Hotline Cases Reviewed by OIG
A Pie Chart Representing the percentage of Hotline cases reviewed by OIG offices in FY 2015:
- Investigation: 53%
- Compliance/Conduct: 29%
- Healthcare: 18%
Out of the 38,098 Hotline contacts received in FY 2015, the Hotline referred the most serious Hotline complaints to OIG reviewers for consideration. These referrals resulted in approximately 200 internal OIG cases in FY 2015. Most Hotline cases reviewed by the OIG are based on allegations of criminal wrongdoing likely to result in prosecution. The second largest group of cases reviewed by the OIG is based on administrative compliance and conduct issues. The results of the latest OIG Hotline work are included in the OIG's Semiannual Reports to Congress: www.va.gov/oig/publications/semiannual-reports.asp
A Pie Chart Representing the percentage of Hotline cases reviewed by VA Management in FY 2015:
- Veterans Health Administration: 84%
- Veterans Benefits Administration: 13%
- Other VA Offices: 3%
Hotline Cases Reviewed by VA Management
In addition to Hotline cases completed by OIG reviewers, another 1,764 cases were referred in FY 2015 to VA management for review and response to the Hotline. VHA reviewed 84 percent of external Hotline cases, and VBA reviewed 13 percent. The OIG evaluated the adequacy of these VA reviews prior to case closure. VA reviewers substantiated 39 percent of Hotline cases closed in FY 2015. Closed Hotline cases reviewed by VA produced a total of 622 administrative and corrective actions and $4.1 million in monetary benefits in FY 2015.
The following are examples of recent Hotline cases substantiated as a result of management reviews:
Malfunctioning Equipment at Batavia Community Living Center Oak Lodge, Buffalo, New York
A veteran reported that it took 50 minutes for staff to respond to his call light requesting assistance. At the time, the veteran was recovering from a stroke and in need of assistance with activities of daily living. A review by the facility determined that there is vulnerability in the call-bell system. The problem can allow for an individual unit to become unplugged but not indicate a problem at the nurse's station if it became unplugged after the call bell was activated. As a result of their investigation, the facility informed the manufacturer of the issue and requested a system upgrade to alleviate the problem. In the interim, new procedures were implemented and additional staff training was provided to ensure disconnected call bells are identified in a timely manner.
Dependency and Indemnity Compensation (DIC) Fraud
The Pension Management Center (PMC) conducted a review of a widow's benefits to determine if she was receiving DIC payments even though she was remarried. After obtaining applicable legal documents the PMC concluded she had remarried. As a result, they sent the individual a due process letter proposing to terminate her DIC benefits effective to the date of her remarriage in 2007. In addition to terminating her benefits, the PMC initiated an overpayment for $114,603.
Benefits Fraud by Incarcerated Veteran
The Regional Office in Little Rock, AR conducted a Social Security Prison Match and confirmed that an incarcerated veteran was still receiving full compensation benefits as well as benefits for a spouse and dependent child. As a result of the check, the veteran's benefits were reduced to 10 percent and an overpayment of $74,969.06 was established against the veteran's account.
Compensation Benefits Fraud
The Seattle, WA, VARO conducted a review to determine if a veteran from Lakewood, CA, was improperly receiving dependent VA benefits for a woman who was not his wife. The veteran failed to respond to a letter of due process notifying him of the proposed reduction in benefits and therefore the Regional Office terminated the veteran's dependent benefits back to 2009 and initiated an overpayment of $9,177.49.
Healthcare Fraud by Using Fraudulent DD 214
The Temple, TX, VAMC conducted a review to determine if a veteran assigned to their facility had been receiving care, to include an extensive hospital stay, even though the individual was not entitled to VA medical benefits. It was determined that the veteran was using several names, all with the same social security number, and that the veteran had multiple, fraudulent DD 214s with those names. The DD 214s all indicated an Honorable discharge when in fact this was not true. As a result of the review, the facility took several corrective actions. They notified the veteran that he was not eligible for care and initiated collection action for care provided since 2011. Additionally, they cancelled all pending appointments and updated records to show that the veteran was ineligible for care.