VA internal audit: Wait-list fraud found at 64% of VA facilities

Hot Air ^ | May 31, 2014 | Ed Morrissey

[2ndDivisionVet]

A new VA internal audit found wait-list fraud at almost two-thirds of all VA facilities, and that 13% of schedulers had been trained to commit fraud as part of their work. This new audit, which is separate from the Inspector General probe of the Phoenix facility, provided the final straw that forced VA Secretary Eric Shinseki to offer his resignation yesterday:

Appointments’ wait times were manipulated at more than 60 percent of the Department of Veterans Affairs health facilities investigated as part of a new internal audit.

The White House-ordered audit found that schedulers faced pressure to manipulate the system and concluded there was a “systemic lack of integrity within some Veterans Health Administration facilities.”

The audit, issued as VA Secretary Eric Shinseki resigned Friday, found that 64 percent of the 216 VA facilities reviewed had at least one instance where a veterans’ desired appointment date had been changed. The review found 13 percent of schedulers had received specific instructions to misrepresent wait times. …

The review also found that 7 percent to 8 percent of scheduling staff said they used alternatives to the VA’s electronic wait list, a practice that occurred in 62 percent of the facilities examined.

This President spent the last several years shrugging off scandals and massive incompetence — Benghazi, the ObamaCare rollout at HHS, Operation Fast & Furious at the Department of Justice, and James Clapper committing perjury in the Senate, just to name a few that resulted in zero firings at any level. This time, though, Obama had no choice, even though he had inexplicably issued two statements of confidence in Shinseki in the previous two weeks. Apparently no one at the White House had bothered to keep up with their own promises to clean up the VA from the 2008 campaign, and got blindsided by the massive corruption that Shinseki allowed to fester:

In other high-profile situations — involving Internal Revenue Service employees targeting Tea Party groups, Secret Service agents partying in foreign countries and the State Department response to the Benghazi consulate attacks in 2012 — Obama also resisted calls from political rivals and media pundits to remove top figures.

In some cases, Obama did not believe the agencies involved had made major transgressions, calling the lapses isolated and trumped up by his political rivals.

Even with Shinseki, Obama went to great lengths to defend the retired general, who had been injured after stepping on a land mine in Vietnam, calling him “ a good man . . .an outstanding soldier. . .a champion of our veterans.” And the president emphasized repeatedly that the problems at veterans hospitals preceded Obama’s tenure and that the specific recent examples of wrongdoing “did not surface to the level where Ric was aware or it or we were able to see it.”

But Shinseki was more exposed when influential Democrats began joining Republicans in calling for his ouster, something that did not happen to Sebelius. In her case, the White House and Democrats feared a nasty confirmation fight for a replacement at a time when Republicans were trying to exploit the health-care Web site problems for political gain heading into the midterm election cycle this fall.

By the time Sebelius had departed, the enrollment figures showed that the White House had surpassed its initial goals, blunting GOP criticism.

In Shinseki’s case, the problems inside the VA are far more in­trac­table and will take a lot longer to fix. The latest blow to the general came Friday morning, when Rep. Tammy Duckworth (D-Ill.), a former Veterans Affairs official who lost both of her legs while serving in combat in Iraq, urged Shinseki to resign.

“Our first priority should be the veterans, and at this point, whether Secretary Shinseki will stay or go is too much of a distraction,” Duckworth said. “I think he has to go. He certainly loves veterans, but it’s time for new leadership.”

Don’t bet on that being the final factor. The audit showing corruption at 64% of VA facilities on an initial and internal audit would have made Shinseki politically radioactive in any context. Shinseki had more than five years to take control of the VA, and the sheer scale of this systemic failure points directly to his incompetence at running the organization. It also points to Obama’s detachment from his own administration again, even on initiatives that Obama himself insists are high priorities for himself.

Next, Congress should insist on conducting its own audit of the VA, probably through GAO. Even with the scale of corruption at the VA registering this high on an internal audit, it’s an easy bet that it’ll be higher in an independent probe of all facilities.

[Enterprise]

Limbaugh was talking about this about a week ago. A study was done on the number of patients seen by 8 VA cardiologists compared to a private cardiologist. Over a period of time, the private practice cardiologist saw the same number of patients as the 8 VA cardiologists. A ratio if you will, of 8 to 1!

[ducks1944]

A men to that….That is another thing look at teacher, college professor & etc. its all most impossible fire one of them or any Gov. working WHY? There is only one group that deserves anything we have & should get it is R TROOPS pure & simple. U can into any Gov. ran place & U can fire half of them & still get job done. If they worked in private sector they would never make it.
Obama has added so many Gov. workers its shameful and the produce NOTHING!!

[Gunpowder green]

The VA is an example of socialism failed. While the care isn’t universally bad, it’s far worse than average. The work ethic is sub-standard because you can’t fire anybody, it’s too heavy with administrators and paperwork, and physician productivity is lower (because of the increased paperwork, etc).

In areas like oncology, it’s never on the cutting edge, and if a veteran needs a drug that’s not in the formulary, he is simply out of luck, he doesn’t get it.

It costs $150 billion dollars a year, and has about 750,000 in-patient admissions per year, do the math... it’s God-awful expensive and doesn’t provide the best care.

We’re better off shutting the whole thing down, firing the bureaucrats and giving out vouchers.

[Enterprise]

Ducks1944: I suspect that this came about this way.

