Shasta County Man Pleads Guilty to Defrauding the VA by Falsely Claiming He Was a Decorated Veteran
Stolen Valor— Shasta County Man pleads guilty to 23 misdemeanor counts in scheme to illegally obtain benefits from the Department of Veterans Affairs.
Review of Alleged Patient Scheduling Issues at the VA Medical Center in Tampa, FL
OIG determined the merits of allegations received in December 2014 about the Veterans Choice Program (VCP) at the James A. Haley Veterans’ Hospital (JAHVH). OIG substantiated the allegation that JAHVH staff did not always cancel the VA appointment when a VCP appointment was made. OIG examined 56 records of veterans who completed a VCP appointment and found that for 12 of the veterans (21 percent), staff did not cancel the veterans’ corresponding VA appointment. This occurred because Non VA Care Coordination staff did not receive prompt notification from the contractor, Health Net, when a veteran scheduled a VCP appointment and no longer needed the VA appointment. OIG also substantiated that prior to May 2015, the Performance Improvement (PI) supervisor did not notify schedulers of errors identified during scheduling audits. The PI supervisor stated that the PI team corrected the errors and notifying schedulers was not his priority. In addition, the OIG substantiated that JAHVH did not add all eligible veterans to the VCL when their scheduled appointment was greater than 30 days from their preferred date, and that staff inappropriately removed veterans from the VCL. This occurred because JAHVH schedulers thought they were appropriately removing the veteran from the Electronic Wait List, when they were actually removing the veteran from the VCL. OIG recommended the Director of the JAHVH ensure the facility receives prompt notification of scheduled VCP appointments and determine if the contractor complies with the requirements. OIG also recommended the Director ensure appropriate staff receive scheduling audit results and PI staff verify correction of errors, and staff receive training regarding management of the VCL. The Director of the JAHVH concurred with the OIG’s report and recommendations. Based on actions already implemented, OIG considered four of the recommendations closed, and will follow up on the implementation of the one remaining recommendation.
OIG Monthly Highlights
Read about our top reports and investigations in December 2015 OIG REPORTS - Allegations of Lapses in Medical Record Documentation Substantiated at Perry Point, Maryland, VA Medical Center Residential Rehabilitation Program - The Office of Inspector General (OIG) conducted an inspection in response to complaints regarding documentation and follow-up of clinical events at the Mental Health (MH) Residential Rehabilitation Treatment Program (RRTP) located at Perry Point VA Medical Center (VAMC). The program is part of the Maryland VA Health Care System (HCS), headquartered in Baltimore, MD. OIG did not substantiate the allegation that facility staff did not follow sufficient practices to manage significant clinical events. OIG substantiated the allegation that some staff did not consistently document significant clinical events in patients’ electronic health records (EHR). OIG did not substantiate the allegation that subject policy-makers knew of documentation lapses but took no action to correct them. Prior to OIG’s inspection, and for unrelated reasons, the current MH Clinical Center Director identified concerns and took steps to revise and improve MH RRTP documentation processes. OIG found that the MH RRTP medical provider staffing of 1.2 providers was not compliant with the Veterans Health Administration’s required minimum core staffing guidelines of 2.3 providers and that staff did not consistently comply with all safe medication management documentation elements. On September 24, 2014, the Chief of Staff approved the hiring of one additional physician and two mid-level practitioners to cover MH rograms. OIG recommended that the System Director ensure that MH RRTP medical providers document information pertinent to medical decision-making related to clinical events in the EHR, managers review and address medical provider staffing needs, and staff document in the EHR all required elements of safe medication management for MH RRTP patients.
Blythewood Man Convicted of Massive Government Fraud
South Carolina man could face up to 20 years of imprisonment, fines up to $500,000 and forfeiture of more than $1.5 million dollars in connection with a fraudulent disability claim.
Federal Jury Convicts North Carolina Couple Of Fraud
Husband and wife conspired to defraud federal contract programs for disadvantaged and disabled veteran-owned small businesses
Audit of VA's Financial Statements for Fiscal Years 2015 and 2014
CliftonLarsonAllen LLP provided an unmodified opinion on VA’s financial statements for FYs 2015 and 2014 and identified four material weaknesses: information technology (IT) security controls; procurement, undelivered orders, and reconciliations; purchased care processing and reconciliations; and financial reporting. OIG contracted with the independent public accounting firm, CliftonLarsonAllen LLP, to audit VA’s fiscal year (FY) 2015 financial statements. This audit is an annual requirement of the Chief Financial Officers Act of 1990. CliftonLarsonAllen LLP also identified two significant deficiencies: accrued operating expenses and CFO organizational structure for VHA and VA. They also reported VA’s substantial noncompliance with applicable Federal financial management systems requirements and the United States Standard General Ledger at the transaction level under the Federal Financial Management Improvement Act (FFMIA). They noted improvements were needed in complying with the Federal Managers’ Financial Integrity Act. They cited instances of noncompliance with section 5315, title 38, United States Code, pertaining to the charging of interest and administrative costs, and three possible violations of the Antideficiency Act, with VA in the process of reporting two others. CliftonLarsonAllen LLP made recommendations regarding VA’s IT security controls, financial management processes, and financial management structure. Department officials expressed a firm commitment to addressing the material weaknesses and significant deficiencies. The independent auditors, will follow up on actions taken during the FY 2016 audit.
Follow Up Review on the Mismanagement of Informal Claims Processing at the VA Regional Office Oakland, California
In our previous report, Review of Alleged Mismanagement of Informal Claims Processing at VA Regional Office Oakland, California (Report No. 14 03981 119, February 18, 2015), we substantiated the allegation that VA Regional Office (VARO) Oakland staff had not processed or properly stored informal claims for benefits. During an April 2015 House Committee on Veterans’ Affairs testimony, the Office of Inspector General received a request from Congressman Doug LaMalfa to conduct a follow up review at VARO Oakland. This request was based on an allegation that management had a list of 13,184 unprocessed informal claims for benefits. Additionally, Congresswoman Jackie Speier asked us to determine whether VARO staff altered dates of claim. We did not find evidence of the existence of the alleged list of approximately 13,184 informal claims even after interviews with current and former VARO staff, whistleblowers, and members of a previous Veterans Benefits Administration (VBA) management support team. We reviewed 60 of 1,308 informal claims and found VARO staff had incorrectly processed 6 claims. Five errors contained incorrect effective dates that resulted in approximately $26,325 in improper payments. We also determined Oakland staff did not timely process 9 of the 60 claims resulting in significant delays in benefit payments to veterans. The delays ranged from approximately 5 years to 7 years and 8 months. Through information obtained from VARO staff, we obtained an additional list of 690 claims. We provided management with the list to determine whether staff had correctly processed these potential informal claims. VARO management did not provide the oversight needed to ensure timely and accurate processing of informal claims, to include the 1,308 identified in March 2015. As a result, veterans did not receive accurate or timely benefits payments. We recommended the VARO Oakland Director provide training to staff on proper informal claims processing procedures, conduct a complete review of the additional list of 690 claims that may be informal claims, and to conduct another review of the remaining 1,248 informal claims. The VARO Director concurred with our recommendations. Management’s planned actions are responsive and we will follow up as required.