Reports

The VA Office of Inspector General (OIG) conducted a healthcare inspection at the Fayetteville VA Coastal Health Care System in North Carolina to assess concerns related to the quality, coordination, and timeliness of care, and the impact of COVID-19 on a patient with unintentional weight loss who was later diagnosed with oral cancer and died at another VA medical center. The OIG substantiated that the primary care provider and dietitians did not provide quality care to the patient. The primary care provider’s failure to follow-up on an earlier finding and not place an order for a medical test...

The objectives of this audit are to: 1) obtain, review, and assess agency plans to expend these funds, 2) determine the current status of the RRB IT initiatives to expend all or part of the appropriation, 3) evaluate if the project progress is in accordance with the RRB’s project plan timeline, and reasons for delay, if any, 4) evaluate if the RRB’s goals and timeline are reasonable and attainable to achieve the intended purpose as stated in agency plans, and 5) evaluate the outcomes of the project relative to the anticipated improvements.

The OIG is conducting an audit of the Office on Violence Against Women’s Grant Administration due to the COVID-19 Pandemic.  The preliminary objectives are to assess: (1) the grant administration and monitoring during the pandemic and (2) the guidance and assistance provided to grant recipients for addressing any increased risks to effective program implementation and to violence against women.

The VA Office of Inspector General (OIG) conducted a healthcare inspection regarding allegations of incompletely screening for COVID-19 and treatment of a patient with serious mental illness who presented for same-day care at the Michael E. DeBakey VA Medical Center (facility). The OIG substantiated that facility staff did not complete the patient’s COVID-19 temperature screening. The OIG substantiated that facility staff failed to medically manage the patient with COVID-19 symptoms, sent the patient to the drive-through testing area without medical evaluation, and did not isolate the patient...

Management advisory memorandum detailing the growth of community telehealth claims and the associated risks.