Audit of VHA’s Alleged Improper Payments to Providers After Veterans’ Reported Deaths
In September 2015, OIG received an allegation that the Veterans Health Administration (VHA) paid non-VA care (NVC) providers for services that could not have been rendered to about 4,200 deceased veterans listed in Social Security Administration’s Death Master File. To investigate the allegation, we reviewed payment records documenting outpatient and inpatient claims worth about $15.5 million to determine whether, and to what extent, improper payments were made from FYs 2011 – 2015. We substantiated the allegation and found VHA improperly paid for 12 of the 25 billed NVC outpatient services reviewed, totaling about $810 in improper payments. These improper payments occurred because NVC authorization clerks failed to update the end dates on veterans’ NVC authorizations to reflect their dates of death, as required by VHA policy. However, we did not substantiate that VHA made improper payments for inpatient services because the services had been rendered before the veterans’ dates of death. For the 60 billed NVC inpatient services reviewed, we determined the veterans’ dates of death in the Death Master File were incorrect and/or the payment records did not reflect the last dates the veterans received care. Although we did not find a systemic issue, we estimated VHA annually makes about $101,000 in improper payments to NVC providers for deceased veterans. VHA could improperly pay NVC providers about $505,000 for outpatient services over the next 5 years unless it ensures NVC authorizations for deceased veterans are updated in accordance with VHA policy. We recommended that the Under Secretary for Health recover the improper payments identified and ensure VA medical facilities update NVC authorizations for deceased veterans as required by VHA policy. The Under Secretary for Health concurred with our report and provided an acceptable action plan.
Owner of New England Compounding Center Convicted of Racketeering Leading to Nationwide Fungal Meningitis Outbreak
Pharmacist convicted of racketeering and mail fraud that contributed to a nationwide fungal meningitis outbreak.
Review of Alleged Mismanagement of Construction Projects at the VA Medical Center in Clarksburg, West Virginia
The OIG substantiated a Hotline allegation of improper management and oversight of minor, nonrecurring maintenance, and clinical specific initiative construction projects at the Louis A. Johnson VA Medical Center (VAMC) in Clarksburg, WV. The complainant alleged eight construction projects were mismanaged, which led to project cost overruns, delays, cancellations, unnecessary change orders, and additional work. Most significant was a parking garage planned for at a cost of approximately $9.7 million that was reduced from approximately 430 new spaces to approximately 25 new spaces before the project was canceled in March 2016. The VAMC also had to reduce other construction projects in scope because of inadequate planning, and delayed project completion. The VAMC has completed only three of the eight projects; all three cost significantly more than planned. This occurred because of inaccurate cost estimates, untimely performance of site surveys, and failure to ensure project designs were within funding limitations. In total, we identified approximately $2.8 million in unnecessary costs and delays in completing projects needed to serve veterans. Accordingly, we recommended the Veterans Integrated Service Network 5 Director ensure the Louis A. Johnson VAMC implements a plan to use or repurpose the heating and air conditioning system identified by this review; train staff on developing cost estimates and funding requests; and ensure timely performance of site surveys.
Ball Man Sentenced to 21 Months in Prison for Stealing More than $100,000 in Veterans Affairs Benefits
Man sentenced to 21 months in prison for defrauding the VA of more than $100,000 in benefits.
VA Office of Inspector General Releases Evaluation of the Veterans Crisis Line
The VA Office of Inspector General (OIG) issued its health care inspection, Evaluation of the Veterans Health Administration Veterans Crisis Line, reporting deficiencies in multiple areas of VA’s administration of its Veterans Crisis Line (VCL).
Mr. Chairman, Ranking Member Wasserman Schultz, and Members of the Subcommittee, thank you for the opportunity to discuss the oversight the Office of Inspector General (OIG) provides to VA programs and operations. I have had the great honor and privilege of serving as the VA Inspector General since May 2016, and today is my first opportunity to testify before this Subcommittee. My statement will focus on the OIG’s mission, some of the more significant enhancements we have recently made and our more meaningful oversight work that we reported on during the past fiscal year. I would first like to take this opportunity to thank the Congress for the increase to our fiscal year (FY) 2017 appropriation. Our FY 2017 appropriation of $159.6 million will greatly assist our ability to fulfill our mission of effective oversight of the programs and operations of VA in the face of the tremendous challenges and expanded growth of many mission critical programs in VA.
Mr. Chairman, Ranking Member Tester, and Members of the Committee, thank you for the opportunity to discuss the work of the VA Office of Inspector General (OIG) and how the OIG provides effective oversight of VA programs and operations through independent audits, inspections, and investigations. The OIG seeks to prevent and detect fraud, waste, and abuse, and make meaningful recommendations to drive economy, efficiency, and effectiveness throughout VA programs and operations. Our goal is to undertake impactful work that will assist VA in providing the appropriate and timely services and benefits that veterans so deservedly earned, and ensuring the proper expenditure of taxpayer funds. I am accompanied by John D. Daigh, Jr., M.D., CPA, Assistant Inspector General for Healthcare Inspections.