A Statement from the Deputy Inspector General
VA OIG Substantiates Whistleblower's Claims of Extensive, Persistent Problems in Veterans Health Care Enrollment Records
Washington, DC – The Department of Veterans Affairs Office of Inspector General (OIG) received a request from the Chairman of the U.S House Committee on Veterans’ Affairs to determine the merits of allegations made by a whistleblower about the Veterans Health Administration’s (VHA) Health Eligibility Center (HEC). The OIG found the Chief Business Office has not effectively managed its business processes to ensure the consistent creation and maintenance of essential data and recommended a multiyear project management plan...
A Statement from the Deputy Inspector General
VA Deputy Inspector General Announces Selections for Chief of Staff for Healthcare Oversight Integration and Assistant Inspector General for Audits and Evaluations
Washington, DC - For a number of years the demand for collaborative oversight projects between the Office of Inspector General’s (OIG) Offices of Investigations, Audits and Evaluations, and Healthcare Inspections has continued to grow, and in particular congressional requests involving complex and overlapping clinical and management issues affecting the Veterans Health Administration (VHA). Access to care, wait times, nurse and physician staffing standards, disability compensation examinations and ratings, non-VA and contracted care, and the new Veterans Choice Act, to name just a few...
Review of Alleged Mismanagement at the Health Eligibility Center
At the request of the House Committee on Veterans’ Affairs, OIG conducted a review of VHA’s Health Eligibility Center (HEC) to evaluate the merit of allegations of mismanagement pertaining to a backlog of pending health care applications, veterans who died while their application were pending, purged or deleted veteran health records, and unprocessed applications. OIG substantiated the existence of about 867,000 pending records that had not reached a final determination as of September 30, 2015. OIG also substantiated that pending records included entries for over 307,000 individuals reported as deceased by the Social Security Administration. However, due to limitations in the HEC’s Enrollment System (ES) data, OIG could not reliably determine how many pending records existed as a result of applications for health care. This occurred because the enrollment program did not effectively define, collect, and manage enrollment data. In addition, VHA lacked adequate procedures to identify data of death information and implement necessary updates to the individual’s status. OIG also substantiated that employees incorrectly marked unprocessed applications as completed and possibly deleted 10,000 or more transactions from the HEC’s Workload Reporting and Productivity (WRAP) tool over the past 5 years. WRAP was vulnerable because the HEC did not ensure that adequate business processes and security controls were in place, manage WRAP user permissions, and maintain audit trails to identify reviews and approvals of any deleted transactions. In addition, the Office of Information and Technology (OI&T) did not provide proper oversight for the development, security, and data backup retention for WRAP. OI&T also did not collect and retain WRAP audit logs in accordance with VA policy. Finally, we substantiated that the HEC identified over 11,000 unprocessed health care applications and about 28,000 other transactions in January 2013. This backlog developed because the HEC did not adequately monitor and manage its workload and lacked controls to ensure entry of WRAP workload into ES. OIG provided recommendations to the Under Secretary for Health (USH) to address ES data integrity issues, enrollment program policy limitations, and the access and security of the WRAP tool. OIG also provided recommendations to the Assistant Secretary for Information and Technology (OI&T) to implement adequate security controls for the WRAP tool, and ensure the collection and retention of WRAP audit logs and system backups. OIG further recommended that the USH and Assistant Secretary OI&T confer with the Office of Human Resources and the Office of General Counsel to fully evaluate the implications of the findings of the report, determine if administrative action should be taken against any VHA or OI&T senior officials involved, and ensure that appropriate action is taken. The USH and Assistant Secretary OI&T concurred with our findings and recommendations.
OIG Determination of Veterans Health Administration’s Occupational Staffing Shortages
The VA Office of Inspector General (OIG) conducted its second of several determinations 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. We interpreted “largest staffing shortage” to encompass broader deliberation than simply the number needed to replace or backfill vacant positions for an occupation and refer to occupations that met broader criteria as critical need occupations. We performed a rule-based analysis of VHA data to identify critical need occupations, analyzed data on gains and losses for these occupations, and assessed VHA’s progress with implementing staffing models. We determined that the top five critical need occupations were Medical Officer, Nurse, Psychologist, Physician Assistant, and Physical Therapist. The identification of these occupations remains unchanged from our initial determination reported in January 2015. Our analysis of staffing gains and losses shows that for these critical need occupations, a significant percentage of total gains was offset by losses. We determined that the number of regrettable losses (that is, resignations and transfers to other government agencies) for many critical need occupations was high. This analysis likely does not capture the effect of the 2014 Veterans Access, Choice, and Accountability Act, as that law was implemented on August 7, 2014, and our analysis only includes data up until September 30, 2014. However, our analysis does provide an understanding of the historical pattern of staffing changes at VHA leading up to the enactment of that law. Further, we found that VHA’s staffing model is in development and consists of different models covering distinct areas of VHA staffing needs. VHA is working on extending the Specialty Productivity Access Report and Quadrant staffing tool to more occupations. We made two recommendations.
