Breadcrumb

Review of Alleged Improper Non-VA Community Care Consult Practices at Ralph H. Johnson VA Medical Center, Charleston, South Carolina

Report Information

Issue Date
Report Number
14-02890-352
VISN
State
South Carolina
District
VA Office
Veterans Health Administration (VHA)
Report Author
Office of Audits and Evaluations
Report Type
Audit
Recommendations
2
Questioned Costs
$0
Better Use of Funds
$0
Congressionally Mandated
No

Summary

Summary
On April 14, 2015, the Office of Special Counsel forwarded to the Department of Veterans Affairs Secretary allegations of wrongdoing that occurred at the Ralph H. Johnson VA Medical Center (VAMC) in Charleston, SC, in early FY 2014. Because of an ongoing VA OIG criminal investigation of related allegations, VA OIG agreed to review these latest allegations. A multidisciplinary team of auditors and health care inspectors began to address the allegations. These allegations were: Management at the VAMC directed claims assistants to discontinue pending consult requests that were “aged out,” a phrase previously unfamiliar to the complainants; Fee Basis clerks were directed to discontinue consults by marking them as completed when they were incomplete; Management interfered in the consult request process, including directing care for ineligible patients and allowing the Fee Basis Unit chief to direct his own care. We partially substantiated the allegation that management directed claims assistants to discontinue consults, but found that practice to be consistent with the VAMC’s administrative policy. We substantiated the allegation that the Fee Basis clerks did not properly discontinue consults, identifying three that had been marked completed prior to medical documentation being uploaded into the patient’s electronic health record. We did not substantiate the allegation that management directed care for ineligible patients and allowed the Fee Basis Unit chief to direct his own care. We recommended the VAMC director initiate an independent review regarding one patient that experienced a delay in receiving specialty care and that the director ensure that consults that were not acted on within seven days can be tracked and managed in accordance with national policy. The VAMC director subsequently had the one patient’s case reviewed by three outside experts who determined that the delay did not change the outcome for the patient.

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 Director, Ralph H. Johnson VAMC, initiate an additional clinical review regarding the patient identified in this report, and take action as appropriate.
No. 2
Closed and Implemented Recommendation Image, Checkmark
to Veterans Health Administration (VHA)
We recommended the Director, Ralph H. Johnson VAMC, ensure that consults that were not acted on within 7 days can be tracked and managed in accordance with national policy.