Report Summary

Title: Review of Alleged Mismanagement at the Health Eligibility Center
Report Number: 14-01792-510 Download
Issue Date: 9/2/2015
VA Office: Veterans Health Administration (VHA)
Report Author: Office of Audits and Evaluations
Report Type: Audit
Release Type: Unrestricted

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.