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Review of Alleged Inappropriate Referrals at VHA’s Southern Nevada Healthcare System to a Non-VA Medical Provider

Report Information

Issue Date
Report Number
15-01590-523
VISN
State
Washington
District
VA Office
Veterans Health Administration (VHA)
Report Author
Office of Audits and Evaluations
Report Type
Audit
Recommendations
3
Questioned Costs
$0
Better Use of Funds
$0
Congressionally Mandated
No

Summary

Summary
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.

Open Recommendation Image, SquareOpenClosed and Implemented Recommendation Image, CheckmarkClosed-ImplementedNot Implemented Recommendation Image, X character'Closed-Not Implemented
No. 1
Closed and Implemented Recommendation Image, Checkmark
to Veterans Health Administration (VHA)
We recommended the Under Secretary for Health ensure that TriWest Healthcare Alliance Corporation meets the terms of the Patient-Centered Community Care contract by referring radiation oncology patients to only American College of Radiology-accredited network practices/facilities.
No. 2
Closed and Implemented Recommendation Image, Checkmark
to Veterans Health Administration (VHA)
We recommended the Under Secretary for Health determine whether the Patient-Centered Community Care contract with TriWest Healthcare Alliance Corporation needs to be amended to allow referrals to other than American College of Radiology-accredited network practices/facilities.
No. 3
Closed and Implemented Recommendation Image, Checkmark
to Veterans Health Administration (VHA)
We recommended the Under Secretary for Health require the review of medical results for the 15 patients referred to practices/facilities not accredited by the American College of Radiology or American College of Radiation Oncology to ensure they received treatment that met Veterans Health Administration standards of care.