Breadcrumb

Review of Alleged Mismanagement at the Health Eligibility Center

Report Information

Issue Date
Report Number
14-01792-510
VA Office
Veterans Health Administration (VHA)
Report Author
Office of Audits and Evaluations
Report Type
Audit
Recommendations
13
Questioned Costs
$0
Better Use of Funds
$0
Congressionally Mandated
No

Summary

Summary
At the request of the House Committee on Veterans’ Affairs, OIG conducted a review of VHA’s Health Eligibility Center (HEC) to evaluate the merit of allegations of mismanagement pertaining to a backlog of pending health care applications, veterans who died while their application were pending, purged or deleted veteran health records, and unprocessed applications. OIG substantiated the existence of about 867,000 pending records that had not reached a final determination as of September 30, 2015. OIG also substantiated that pending records included entries for over 307,000 individuals reported as deceased by the Social Security Administration. However, due to limitations in the HEC’s Enrollment System (ES) data, OIG could not reliably determine how many pending records existed as a result of applications for health care. This occurred because the enrollment program did not effectively define, collect, and manage enrollment data. In addition, VHA lacked adequate procedures to identify data of death information and implement necessary updates to the individual’s status. OIG also substantiated that employees incorrectly marked unprocessed applications as completed and possibly deleted 10,000 or more transactions from the HEC’s Workload Reporting and Productivity (WRAP) tool over the past 5 years. WRAP was vulnerable because the HEC did not ensure that adequate business processes and security controls were in place, manage WRAP user permissions, and maintain audit trails to identify reviews and approvals of any deleted transactions. In addition, the Office of Information and Technology (OI&T) did not provide proper oversight for the development, security, and data backup retention for WRAP. OI&T also did not collect and retain WRAP audit logs in accordance with VA policy. Finally, we substantiated that the HEC identified over 11,000 unprocessed health care applications and about 28,000 other transactions in January 2013. This backlog developed because the HEC did not adequately monitor and manage its workload and lacked controls to ensure entry of WRAP workload into ES. OIG provided recommendations to the Under Secretary for Health (USH) to address ES data integrity issues, enrollment program policy limitations, and the access and security of the WRAP tool. OIG also provided recommendations to the Assistant Secretary for Information and Technology (OI&T) to implement adequate security controls for the WRAP tool, and ensure the collection and retention of WRAP audit logs and system backups. OIG further recommended that the USH and Assistant Secretary OI&T confer with the Office of Human Resources and the Office of General Counsel to fully evaluate the implications of the findings of the report, determine if administrative action should be taken against any VHA or OI&T senior officials involved, and ensure that appropriate action is taken. The USH and Assistant Secretary OI&T concurred with our findings and recommendations.

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 provide guidance concerning how long applications may remain pending before reaching a final determination.
No. 2
Closed and Implemented Recommendation Image, Checkmark
to Veterans Health Administration (VHA)
We recommended the Under Secretary for Health assign an accountable official responsible to implement a plan to correct current data integrity issues in the Enrollment System.
No. 3
Closed and Implemented Recommendation Image, Checkmark
to Veterans Health Administration (VHA)
We recommended the Under Secretary for Health develop and execute a project management plan to ensure that Enrollment System data are fully evaluated and properly categorized.
No. 4
Closed and Implemented Recommendation Image, Checkmark
to Veterans Health Administration (VHA)
We recommended the Under Secretary for Health implement controls to ensure that future enrollment data are accurate and reliable before being entered in the Enrollment System.
No. 5
Closed and Implemented Recommendation Image, Checkmark
to Veterans Health Administration (VHA)
We recommended the Under Secretary for Health implement effective policies and procedures to accurately and timely identify deceased individuals with records in the Enrollment System and record their changed status in the system.
No. 6
Closed and Implemented Recommendation Image, Checkmark
to Veterans Health Administration (VHA)
We recommended the Under Secretary for Health establish appropriate policies and procedures to ensure Health Eligibility Center workload data are not deleted or changed without appropriate management review, approval, and audit trails.
No. 7
Closed and Implemented Recommendation Image, Checkmark
to Veterans Health Administration (VHA)
We recommended the Under Secretary for Health implement mechanisms to ensure that privileges and access rights to Health Eligibility Center workload data are based upon specific job duties and the need to know.
No. 8
Closed and Implemented Recommendation Image, Checkmark
to Veterans Health Administration (VHA)
We recommended the Under Secretary for Health confer with the Office of Human Resources and the Office of General Counsel to fully evaluate the implications of the first three allegations, determine if administrative action should be taken against any senior Veterans Health Administration officials involved, and ensure that appropriate action is taken.
No. 9
Closed and Implemented Recommendation Image, Checkmark
to Information and Technology (OIT)
We recommended that the Assistant Secretary for Information and Technology implement adequate security controls to enforce separation of duties and role-based access control for Workload Reporting and Productivity tool developers and administrators.
No. 10
Closed and Implemented Recommendation Image, Checkmark
to Information and Technology (OIT)
We recommended that the Assistant Secretary for Information and Technology implement adequate security controls to enforce separation of duties and role-based access control for Workload Reporting and Productivity tool developers and administrators.
No. 11
Closed and Implemented Recommendation Image, Checkmark
to Information and Technology (OIT)
We recommended that the Assistant Secretary for Information and Technology develop a monthly schedule to test whether Health Eligibility Center workload data are backed up properly and to provide the results of such testing to the Chief Business Office.
No. 12
Closed and Implemented Recommendation Image, Checkmark
to Information and Technology (OIT)
We recommended the Assistant Secretary for Information and Technology confer with the Office of Human Resources and the Office of General Counsel to fully evaluate the implications of the lack of controls over the Workload Reporting and Productivity tool, determine if administrative action should be taken against any senior Office of Information Technology officials involved, and ensure that appropriate action is taken.
No. 13
Closed and Implemented Recommendation Image, Checkmark
to Veterans Health Administration (VHA)
We recommended the Under Secretary for Health perform monthly comparisons between Workload Reporting and Productivity reports and enrollment records to ensure the timely processing of applications and related documents.