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...
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
Former Executive Convicted of Bribing Former Director of Cleveland VA Medical Center
OIG, FBI Investigation Results in Conviction of Design Contractor Who Received Inside Information from Former VA Executive
Review of Alleged Shredding of Claims-Related Evidence at the VA Regional Office Los Angeles, California
We substantiated that VARO Los Angeles staff were not following VBA’s policy on management of veterans’ and other governmental paper records. We found 9 pieces of claims- related mail that VARO staff failed to properly process. Eight of the documents had the potential to affect veterans’ benefits, while one had no effect on a veteran’s benefits. Although we could not substantiate that the VARO inappropriately shredded some claims-related documents, we found sufficient evidence to conclude the VARO staff likely would have inappropriately shredded the 9 documents we found. Our review determined that the Los Angeles’ VAROs implementation of VBA’s established processes for the disposition of paper records were not adequate. We found that the Los Angeles VARO Records Management Officer (RMO) position was vacant from August 2014 until our inspection in February 2015. This was because the VARO’s Assistant Director had determined that it was not necessary to fill the RMO position when the incumbent was promoted. Not filling the RMO position eliminated the final certification in the VARO’s authorized shredding process, which VBA established to prevent improper shredding of claims-related documents. If not for our review, it is likely that the VARO staff would have inappropriately destroyed these 9 claims-related documents we found. We recommend the VARO Director implement a plan and provide training to ensure all VARO staff comply with VBA’s policy for handling, processing, and protection of claims-related documents and other Government records. We also recommend that the VARO Director take proper action on the eight cases that had the potential to affect veterans’ benefits. In order to determine whether this is an isolated problem or a systemic issue, we have initiated surprise inspections at 10 selected VAROs across the nation. These 10 sites are Atlanta, GA; Baltimore, MD; Chicago, IL; Houston, TX; New Orleans, LA; Oakland, CA; Philadelphia, PA; Reno, NV; San Juan, PR; and St. Petersburg, FL. We expect to publish a final report and offer additional recommendations for improvement once the results of the 10 VARO inspections are complete. We will request the Under Secretary’s comments and publish the Los Angeles VARO Director’s action plan when we publish the summary results of our surprise inspections.