A Statement from the Deputy Inspector General - VA OIG Review of Anonymous Complaint Finds That Two VBA Senior Executives Inappropriately Used Their Positions for Personal and Financial Benefit, and That VBA Misused VA’s Relocation Program
Washington, DC – The Chairman and Ranking Member of the House Committee on Veterans’ Affairs and the Chairman and Ranking Member of the Senate Committee on Veterans’ Affairs requested the VA Office of Inspector General (OIG) investigate allegations concerning financial benefits and preference given at VA. An anonymous complainant alleged that Ms. Diana Rubens, Philadelphia VA Regional Office (VARO) Director, improperly received $288,206.77 in relocation expenses for transferring from the Veterans Benefits Administration (VBA) Headquarters to her current position at the VARO and retained her high-level Senior Executive Service (SES) salary, despite the position being two levels lower on VA’s SES pay scale. We were also asked to conduct a broader review of VA’s Permanent Change of Station (PCS) Relocation program. Our investigation substantiated the allegations. The OIG issued its report http://www.va.gov/oig/pubs/VAOIG-15-02997-526.pdf on September 28, 2015.
OIG Monthly Highlights
Read about our top reports and investigations in August 2015 CONGRESSIONAL TESTIMONY - Chief of Staff for Healthcare Oversight Integration Testifies on Challenges Alaska Veterans Face Getting Timely Care Dr. Andrea C. Buck, Office of Inspector General (OIG) Chief of Staff for Healthcare Oversight Integration, testified at a field hearing in Eagle River, AK, before the Committee on Veterans’ Affairs, United States Senate, on “Exploring the Veterans Choice Program's Problems in Alaska.” She highlighted the challenges some veterans have faced in receiving timely access to care in Alaska. Although the Veterans Health Administration (VHA) reported that as of May 2014 the Alaska VA Healthcare System (VAHCS) provided overall good access to care, Dr. Buck discussed that an OIG healthcare inspection conducted in August 2014 revealed that there were significant access to care problems at the Mat-Su clinic in Wasilla, AK. She emphasized that meeting the health care needs of Alaska veterans must remain one of VA’s highest health care priorities and discussed several additional OIG oversight projects planned or underway that focus on the Alaska VAHCS and/or issues related to veterans’ access to health care. Dr. Buck was accompanied by Ms. Sami O’Neill, Director of the Seattle, WA, Office of Healthcare Inspections.
Review of Patient-Centered Community Care (PC3) Health Record Coordination
We estimate PC3 contractors did not meet the clinical documentation requirements for 68 percent of episodes of care during our period of review from January 1, 2014, through September 30, 2014. We estimate that 48 percent of the clinical documentation was provided to VA late and 20 percent was incomplete. VHA made about $870,400 of improper payments when payments should not have been made prior to receiving complete clinical documentation. VHA did not apply contract penalties to Health Net Federal Services, LLC when it did not meet performance requirements related to the timely return of clinical documentation. VHA applied a penalty of only $753. The maximum allowable penalty was $15,909. If VA exercises the remaining three option years of the PC3 contract without adequately addressing the identified issues, VA could make about $5.5 million in improper payments and missed assessed penalties. We also found that PC3 patients experienced delays in VHA referring and following up on their care with TriWest Healthcare Alliance Corporation (TriWest), as well as TriWest not timely notifying VHA of three malignancy diagnoses resulting from colonoscopies. These issues occurred because VHA relied on contractor-reported data, lacked an adequate program for monitoring contractor performance, and a process to verify whether the contractor meets contract performance standards. As a result, VHA lacked assurance that PC3 is providing patients adequate continuity of care. We recommended VHA implement a mechanism to verify PC3 contractors’ performance without relying on contractors’ self-reported data, VHA ensure PC3 contractors properly annotate and report critical findings in a timely manner, and that VHA imposes financial or other remedies when contractors fail to meet requirements.
