Phoenix VA Scheduling Fraud Dates Back a Decade

By Walter F. Roche Jr.

An internal report by the Veterans Affairs Inspector General shows that scheduling fraud to cover up lengthy delays in getting services for veterans at  the VA's Phoenix health facility dates back to 2008 and possibly 2004 and the practice was known by top agency officials.
The secret IG report dated Sept. 2, 2008 recounts how staffers at the Arizona facility routinely manipulated appointment requests to make it appear that veterans waited little or no time to see a physician or to get needed services.
The report which was sent to the then director of the Phoenix VA discloses that the staffers were fearful that if the true waiting times were disclosed they would be subject to criticism and possible disciplinary action by their superiors.
"We found that it was accepted past practice at the medical center to avoid wait times greater than 30 days and that employees continue this practice," the report states.
The report states that it was common practice that if a veteran asked in June for an appointment in August, the schedulers would automatically change the request date to the actual August date of the appointment creating the fiction that there was no wait time.
Another Phoenix staffer told the IG that the practice of manipulating appointment requests dated back to at least 2004 when she first went to work there.
Disclosure of the 2008 findings comes amidst recent disclosures of lengthy delays in veterans getting critical life saving care at the Phoenix facility.
U.S. Rep. Jeff Miller, a Florida Republican and chairman of the House Veterans Affairs Committee said the report shows top level VA officials knew about the scheduling errors and sought to keep it secret.

“Make no mistake. The department’s data manipulation scandal was caused by selfish VA bureaucrats who lied in order to hide interminable waits for medical care," he said, adding that the inspector general  "missed the forest for the trees, often labeling what we now know to be systemic and willful manipulation of medical care appointment data as basic procedural problems and breakdowns in training.

The 2008 report states, "Two medical center schedulers told us that it was common practice to alter appointments to obtain  0-days wait time to avoid wait times greater than 30 days."
The auditors interviewed a supervisor who worked at the center at the time who corroborated the accounts of the schedulers.
"She (the supervisor) said that they did this to avoid making appointments that showed up on a negative list generated by supervisors that listed appointments with more than a 30.-day wait time. She explained that, in the past, to avoid having her name on the list, she scheduled appointments twice."
The supervisor said the actual request dates were eventually erased to make it appear that the veteran got the requested appointment immediately.
Though the supervisor told auditors she thought the practice had been changed, a scheduler told the inspector general's investigators that she had followed the exact same procedure.
"She (the scheduler) said that she changed one as recently as one hour prior to her interview with us and that they (supervisors) will ding the heck out of you if they see a (wrong) number on the bottom of their report,"  the IG official wrote.

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Review Finds Multiple Faults at Nashville, York VA

By Walter F. Roche Jr.

An inspector general's report on U.S. Veterans Affairs facilities in Nashville and York has found multiple serious deficiencies in the care provided to veterans including the failure to adequately review surgical procedures resulting in death.
The report from the VA Office of Inspector General issued Thursday also found that the care provided to severe stroke victims did not meet expected standards primarily due to the complete lack of a stroke management policy.
At York, auditors found, three veterans suffering acute strokes were not considered for transfer to a stroke specialty facility due to the lack of a set policy for doing so.
In the review of surgical procedures, the report states, "Several surgical deaths that occurred from January to June of 2013 had identified problems or opportunities for improvement. There was no evidence that the morbidity and mortality committee reviewed one of those deaths."
Other deficiencies in stroke care included failure to screen 12 of 26 patients in Nashville and five of nine in York for swallowing difficulties before they were fed.
The audit covered fiscal 2013 and the first eight months of 2014 and the findings were not disputed by the VA. The agency also agreed to corrective actions recommended by the inspector general.
The two facilities were praised for the care provided by telephone consultations, but in many other areas deficiencies were noted.
For instance so-called peer reviews of cases over a six month period had not been reported to an oversight panel in 20 of 28 cases. Six focused reviews of physicians' performances had not been reported to the Medical Executive Board, the panel that issues credentials to physicians.
Reviews required in cases where cardio-pulmonary resuscitation was used were not performed and a surgical quality review committee had met only two times over six months.
Minutes of the meetings of the executive board "did not reflect sufficient discussion of corrective action and tracking of events to closure," the audit states.
Electronic medical records both at York and Nashville did not include discharge instructions in nine cases and five patients did not receive "services or items ordered for them within the prescribed time frame."