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Insufficient Oversight for Issuing Prosthetic Supplies and Devices

Report Information

Issue Date
Report Number
18-00972-38
VA Office
Veterans Health Administration (VHA)
Report Author
Office of Audits and Evaluations
Report Type
Audit
Report Topic
Patient Care Services Operations
Major Management Challenges
Stewardship of Taxpayer Dollars
Recommendations
4
Questioned Costs
$0
Better Use of Funds
$0
Congressionally Mandated
No

Summary

Summary
This audit assessed the Veterans Health Administration’s (VHA) oversight of the issuance of prosthetic supplies and devices to veterans. VA’s Prosthetic and Sensory Aids Service (PSAS) is the world’s largest provider of prosthetic devices and sensory aids. Prosthetics include not only artificial limbs, but any device that supports or replaces a body part or function such as wheelchairs and pacemakers. Sensory aids include hearing aids, optical prescriptions, low vision and mobility aids, or speech and communication aids. The cost of PSAS services increased from over $2.9 billion in fiscal year (FY) 2016 to nearly $3.5 billion in FY 2019. The VA Office of Inspector General (OIG) found weaknesses in VHA oversight contributed to PSAS staff cloning (copying) consults improperly that also affected its ability to track fulfillment times. Consequently, VHA improperly issued an estimated $15.8 million in prosthetic supplies in 2017. However, 94 percent of transactions related to deceased veterans were proper. The remaining 6 percent were improper, but the OIG did not identify evidence of fraud with respect to these errors. VHA also maintained adequate oversight of duplicate supply issuance. The OIG made four recommendations with which VHA concurred to improve oversight of the clone consult function. Specifically, the OIG called on VHA to ensure PSAS business practice guidelines include requirements for conducting and documenting reviews of cloned and pending consults; staff develop a process to verify that consults include accessory and consumable supplies for prosthetic items before issuance; establishes field consistency requirements for program reviews and evaluations, and complies with existing policy for reviewing program assessments and evaluations, and communicate the results to the regional prosthetic representatives.

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)
Ensure Prosthetic and Sensory Aids Service business practice guidelines include specific requirements for conducting and properly documenting reviews of cloned and pending consults.
No. 2
Closed and Implemented Recommendation Image, Checkmark
to Veterans Health Administration (VHA)
Ensure Prosthetic and Sensory Aids Service staff develop a process to verify that consults include accessory and consumable supplies for prosthetic items prior to issuance.
No. 3
Closed and Implemented Recommendation Image, Checkmark
to Veterans Health Administration (VHA)
Ensure Prosthetic and Sensory Aids Service establishes field consistency requirements for conducting program reviews and evaluations.
No. 4
Closed and Implemented Recommendation Image, Checkmark
to Veterans Health Administration (VHA)
Ensure the executive director of the Prosthetic and Sensory Aids Service complies with existing policy for reviewing program assessments and evaluations and communicates review and evaluation results to the regional prosthetic representatives.
Total Monetary Impact of All Recommendations
Open: $ 0.00
Closed: $ 79,200,000.00