Chief Financial Officer, DoD work with the Navy and the Marine Corps to ensure that the Coronavirus Aid, Relief, and Economic Security Act obligation and disbursement transactions processed through their accounting systems and journal vouchers are properly reported in USASpending.gov.
Rec. 3.a: The DoD OIG recommended that the Under Secretary of Defense (Comptroller)/Chief Financial Officer, DoD develop procedures to confirm that DoD Components have appropriately implemented the policies DoD prescribed for coding Coronavirus Aid, Relief, and Economic Security Act fund transactions.
Rec. 3.b: The DoD OIG recommended that the Under Secretary of Defense (Comptroller)/Chief Financial Officer, DoD issue funding authorization documents that include a Disaster Emergency Fund Code value to ensure all DoD budget and accounting systems have a consistent basis to record and report funding and execution by Disaster Emergency Fund Code, in accordance with Office of Management and Budget Memorandum M-18-08.
Audit of the Reimbursement for Department of Defense Mission Assignments for Coronavirus Disease–2019 Pandemic Response in the U.S. Northern Command Area of Responsibility
Rec. 1: The DoD OIG recommended that the Deputy Comptroller (Program/Budget), Office of the Under Secretary of Defense (Comptroller)/Chief Financial Officer, DoD, in coordination with DoD Component comptrollers, initiate a review of all COVID-19 pandemic response mission assignments to ensure reimbursement requests for costs incurred are submitted in accordance with DoD policy.
Rec. 2.a: The DoD OIG recommended that the Director, Army Budget, Office of the Assistant Secretary of the Army (Financial Management and Comptroller), immediately require tasked units to review costs incurred for mission assignments 4480DR-NY-DOD-10, 4480DR-NY-DOD-11, 4480DR-NY-DOD-12, and 4481DR-WA-DOD-02 as of July 31, 2020, for completeness and accuracy, and submit reimbursement requests for those costs with required documentation to the Federal Emergency Management Agency in accordance with DoD policy.
Rec. 2.b: The DoD OIG recommended that the Assistant Director of the Office of Budget Fiscal Management, Office of the Assistant Secretary of the Navy (Financial Management and Comptroller), immediately require tasked units to review costs incurred for mission assignments 4482DR-CA-DOD-01, 4482DR-CA-DOD-02, and 4488DR-NJ-DOD-04 as of July 31, 2020, for completeness and accuracy, and submit reimbursement requests for those costs with required documentation to the Federal Emergency Management Agency in accordance with DoD policy.
Rec. 2.c: The DoD OIG recommended that the Deputy for Budget, Office of the Assistant Secretary of the Air Force (Financial Management and Comptroller), immediately require tasked units to review costs incurred for mission assignment 4480DR-NY-DOD-10 as of July 31, 2020, for completeness and accuracy, and submit reimbursement requests for those costs with required documentation to the Federal Emergency Management Agency in accordance with DoD policy.
Rec. 2.d: The DoD OIG recommended that the Comptroller of the United States Marine Corps immediately require tasked units to review costs incurred for 4482DR-CA-DOD-01, 4482DR-CA-DOD-02, and 4488DR-NJ-DOD-04 as of July 31, 2020, for completeness and accuracy, and submit reimbursement requests for those costs with required documentation to the Federal Emergency Management Agency in accordance with DoD policy.
Rec. 2.e: The DoD OIG recommended that the Comptroller of the National Guard Bureau immediately require tasked units to review costs incurred for mission assignments 4480DR-NY-DOD-05, 4481DR-WA-DOD-05, 4482DR-CA-DOD-07, and 4491DR-MD-DOD-01 as of July 31, 2020, for completeness and accuracy, as well as any additional costs incurred and identified after July 31, 2020, and submit reimbursement requests for those costs with required documentation to the Federal Emergency Management Agency in accordance with DoD policy.
Rec. 3.a.1: The DoD OIG recommended that the Director, Army Budget, Office of the Assistant Secretary of the Army (Financial Management and Comptroller), in coordination with the Financial Management Augmentation Team, develop and provide to tasked units, an Army-specific desk manual for mission assignments that includes, at a minimum, step-by-step procedures for initial set-up, real-time cost input, cost tracking, cost reporting, and submitting partial and final billings to ensure compliance with DoD policy.
Rec. 3.a.2: The DoD OIG recommended that the Director, Army Budget, Office of the Assistant Secretary of the Army (Financial Management and Comptroller) train tasked-unit personnel on how to navigate the Army-specific desk manual and apply the procedures appropriately.
Rec. 3.b.1: The DoD OIG recommended that the Assistant Director of the Office of Budget Fiscal Management, Office of the Assistant Secretary of the Navy (Financial Management and Comptroller), in coordination with the Financial Management Augmentation Team, develop and provide to tasked units, a Navy-specific desk manual for mission assignments that includes, at a minimum, step-by-step procedures for initial set-up, real-time cost input, cost tracking, cost reporting, and submitting partial and final billings to ensure compliance with DoD policy.
Rec. 3.b.2: The DoD OIG recommended that the Assistant Director of the Office of Budget Fiscal Management, Office of the Assistant Secretary of the Navy (Financial Management and Comptroller) train tasked-unit personnel on how to navigate the Navy-specific desk manual and apply the procedures appropriately.
Rec. 3.c.1: The DoD OIG recommended that the Deputy for Budget, Office of the Assistant Secretary of the Air Force (Financial Management and Comptroller), in coordination with the Financial Management Augmentation Team, develop and provide to tasked units, an Air Force-specific desk manual for mission assignments that includes, at a minimum, step-by-step procedures for initial set-up, real-time cost input, cost tracking, cost reporting, and submitting partial and final billings to ensure compliance with DoD policy.
Rec. 3.c.2: The DoD OIG recommended that the Deputy for Budget, Office of the Assistant Secretary of the Air Force (Financial Management and Comptroller) train taskeDODIG-unit personnel on how to navigate the Air Force-specific desk manual and apply the procedures appropriately.
Rec. 3.d.1: The DoD OIG recommended that the Comptroller of the United States Marine Corps, in coordination with the Financial Management Augmentation Team, develop and provide to tasked units, a Marine Corps-specific desk manual for mission assignments that includes, at a minimum, step-by-step procedures for initial set-up, real-time cost input, cost tracking, cost reporting, and submitting partial and final billings to ensure compliance with DoD policy.
Rec. 3.d.2: The DoD OIG recommended that the Comptroller of the United States Marine Corps train tasked-unit personnel on how to navigate the Marine Corps-specific desk manual and apply the procedures appropriately.
Rec. 3.e.1: The DoD OIG recommended that the Comptroller of the National Guard Bureau, in coordination with the Financial Management Augmentation Team, develop and provide to tasked units a National Guard-specific desk manual for mission assignments that includes, at a minimum, step-by-step procedures for initial set-up, real-time cost input, cost tracking, cost reporting, and submitting partial and final billing to ensure compliance with DoD policy.
Rec. 3.e.2: The DoD OIG recommended that the Comptroller of the National Guard Bureau train tasked-unit personnel on how to navigate the National Guard-specific desk manuals and apply the procedures appropriately.