Review of Alleged Inappropriate Referrals at VHA’s Southern Nevada Healthcare System to a Non-VA Medical Provider
OIG performed this review to determine the merits of allegations made to the Office of Inspector General in November 2014. The complainant alleged that a VA Southern Nevada Healthcare System (VASNHS) employee limited the choice of providers for patients needing non-VA care (NVC) for radiation oncology treatments and directed patients to one NVC provider because of a friendship with a physician associated with the provider’s business. It was further alleged the VASNHS Chief of Staff directed staff not to refer patients to the NVC provider and the NVC provider had a previous contract that VA canceled due to poor performance. We did not substantiate the allegations. However, while reviewing these allegations we found TriWest, a Patient-Centered Community Care contractor, referred 15 of 58 oncology patients to network practices that did not meet clinical accreditation standards established under the terms of the Patient-Centered Community Care contract. We recommended the Under Secretary for Health ensure that TriWest refers radiation oncology patients only to practices/facilities properly accredited under the terms of the contract, determine whether the Patient-Centered Community Care contract needs to be amended, and to ensure patients receive radiation oncology treatments that meet VHA’s standards of care.
Review of VBA's Alleged Mismanagement of Unemployability Benefits at VARO Seattle, Washington
On March 6, 2015, the Office of Inspector General (OIG) received allegations that VARO staff were storing more than 1,000 pieces of unprocessed mail, primarily Employment Questionnaires, which were needed to continue individual unemployability benefits, for several months. The complainant alleged the mismanagement of Employment Questionnaires resulted in the transmission of hundreds of unnecessary notifications proposing to discontinue individual unemployability benefits. The complainant also alleged VARO management delayed taking any action to process the unprocessed mail. We substantiated VARO staff mismanaged unprocessed mail relating to IU benefits and unnecessarily proposed to discontinue IU benefits for 27 (20 percent) of the 132 employment questionnaires we reviewed. We did not substantiate the allegation that VARO management delayed taking corrective actions to address unprocessed mail—rather, the Director instructed staff to take immediate action to process the mail once he learned of the situation. Recommendations for improvement included convening administrative investigation boards to: determine why VARO management was unaware that unprocessed mail had been stored within the Intake Processing Center (IPC) and determine why IPC staff did not seek assistance for processing employment questionnaires. We also recommended refresher training for staff with oversight and functional responsibility for mail processing. Further, we recommended that the Under Secretary for Benefits ensure audit trails coexist with corrective action plans in all instances of mismanagement or data manipulation. VBA's Pacific District Director concurred in principle with our first two recommendations but proposed an alternative to administrative investigation boards. We will monitor planned actions and follow up on their implementation.
Administrative Investigation: Inappropriate Use of Position and Misuse of Relocation Program and Incentives in VBA
The Chairman and Ranking Member of the House Committee on Veterans’ Affairs and the Chairman and Ranking Member of the Senate Committee on Veterans’ Affairs requested the VA Office of Inspector General (OIG) investigate allegations concerning financial benefits and preference given at VA. An anonymous complainant alleged that Ms. Diana Rubens, Philadelphia VA Regional Office (VARO) Director, improperly received $288,206.77 in relocation expenses for transferring from the Veterans Benefits Administration (VBA) Headquarters to her current position at the VARO and retained her high-level Senior Executive Service (SES) salary, despite the position being two levels lower on VA’s SES pay scale. We were also asked to conduct a broader review of VA’s Permanent Change of Station (PCS) Relocation program. Ms. Rubens was reassigned from her position as Deputy Under Secretary for Field Operations to the position of Director, Philadelphia VARO, effective June 1, 2014. VA paid $274,019.12 related to Ms. Rubens’ PCS move. Relocation expenses paid for Ms. Rubens’ move were generally allowable under Federal and VA policy; however, the OIG identified issues with the timeliness of VA’s approval of Ms. Rubens’ participation in the Appraised Value Offer program, as well as a 17-day extension for temporary quarters subsistence expense allowance. In addition, Ms. Rubens was reimbursed $76.50 for alcoholic beverages, which is prohibited, and $47 for meal and tip expenses that were not supported by required receipts. More importantly, the OIG concluded that Ms. Rubens inappropriately used her position of authority for personal and financial