A new report shows VA was caught referring veterans to ineligible healthcare providers with suspended or revoked medical licenses – two of whom had criminal records.
A government investigation showed many providers were ineligible to participate in the VA community care program. Ineligible providers are not supposed to be included in the referral system and are therefore unqualified for the role for some reason or another.
But they were included, anyway. An estimated 1,600 ineligible providers were identified.
This problem of VA improperly using certain providers to give care to veterans is not new.
In 2019, VA was caught using unqualified doctors to treat veterans within his facilities. In 2015, VA was caught using unqualified doctors and nurses to diagnose traumatic brain injury.
Now, in 2022, this newly released report shows VA was using ineligible providers to treat veterans outside VA in the community care program – – little was learned from past failures, apparently.
What was going on?
GAO Community Care Provider Report
An investigation by the Government Accountability Office (GAO) found VA had improperly approved 1,600 physicians for referral in the community care program.
The community care program allows veterans to seek care in the community when challenges are experienced getting care within a VA facility.
The Veterans Health Administration (VHA) is responsible to oversight of the program formally known at the VA Community Care Program (VACCP). The VACCP program falls under the Office of Community Care. That office maintains a database created by contractors that is supposed to include only eligible healthcare providers.
But, as the report showed, at least 1,600 providers in the database are ineligible. They are ineligible in many instances due to revoked or suspended licenses. In a few instances, the provider had been accused of patient abuse, fraud, or other crimes that preclude participation. A large number of the ineligible were deceased.
One provider was found to be previously convicted of patient abuse and neglect with an expired medical license. The provider was previously arrested for assault and excluded from other federal healthcare programs.
Another provider previously posed a “clear and immediate danger to public health and safety.” That physician’s medical license was revoked.
The report, published by Government Accountability Office (GAO), showed VA was “cutting corners” when approving providers who are legally ineligible to get paid under the VA community care program.
“Our work … basically found that they were really cutting corners,” said Seto Bagdoyan, director of audits at GAO. “They were not performing monthly checks, for example. And even when they did flag someone as ineligible, that individual… was not removed in a timely manner.”
From GAO Report
GAO provided the following summary in italics:
Of over 800,000 providers assessed, GAO identified approximately 1,600 VCCP providers who were deceased, were ineligible to work with the federal government, or had revoked or suspended medical licenses. VHA and its contractors had controls in place to identify such providers. However, the existing controls missed some providers who could have been identified with enhanced controls and more consistent implementation of standard operating procedures. For example, GAO found the following:
– One provider had an expired nursing license in April 2016 and was arrested for assault in October 2018. This provider was excluded from working in federally funded health care programs. The provider was convicted of patient abuse and neglect in July 2019. The provider entered the VCCP in November 2019. VHA officials stated that this provider was uploaded into the system in error.
– One provider was eligible for referrals in the VHA system, but his medical license had been revoked in 2019. Licensing documents stated that the provider posed a clear and immediate danger to public health and safety.
GAO also identified weaknesses in oversight of provider address data. Some VCCP providers used commercial mail receiving addresses as their only service address. Such addresses have been disguised as business addresses in the past by individuals intending to commit fraud. VHA has not assessed the fraud risk that invalid address data pose to the program.
These vulnerabilities potentially put veterans at risk of receiving care from unqualified providers. Additionally, VHA is at risk of fraudulent activity, as some of the providers GAO identified had previous convictions of health-care fraud. VA has an opportunity to address these limitations as it continues to refine the controls, policies, and procedures for this 2-year old program.
Lawmaker Seek Community Care Accountability
Lawmakers in the House Committee on Veterans Affairs sent a letter to the current acting head of VHA a strongly worded letter about the investigation’s findings:
The GAO report found that VHA and the third-party administrators responsible for developing and managing its Community Care Network failed to perform adequate and complete checks using several exclusionary data sources, as required by federal statute and the VHA Office of Community Care’s own standard operating procedures. As a result, GAO identified examples of healthcare providers remaining active in the Community Care Network, and therefore able to receive VA patient referrals, despite strong evidence of ineligibility. This included ineligibility based on previous healthcare fraud convictions, loss of medical licenses, and instances where providers appeared on the Social Security Administration’s Death Master File (i.e., were deceased).
The letter was addressed to Steven Lieberman, MD, the Deputy to the Under Secretary for Health performing the Delegable Duties of the Under Secretary of Health.
Boy, that is a mouthful of a title. Why is that?
Word Soup Titles Without Senate-Confirmed Leadership
Lieberman is the deputy to the Under Secretary for Health. But there is no Senate-confirmed Under Secretary for Health.
Lieberman is also performing the delegable duties of the Under Secretary for Health and apparently his own duties, somehow.
The VHA has lacked a Senate-confirmed Under Secretary for Health since the prior confirmed Under Secretary, David Shulkin, MD, was selected to serve as the Secretary for Veterans Affairs.
Dr. Shulkin was the last person confirmed into that role. Since then, the position has been vacant. We instead saw a word soup of titles used by the White House to explain the role of the decisionmaker in charge of Veterans Health Administration.
Some might say the lack of a confirmed head of the health agency is used as a device to limit political oversight.
But to what end?
Lieberman is not the only senior VA official to hold a similar title.
The Veterans Benefits Administration (VBA) also lacks a Senate-confirmed Under Secretary for Benefits.
The top spot is presently maintained by an official who previously held the acting role under President Barack Obama.
Thomas Murphy, Director of the Northeast District, is presently using the title Performing the Delegable Duties of the Under Secretary for Benefits to lead VBA. In 2016, Murphy did not receive the political support needed for a nomination to the top slot.
But, Murphy is now back in that same position after a long break from VA Central Office operations running various field offices.
It is unclear how long Secretary of Veterans Affairs Denis McDonough will tolerate no Senate-confirmed head of these agencies. With the White House and majority in the Senate and House, the lack of political leadership in either role is puzzling.