Albuquerque Man Sentenced to Probation for Stealing from Department of Veterans Affairs
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Review of Alleged Mismanagement of Informal Claims Processing at VA Regional Office Oakland, California
On July 10, 2014, the Office of Inspector General (OIG) received a request for assistance from the Under Secretary for Benefits to review allegations that the VA Regional Office (VARO) in Oakland, CA, had not processed nearly 14,000 informal requests. The allegation indicated some claims dated back to the mid 1990s. The same allegation was forwarded to us by Representative Doug LaMalfa, who also requested an OIG review. In addition, another complainant alleged that “informal claims” were being improperly stored. We immediately initiated an unannounced, onsite review at VARO Oakland and its Sacramento satellite office. We substantiated the allegations that VARO staff had not processed informal claims. We confirmed that staff had not properly controlled these claims documents, which were accidently found in a filing cabinet, during a construction project. We did not identify any current storage or control issues during our site visit. VARO management advised that a team assisting the Oakland Veterans Service Center (VCS) had located approximately 14,000 informal claims, some of which dated back to the mid-1990s. VA considers an informal claim as any type of communication or action, indicating the intent to apply for one or more benefits, in accordance with existing laws. Management stated it counted the documents and actually identified 13,184 informal claims. Of these 13,184 informal claims, 2,155 required review or action by VARO staff. VARO management told us they had created a “special project team” to process the 2,155 informal claims and thought the task had been completed. However, in April through May 2014, VARO staff again “discovered” additional claims, some of which the VARO’s “special project team” had annotated as reviewed. After two months, VARO management created a tracking spreadsheet to determine which claims needed to be processed. VARO management determined staff (assigned to the special project team) had not processed 537 informal claims. At the time of our onsite review, we could not confirm the existence of the 13,184 informal claims, or which of them were the 2,155 claims needing review or action. We reviewed 34 of these newly “discovered” claims and found 7 (21 percent) remained unprocessed. While no claims in our sample dated back to the mid-1990s, some were as old as July 2002. We also found VARO staff had repeatedly reviewed these seven informal claims from December 2012 through June 2014 for various reasons, but took no additional action on them, as required. VARO staff did not maintain adequate records or provide proper supervision to ensure informal claims received timely processing. As a result, veterans did not receive consideration for benefits to which they may have been entitled. During our inspection, no current issues related to the lack of control and improper storage of informal claims documents came to our attention. We recommended the VARO Director complete and certify the review of the 537 informal claims, take appropriate action, and provide documentation to certify these actions are complete. Also, the Director should better enforce compliance with existing VBA and VARO policies pertaining to the processing of informal claims.
OIG Monthly Highlights
Read about our top reports and investigations in January 2015 OIG Identifies Top Five VHA Shortage Occupations To Meet Veterans Access, Choice, and Accountability Act Reporting Mandate The Office of Inspector General (OIG) conducted a determination of Veterans Health Administration (VHA) occupations with the largest staffing shortages as required by Section 301 of the Veterans Access, Choice, and Accountability Act of 2014. OIG interpreted “largest staffing shortage” to encompass broader deliberation than simply the number needed to replace or backfill vacant positions. OIG performed a rules-based analysis on VHA data to identify these occupations. OIG determined that the five occupations with the “largest staffing shortages” were Medical Officer, Nurse, Physician Assistant, Physical Therapist, and Psychologist. This determination is the first of several OIG determinations on VHA occupational staffing shortages. OIG plans to incorporate additional data in future determinations to provide more detailed recommendations.
OIG Monthly Highlights
Read about our top reports and investigations in December 2014 Review Finds Physicians Did Not Thoroughly Assess Patients Before Renewing Opioid Prescriptions at Chillicothe, Ohio VA Medical Center The Office of Inspector General (OIG) conducted an inspection in response to allegations that physicians at the Chillicothe, OH, VA Medical Center (VAMC) prescribed opioid medications for patients they had never evaluated. In addition, patients were alleged to be at risk because no prescriber was monitoring them for adverse reactions, pain relief, or opioid abuse. OIG did not substantiate that physicians improperly prescribed opioid medications for patients whom they had not seen or examined. OIG did substantiate that physicians prescribed opioids for patients with whom they had no direct interaction, but this is not a violation of law or VA policy. OIG substantiated that physicians did not consistently document medication effectiveness prior to renewing prescriptions for patients at increased risk for adverse medication effects or diversion. OIG also found that physicians were not consistently documenting use of the Ohio Automated Rx Reporting System, a state prescription drug monitoring program. OIG did find that urine drug screens were routinely performed. According to Veterans Health Administration (VHA) policy, patients on chronic opioid therapy are to be evaluated every 1 to 6 months.
Combined Assessment Program Summary Report - Evaluation of Pressure Ulcer Prevention and Management at Veterans Health Administration Facilities
The VA Office of Inspector General (OIG) conducted a review to determine whether Veterans Health Administration clinicians complied with selected requirements related to pressure ulcer prevention and management. OIG performed this evaluation in conjunction with 47 Combined Assessment Program reviews of Veterans Health Administration medical facilities conducted from April 1, 2013, through March 31, 2014. OIG noted high compliance with Veterans Health Administration policy in many areas, including facilities’ local pressure ulcer policies, requirements for comprehensive skin assessments, and use of a standardized risk assessment tool. OIG identified opportunities for improvement in administrative requirements and employee training, risk assessment and prevention, documentation, and medication storage and made nine recommendations.
Interim Report - Review of Phoenix VA Health Care System's Urology Department, Phoenix, AZ
During the VA Office of Inspector General’s (OIG) 2014 review of scheduling practices and wait times at the Phoenix VA Health Care System (PVAHCS), OIG found that large numbers of patients who were referred for urological evaluation and/or treatment experienced significant delays in either obtaining an appointment, scheduling follow-up, and/or receiving authorizations for non-VA urology care. This prompted OIG to open an expanded review, specifically focusing on access to care within PVAHCS’ Urology Department. While the OIG review is ongoing, some concerning preliminary findings requiring the Interim Under Secretary for Health’s immediate attention were identified. These findings suggest that delays associated with the processing of referrals through the Office of Non-VA Care Coordination (NVCC) could potentially be putting patients at risk for being lost to follow-up. As PVAHCS continues to recruit and hire physicians and mid-level providers to staff its Urology Department, it is critical that staffing and administrative processes related to non-VA authorized care be properly administered.