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U.S. Postal Service OIG
Military, Diplomatic, and Other International Election Mail
The Postal Service processes international election and political mail for eligible U.S. citizens throughout the world. Military and diplomatic members and their families or other U.S. citizens located in foreign countries can use or receive these types of mail. Election mail is any item mailed to, or from, authorized election officials that enables citizens to participate in the voting process. For example, local election offices in the U.S. send ballots or other election materials to international recipients and the international voters mail their completed election ballots back. Political mail is related campaign or messaging mail, and generally entails only outbound operations. Our objective was to evaluate the Postal Service’s preparedness for processing international election mail, including military and diplomatic mail.
Department of Veterans Affairs OIG
Date of Receipt of Claims and Mail Processing During the COVID-19 National State of Emergency
The OIG reviewed the Veterans Benefits Administration’s (VBA) processing of mail and benefit claims during the COVID-19 pandemic. Specifically, the review team examined whether VBA staff documented the date of receipt for benefits-related correspondence as required by new guidance during the national state of emergency and continued mail operations at VA facilities to ensure benefit claims were processed. Based on its sample analysis, the OIG found VBA staff did not properly apply date of receipt documentation guidance for an estimated 98 percent of 3,200 claims established from April 7 through April 20, 2020. The date of receipt is important because it may be used to establish when veterans become entitled to benefit payments. Veterans could be underpaid if staff record an incorrect date of receipt. However, VBA staff were not always aware of all aspects of documentation guidance and had not received training on it. VBA staff did continue to process mail received at VA facilities, with the postal service forwarding all regional office mail to a scanning facility starting March 31, 2020. Offices that did not have mail automatically forwarded were to have staff available to process incoming mail. The team surveyed regional office staff and found that the majority of regional offices used these methods to continue mail operations. Representatives from veterans service organizations also confirmed that mail operations continued at their offices in Detroit and Los Angeles, where they are colocated with VBA staff. VBA concurred with the OIG’s three recommendations to: (1) ensure VBA staff understand date of receipt guidance for claims received during the pandemic and implement those actions; (2) make certain that claims received and completed from March 1, 2020, had the correct date of entitlement; and (3) evaluate existing guidance for recording the date of receipt for claims without a postmark.
Department of Veterans Affairs OIG
Appointment Management During the COVID-19 Pandemic
The Veterans Health Administration (VHA) took measures to protect patients and employees from COVID-19 by canceling face-to-face appointments that were not urgent and converting some of them to virtual appointments. The VA Office of Inspector General (OIG) assessed VHA’s appointment management strategies and the status of canceled appointments. The review team found that about five million appointments (68 percent) canceled from March 15 through May 1, 2020, had evidence of follow up or other tracking. Patients completed appointments predominantly by telephone and some by video. Other appointments were tracked for future follow-up in VA’s scheduling system. However, about 2.3 million cancellations (32 percent) had no indication of follow up or tracking at the time of review. The review team also examined whether medical facilities followed VHA’s guidance on annotating the appointment cancellations. Doing so consistently would have allowed facilities to better determine which appointments needed to be rescheduled. However, VHA’s guidance changed over time, and facilities applied it inconsistently. Facilities also did not consistently follow guidance on leaving consults open so that medical providers could reschedule them. In addition, the team noted that canceling appointments in batches could mask the instances where patients were not contacted about the cancellations. The OIG’s ongoing surveillance of VHA data shows that overall, from March 15 through June 15, 2020, VHA has canceled nearly 11.2 million appointments and needs to follow up on about 3.3 million of those cancellations. The OIG recommended that VHA coordinate a well defined rescheduling strategy with all facilities and provide oversight to facilities that have a significant rate of appointments with no evidence of follow up or tracking. The OIG also recommended VHA ensure facilities do not solely rely on appointment annotations when rescheduling. Finally, the OIG recommended that facilities take appropriate action on canceled or discontinued consults.