benefit when she participated personally and substantially in creating the Philadelphia VARO Director vacancy and then volunteering for the vacancy. During the course of our investigation, we identified a second instance of a senior executive’s inappropriate use of her position. Ms. Kimberly Graves was reassigned from her position as the Director of VBA’s Eastern Area Office to the position of Director, St. Paul VARO, effective October 19, 2014. VA paid $129,467.56 related to Ms. Graves’ PCS move. OIG concluded that Ms. Graves also inappropriately used her position of authority for personal and financial benefit when she participated personally and substantially in creating the St. Paul VARO Director vacancy and then volunteering for the vacancy. Both Ms. Rubens and Ms. Graves’ reassignments resulted in a significant decrease in job responsibilities, yet both retained their annual salaries—$181,497 and $173,949, respectively. Based on Federal regulations, we determined that VA could not reduce their annual salaries upon reassignment despite the decrease in the scope of their responsibilities. However, a senior executive’s annual salary can be reduced if the individual receives a less than fully successful annual summary rating; fails to meet performance requirements for a critical element; or, as a disciplinary or adverse action resulting from conduct related activity. The OIG also reviewed records related to 23 VBA reassignments of employees who were either promoted to SES positions or were moved to different SES positions in fiscal years (FYs) 2013, 2014, and 2015. Twenty-one of the 23 reassignments included salary increases. We determined that VBA management used moves of senior executives as a method to justify annual salary increases and used VA’s PCS program to pay moving expenses for these employees. From FY 2010 to 2013, U.S. Office of Personnel Management guidelines precluded all SES employees from receiving annual pay increases. In FY 2012, the VA Secretary determined no VBA executives would receive performance awards based on concerns over the backlog of veterans’ disability claims. The OIG identified salary increases that did not consistently reflect changes in the positions’ scope of responsibility and that when VBA filled vacant SES positions the selectees often received significant annual salary increases over what their predecessors were paid. For example, one VARO Director received a salary increase of $30,417 or 22 percent more than his predecessor. Annual salary increases associated with these relocations totaled about $321,000, and PCS relocation expenses paid were valued at about $1.3 million. Additionally, VBA paid $140,000 in unjustified relocation incentives. In total, VA spent just over $1.8 million on the reassignments. The OIG does not question the need to reassign some staff to manage a national network of VAROs; however, we concluded that VBA misused VA’s PCS program for the benefit of its SES workforce. The OIG made criminal referrals to the U.S. Attorney’s Office, District of Columbia, regarding official actions orchestrated by Ms. Rubens and Ms. Graves. Formal decisions regarding prosecutorial merit are pending. We provided 12 recommendations to VA to increase oversight of the Department’s Permanent Change of Station program and to determine appropriate administrative actions to take, if any, against senior VBA officials.
Review of VHA's Patient-Centered Community Care (PC3) Provider Network Adequacy
OIG assessed the adequacy of Patient-Centered Community Care (PC3) provider networks developed under Veterans Health Administration’s (VHA) contracts valued at approximately $9.4 billion. We found inadequate PC3 provider networks contributed significantly to VA medical facilities’ limited use of PC3. VHA spent $3.8 million of its $2.8 billion FY 2014 non VA care (NVC) budget (0.14 percent) on PC3. During the first 6 months of FY 2015, VHA’s PC3 purchases increased but still constituted less than 5 percent of its NVC expenditures. VHA staff attributed the limited use of PC3 to inadequate provider networks that lacked sufficient numbers and mixes of health care providers in the geographic locations where veterans needed them. VA medical facility staff considered the PC3 networks inadequate because PC3 networks lacked needed specialty care providers; returned authorizations had to be re-authorized through NVC and increased veterans’ wait times for care; and NVC provided veterans more timely care than PC3. VHA could not ensure the development of adequate PC3 provider networks because it lacked an effective governance structure to oversee the Chief Business Office’s planning and implementation of PC3; the Chief Business Office lacked an effective implementation strategy for the roll-out of PC3; and neither VHA nor the PC3 contractors maintained adequate data to measure and monitor network adequacy. We recommended the Under Secretary for Health strengthen controls over the monitoring of PC3 network adequacy and ensure adequate implementation and monitoring plans are developed for future complex healthcare initiatives.