Review of VHA’s Alleged Manipulation of Appointment Cancellations at VAMC Houston, TX

The Office of Inspector General (OIG) received an anonymous allegation that leadership was instructing staff at the Michael E. DeBakey VA Medical Center (VAMC) and its associated Community Based Outpatient Clinics (CBOCs) to incorrectly record clinic cancellations as patient cancellations. OIG found no evidence the VAMC Director instructed supervisors or staff to incorrectly record appointment cancellations. OIG substantiated that two previous scheduling supervisors and a current director of two CBOCs instructed staff to incorrectly record cancellations as canceled by the patient. OIG identified 223 appointments incorrectly recorded as patient cancellations during the July 2014 through June 2015 time frame. Of the 223 appointment cancellations, staff rescheduled 94 appointments (42 percent) beyond 30 days. For these 94 appointments, veterans encountered an average 81-day wait, which was 78 days longer than shown in the electronic scheduling system. OIG also found that wait times were understated about 66 days for 50 appointments (22 percent) when they were initially scheduled. These issues have continued despite the Veterans Health Administration (VHA) having identified similar issues during a May and June 2014 system-wide review of access. These conditions persisted because of a lack of effective training and oversight. As a result, VHA’s recorded wait times did not reflect the actual wait experienced by the veterans and the wait time remained unreliable and understated. OIG recommended the Veterans Integrated Service Network (VISN) 16 Director ensure the VAMC Director confers with VA’s Office of Accountability Review; provides scheduling staff training; improves scheduling audit procedures; and takes actions when the audits identify deficiencies. The VISN Director did not agree with Recommendations 1 and 2 but OIG considered the VISN’s decision not to take administrative action the responsibility of the Director. The VISN Director concurred with Recommendations 3 through 6 providing acceptable planned actions. Based on the actions taken, we consider Recommendations 1 and 2 closed, and will monitor the implementation of the remaining recommendations until all actions are completed.