Review of Allegations of Inappropriately Completed Consults and Inappropriate Bonuses at the St. Louis VA Health Care System

OIG determined the merits of allegations received during May and June 2014. OIG substantiated the allegation that the St. Louis VA HCS inappropriately changed the status of consults to “complete” prior to the provider actually completing the appointment with the patient. Starting in October 2013 and continuing through June 2014, an HCS employee inappropriately changed the status of 12 of 20 sampled consults (60 percent) to “Complete” before the provider completed the appointment. OIG found that St. Louis VA HCS Mental Health Clinic leadership did not provide sufficient oversight for processing consults and the St. Louis VA HCS did not have well-defined guidance to ensure staff took appropriate actions when processing consults. In addition, OIG substantiated the allegation that St. Louis VA HCS psychiatrists received performance pay based on productivity data. The OIG reviewed the FY 2013 performance pay assessments completed by the Associate Chief of Staff for Mental Health for eight full-time outpatient psychiatrists and found they each received an average of $13,710 in total performance pay. Seven of the eight psychiatrists met or exceeded the productivity goal. As a result, each received an average of $2,920 for meeting the productivity goal. OIG determined that the one psychiatrist who did not meet the productivity goal received no performance pay for productivity, but he did receive 80 percent of the performance pay—a total of $11,896—because he met the other goals of his performance pay assessment. OIG recommended the Acting Director of the St. Louis VA HCS ensure staff receive appropriate training and guidance on consult management, and perform a follow up analysis of completed consults to ensure they are not completed inappropriately. The Acting Director of the St. Louis VA HCS concurred with the OIG’s report. The Acting Director’s corrective actions were acceptable and we consider the recommendations closed.