Healthcare Inspection – Improper Consult and Appointment Management Practices, False Documentation, and Document Scanning Errors, Charlie Norwood VA Medical Center, Augusta, Georgia

OIG conducted an inspection to evaluate allegations involving improper completion of consults, false documentation, inappropriate scheduling practices, and Non-VA Care Coordination (NVCC) document scanning errors at the Charlie Norwood VA Medical Center (facility), Augusta, GA. We did not substantiate that senior managers instructed clerks to delete consults for all clinics. We substantiated a physician was completing consults prior to seeing patients and a supervisor instructed some employees to improperly complete NVCC consults and document, “Services provided or patient refused services.” We also substantiated that a clinic scheduler manipulated patients’ desired appointment dates in an effort to correct scheduling errors and that managers directed a clerk not to schedule new patients if they could not be scheduled within 14 days [of desired date]. We found the facility identified 3,776 “errors” that prevented uploading of NVCC documentation because a software option had not been enabled. OIG learned that the employees who had been instructed to improperly close consults had completed an additional 1,212 NVCC consults. In support of an OIG criminal investigation, we reviewed all 2,726 consults. The false documentation aspect of this review was under criminal investigation for more than 18 months, and OIG delayed publication of this report pending completion of the investigation. We recommended the Interim Under Secretary for Health ensure that VA facilities certify the use of appropriate DocManager™ software settings, the VISN Director review the circumstances surrounding improperly completed consults and managers’ failures to promptly and fully evaluate the improperly completed urology consults, and confer with appropriate VA offices to determine the need for administrative action, if any. We also recommended that the Facility Director clinically evaluate the improperly completed urology consults, monitor the status of the improperly completed NVCC consults, and ensure that all clinic schedulers are trained on correct scheduling practices.