U.S. Postal Service OIG
Processing Readiness of Election and Political Mail During the 2020 General Elections
The Postal Service plays a vital role in the American democratic process and this role continues to grow as the volume of Election and Political Mail increases. In addition to the next general election, which will be held November 3, 2020, there will be federal elections for all 435 seats in the U.S. House of Representatives and 35 of the 100 seats in the U.S. Senate. There will also be 13 state and territorial elections for governor and numerous other state and local elections. Due to the COVID-19 pandemic, there is an expected increase in the number of Americans who will choose to vote by mail and avoid in-person voting. Our objective was to evaluate the Postal Service’s readiness for timely processing of Election and Political Mail for the 2020 general elections.
Department of Veterans Affairs OIG
Alleged Deficiencies in the Management of Staff Exposure to a Patient with COVID-19 at the VA Portland Health Care System in Oregon
The VA Office of Inspector General (OIG) conducted a healthcare inspection to determine the validity of allegations related to the management of staff exposure to a patient diagnosed with COVID-19 at the VA Portland Medical Center (facility) in Oregon. The events under review involved the facility’s first patient diagnosed with COVID-19. The OIG did not substantiate that emergency department staff failed to notify imaging department staff that a patient was suspected to have COVID-19 before sending the patient to the imaging department. At the time of the patient’s transport to the imaging department, emergency department staff had not identified suspicion of COVID-19. However, emergency department staff failed to alert imaging department staff of the patient’s potential influenza. The OIG did not substantiate that imaging department supervisors failed to properly and promptly notify imaging department staff who had contact with a patient who was diagnosed with COVID-19 after admission to the facility, or that leaders failed to take appropriate action following staff exposure to a patient with COVID-19. The OIG identified some missteps in the facility’s processes when responding to staff exposure, which affected the accuracy of exposure risk assessments and monitoring for some exposed staff. While missteps were noted, the facility made a significant and timely effort to identify staff with potential exposure and respond in accordance with the most current guidance from the Centers for Disease Control and Prevention and Oregon Health Authority. Facility leaders and infection prevention and control staff developed and revised COVID-19-related policies as new guidance became available. The OIG made five recommendations to the facility director related to communicating infection control precautions prior to transfer, management of staff with exposure to high-consequence infections, and inclusion of a detailed staff exposure management process in relevant facility policies.
Department of Veterans Affairs OIG
Alleged Deficiencies in the Management of Staff Exposure to a Patient with COVID-19 at the VA Portland Health Care System in Oregon
The VA Office of Inspector General (OIG) conducted a healthcare inspection to determine the validity of allegations related to the management of staff exposure to a patient diagnosed with COVID-19 at the VA Portland Medical Center (facility) in Oregon. The events under review involved the facility’s first patient diagnosed with COVID-19. The OIG did not substantiate that emergency department staff failed to notify imaging department staff that a patient was suspected to have COVID-19 before sending the patient to the imaging department. At the time of the patient’s transport to the imaging department, emergency department staff had not identified suspicion of COVID-19. However, emergency department staff failed to alert imaging department staff of the patient’s potential influenza. The OIG did not substantiate that imaging department supervisors failed to properly and promptly notify imaging department staff who had contact with a patient who was diagnosed with COVID-19 after admission to the facility, or that leaders failed to take appropriate action following staff exposure to a patient with COVID-19. The OIG identified some missteps in the facility’s processes when responding to staff exposure, which affected the accuracy of exposure risk assessments and monitoring for some exposed staff. While missteps were noted, the facility made a significant and timely effort to identify staff with potential exposure and respond in accordance with the most current guidance from the Centers for Disease Control and Prevention and Oregon Health Authority. Facility leaders and infection prevention and control staff developed and revised COVID-19-related policies as new guidance became available. The OIG made five recommendations to the facility director related to communicating infection control precautions prior to transfer, management of staff with exposure to high-consequence infections, and inclusion of a detailed staff exposure management process in relevant facility policies.