Audit of Fiduciary Program Controls Addressing Beneficiary Fund Misuse
We conducted this audit to determine whether the Veterans Benefits Administration (VBA) protects the VA-derived income and estates of beneficiaries who are unable to manage their financial affairs when misuse of beneficiary funds is alleged. VBA did not process 147 of 304 (48 percent ) required actions associated with 122 beneficiaries timely or according to policy in response to allegations or indications of misuse of beneficiary funds during calendar year (CY) 2013. VBA also did not replace two fiduciaries who misused beneficiary funds. Specifically, VBA did not: Timely complete 117 of 265 (44 percent) required actions to determine if misuse of funds occurred in response to allegations and indications of beneficiary fund misuse. Complete 30 of 39 (77 percent) required actions after VBA concluded misuse of funds occurred, such as reissuing (restoring) misused funds, performing effective collection actions, and completing internal negligence determinations. Replace two fiduciaries that misused beneficiary funds and allowed both to continue to manage the combined estates of 48 other beneficiaries. Fiduciary Hub management generally attributed untimely misuse actions to increases in Fiduciary Hub workload. Required actions after VBA concluded misuse of funds occurred were not completed due to a lack of policies and VBA staff not being clear about some policies. Also, VBA did not monitor or perform quality reviews of all misuse activities, which contributed to untimely and uncompleted misuse actions. If VBA does not timely complete misuse actions, beneficiary funds are at increased risk of misuse. We project, during CY 2013, VBA did not timely complete required misuse actions to ensure the protection of 758 beneficiaries’ VA‑derived estates valued at about $45.2 million. VBA also did not restore approximately $2.1 million of misused beneficiary funds. Additionally, unless VBA improves the timeliness of actions in response to allegations and indications of misuse, we project VBA may not adequately protect annual benefit payments to beneficiaries valued at approximately $16 million, or $80 million during CYs 2014 through 2018.
Audit of VHA’s Efforts To Improve Veterans’ Access to Outpatient Psychiatrists
OIG conducted this audit to evaluate VHA’s efforts to improve veterans’ access to outpatient psychiatrists. OIG determined that VHA has not been fully effective in its use of hiring opportunities or its use of existing personnel to improve veterans’ access to psychiatrists. From FY 2012 through FY 2014, VHA increased outpatient psychiatrist full time equivalents (FTEs) by almost 15 percent. During that time, the number of veterans’ outpatient encounters with psychiatrists increased by about 10 percent, and the number of individual veterans who received outpatient care from a psychiatrist increased about 9 percent. OIG found that VHA did not have an effective method for establishing psychiatrist staffing needs. Throughout recent hiring initiatives, VHA did not stress a specific need for psychiatrists; instead, facilities determined their own staffing needs. This resulted in 94 of 140 health care facilities that needed additional psychiatrist FTEs to meet demand, as of December 2014. In addition, OIG found that VHA did not ensure facilities used consistent and effective clinic management practices. Because of this, OIG determined that VHA facilities could have better used about 25 percent of psychiatrist FTE clinical time to see veterans in FY 2014, which equated to nearly $113.5 million in psychiatrists’ pay. Over the next 5 years, this would equate to over $567 million if VHA does not strengthen clinic management now. OIG recommended the USH ensure facilities incorporate the Office of Mental Health Operations staffing model to determine the appropriate number of psychiatrists needed, and attain appropriate staffing levels or identify alternative options. OIG also recommended the USH develop clinic management business rules, reassess the appropriateness of VHA’s productivity target for psychiatrists, and develop a mechanism to monitor the variance in which psychiatrists code encounters. The USH concurred with OIG’s findings and recommendations and plans to complete all corrective actions by September 2016.
Mr. Chairman and Members of the Committee, thank you for the opportunity to testify before the Committee today on veterans’ access to care in Alaska and our recent report, Scheduling, Staffing, and Quality of Care Concerns at the Alaska VA Healthcare System, Anchorage, Alaska, which highlights the challenges some veterans have faced in receiving timely access to care in Alaska. I am accompanied by Ms. Sami O’Neill, Director of the Seattle, Washington, Office of Healthcare Inspections.
OIG Monthly Highlights
Read about our top reports and investigations in July 2015
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