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Review of Resident and Part-Time Physician Time and Attendance at Oklahoma City VA Health Care System

Report Information

Issue Date
Report Number
17-00253-93
VISN
State
Oklahoma
District
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
The VA Office of Inspector General (OIG) assessed the effectiveness of the Oklahoma City VA Health Care System’s (Health Care System) oversight of its disbursement agreement and time and attendance for part-time physicians. The OIG found that Health Care System managers did not monitor resident participation to ensure they were performing VA work as scheduled or ensure part-time physicians met their employment obligations. This occurred in part because former leaders of the Health Care System did not establish an effective governance environment. The OIG also found the Health Care System lacked required local policies and procedures for resident educational activity record keeping, did not adequately monitor resident participation in educational activities, and did not reconcile educational activity records with invoices submitted by the University of Oklahoma College of Medicine—the affiliated medical school. In addition, former Health Care System directors did not appoint a team to conduct required periodic audits of the disbursement agreement. As a result, the Health Care System could not provide adequate supporting documentation to substantiate its reimbursement payments for residents. Therefore, the Health Care System’s approximately $6.9 million in reimbursements to the medical school during academic year 2015–2016 are considered improper payments. In addition, there was no assurance the Health Care System received all of the resident services that it paid for. Health Care System managers also did not effectively oversee time and attendance for part-time physicians because they did not monitor time and attendance and ensure part-time physicians recorded work hours daily in the system. Because the Health Care System did not reconcile payments made to part-time physicians on adjustable work schedules with their actual work performance, it made approximately $507,000 in improper payments and there was no assurance that these physicians were fully meeting their VA employment obligations.

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)
The OIG recommended the Oklahoma City VA Health Care System Director ensure local policies and procedures are established for resident educational activity record keeping, monitoring resident participation in assigned educational activities, and reconciling VA educational activity with invoices submitted by the University of Oklahoma College of Medicine.
No. 2
Closed and Implemented Recommendation Image, Checkmark
to Veterans Health Administration (VHA)
The OIG recommended the Oklahoma City VA Health Care System Director ensure all staff involved in educational activity record keeping receive initial and annual refresher training on how to maintain the records.
No. 3
Closed and Implemented Recommendation Image, Checkmark
to Veterans Health Administration (VHA)
The OIG recommended the Oklahoma City VA Health Care System Director establish procedures to ensure agreed-upon salary and benefits rates for residents are properly approved by the Office of Academic Affiliations.
No. 4
Closed and Implemented Recommendation Image, Checkmark
to Veterans Health Administration (VHA)
The OIG recommended the Oklahoma City VA Health Care System Director require the medical school to submit adequate documentation tosupport its benefits rate for Social Security and Medicare costs for residents who are exempt from those taxes.
No. 5
Closed and Implemented Recommendation Image, Checkmark
to Veterans Health Administration (VHA)
The OIG recommended the Oklahoma City VA Health Care System Director ensure the Designated Education Officer certifies final invoices for payment after all discrepancies identified in the reconciliation process are resolved.
No. 6
Closed and Implemented Recommendation Image, Checkmark
to Veterans Health Administration (VHA)
The OIG recommended the Oklahoma City VA Health Care System Director ensure the Designated Education Officer approves and maintains copies of the approved agreements for all off-site educational activities each academic year.
No. 7
Closed and Implemented Recommendation Image, Checkmark
to Veterans Health Administration (VHA)
The OIG recommended the Oklahoma City VA Health Care System Director review all academic year 2015–2016 invoices and initiateactions to recover overpayments from the medical school for residents who worked at non-VA facilities without prior written approval of the VA site directors and Designated Education Officer.
No. 8
Closed and Implemented Recommendation Image, Checkmark
to Veterans Health Administration (VHA)
The OIG recommended the Oklahoma City VA Health Care System Director appoint a team to conduct periodic audits of the disbursement agreement, including educational activity record keeping at the service and section level, reconciliation procedures, and the accuracy of the invoices submitted by the medical school.
No. 9
Closed and Implemented Recommendation Image, Checkmark
to Veterans Health Administration (VHA)
The OIG recommended the Oklahoma City VA Health Care System Director ensure service chiefs conduct required reviews of part-time physicians to ensure they are working as scheduled.
No. 10
Closed and Implemented Recommendation Image, Checkmark
to Veterans Health Administration (VHA)
The OIG recommended the Oklahoma City VA Health Care System Director require service chiefs and supervisors ensure part-time physicians on adjustable work schedules enter their work hours in the electronic subsidiary record on a daily basis.
No. 11
Closed and Implemented Recommendation Image, Checkmark
to Veterans Health Administration (VHA)
The OIG recommended the Oklahoma City VA Health Care System Director ensure that all overdue reconciliations of part-time physicians’ adjustable work hour agreements identified in the report are performed and actions are taken to address over- and underpayments.
No. 12
Closed and Implemented Recommendation Image, Checkmark
to Veterans Health Administration (VHA)
The OIG recommended the Oklahoma City VA Health Care System Director establish procedures to verify that all reconciliations of part-time physicians’ adjustable work hour agreements are completed timely.
No. 13
Closed and Implemented Recommendation Image, Checkmark
to Veterans Health Administration (VHA)
The OIG recommended the Oklahoma City VA Health Care System Director ensure service chiefs conduct quarterly reviews of all part-time physicians on adjustable work schedules.
Total Monetary Impact of All Recommendations
Open: $ 0.00
Closed: $ 7,407,000.00