Report Summary

Title: Audit of the Community Nursing Home Program
Report Number: 11-00331-160
Issue Date: 3/29/2013
City/State: Loma Linda, CA
Los Angeles, CA
Chicago, IL
Minneapolis, MN
Biloxi, MS
Huntington, WV
VA Office: Veterans Health Administration (VHA)
Report Author: Office of Audits and Evaluations
Report Type: Audits, Reviews & Evaluations
Release Type: Unrestricted
Summary: OIG evaluated VHA’s community nursing home program to determine if nursing homes met eligibility requirements. VHA’s Office of Finance reported nursing home program expenditures totaled $614 million in FY 2012 and were estimated to grow to $767 million in FY 2013. We found weaknesses and untimely VA healthcare facility eligibility reviews of 30 nursing homes resulted in the renewal of five ineligible nursing homes’ contracts. This occurred because VA officials did not effectively monitor the nursing home program and did not provide guidance needed to ensure the proper completion of eligibility reviews. Further, VA review teams did not always obtain and evaluate required operational information about the nursing homes when they performed their initial and subsequent annual reviews. Over the next 5 years, VHA will place about 33,500 patients at a cost of about $296.5 million in ineligible nursing homes if VHA does not strengthen program oversight and improve its eligibility reviews. This amount is not a “cost savings,” as veterans need these vital services, but future payments should be provided to eligible nursing homes that provide the quality of care our veterans deserve. We recommended the Under Secretary for Health update community nursing home policies, conduct a national review to ensure veterans are not currently in ineligible nursing homes, and strengthen nursing home program oversight and monitoring.