Auditing or monitoring case loads showed that there was a long wait time for vets to be given appointments. So, rather than insist that the managers crack down and solve the problem (something which may have been thwarted by the union members anyway), Congress decided to throw money at the problem. As an incentive to reduce wait times, Congress offered bonuses.

Seeing an opportunity to make some extra money, or realizing that they could not possibly make the union workers be more productive, the managers came up with a scheme which would create secret waiting lists. This way, it would seem that great progress was being made to reduce waiting times, at least on paper! The people who were put on the lists thought they were going to get appointments, so they simply waited and suffered, or died. Also, the managers were able to disable the computer codes which tracked the case loads so that those who were put on the lists wouldn't show up.

Let's personalize this though. What if some of the people on the waiting lists were survivors of:

The Bataan Death March
Omaha Beach at Normandy
The Battle of the Bulge
Guadalcanal, Iwo Jima, Peleliu, Saipan, Okinawa
The withdrawal at the Chosin Reservoir
Agent Orange, The Tet Offensive
The wars in Iraq and Afghanistan.

The managers decided that it was simply someone who would have to "wait." And so they waited, continued suffering, and some died.

I wonder if the cadets at West Point understood on an unspoken level the essence of the Obama Administrtion VA scandal. The scandal meant that if the enemy didn't make them suffer and die, then the United States would finish the job.

[unixfox]

And the other 36% haven’t been uncovered just yet.

There isn’t a single government agency that isn’t rife with corruption and fraud. Not ONE.

The only cure will be another civil war. Just hope I’m still alive to take part in it.

[blam]

Call the telephone number to the VA in Mobile, Alabama and see if you can get anyone to answer. They usually don’t.

[nathanbedford]

One is reminded of the central theme of, The Best and Brightest, about the Vietnam War in which the whiz kids installed in the White House by Jack Kennedy went on to manage the Vietnam War to failure.

The author, the late David Halberstam, whom I would characterize as a member of a vanishing breed of reasonable liberals, demonstrated with painstaking research but lively and readable writing the self-defeating management techniques of "the best and brightest" like Secretary of Defense Robert McNamara who was one of the "whiz kids" who went on to be president of Ford Motor Company post-World War II and then into the Kennedy administration.

Halberstam describes McNamara's quantification of the business of making automobiles a top down approach in which he tried to control the minutest functions of the vast Ford Motor Company through data collection and analysis. The remote facilities of the Ford Motor Company felt pressure quite naturally and, quite naturally, they began to Doctor the reports that were sent back to Detroit in order to maintain their jobs and even gain promotion and bonuses. The very controls which were put in place to streamline and gain efficiency resulted in the company's subordinates simply cooking the books.

Halberstam argues that McNamara replicated the process in Vietnam. We all know what happened in Vietnam and the metaphor for the whole business of self deception which occurred up and down the ranks in that war was the "body count." So notoriously had not been discredited as a viable management tool that the Pentagon, at least publicly, abandoned it in subsequent actions.

The parallel to what is happening today in the Veterans Administration is obvious and we should not be surprised that, if people of the candlepower possessed by Robert McNamara could be fooled, so could management in the Veterans Administration be fooled, or just as likely, be happy not to really know.

There are lessons to be learned from this and the first lesson is not to try harder to micromanage a huge and far-flung operation. The lesson is to go back to our founding fathers and set in place separation of powers and checks and balances which cause the machine to operate as its own gyroscope keeping the operation upright (in both senses of the word). That means we should privatize and set competing forces in motion.

[jch10]

My suggestions would be for the Patient Advocate to have guidelines to recommend actions, including firing of employees, when complaints are filed, to hire ONLY VETS to fill the administrative positions, and to do away with bonus pay.

It isn’t the doctors and nurses being complained about....it is the OTHER positions.

[BradyLS]

Who is benefitting from manipulating the lists? I know that bonuses, promotions, and recognition are passed all ‘round management and staff for making the books look good, but what about among the patients themselves? Are “easy” patients being taken over more difficult cases? Are patients being encouraged to pay some sort of “fee” to receive treatment? Do some patients have the “pull” to get on lists no matter who may be ahead of them?

All of that?

[BradyLS]

Or is it so bad that nobody is getting the service they need?

[Enterprise]

" if people of the candlepower possessed by Robert McNamara could be fooled, so could management in the Veterans Administration be fooled, or just as likely, be happy not to really know."

I can see that happening here also. Big management (Shinseki) gave little management (Local VA Supervisors) orders to reduce waiting times. Little management cheated and submitted false numbers. Big management was satisfied with the numbers but didn't want to know if they were accurate.

"That means we should privatize and set competing forces in motion."

Private industry would take a hard look at the vouchers given to the vets. If the money is satisfactory, wait times will be reduced with breath taking speed.

[montanajoe]

Privatization of the entire VA is unlikely to be the answer, although it might work in some rural areas.

You see article after article here pointing out there are not enough doctors and nurses to handle the influx of bodies from the ACA. Dumping 20 plus million Vets into the nations civilian health care system will only make that situation worse.

Additionally, the Veteran population, needs a greater amount now and a far greater level of care in the next 40 years. The VA although flawed has demonstrated it can control costs much better than the private health-care system in the United States. Most civilians expect the accommodations at a civilian hospital be on par with a luxury hotel.

The VA can and does provide top notch care to most that use its services. In my view making sure every Vet receives that care is far preferable and much more cost effective in the long run than privatizing the system.

[Enterprise]

I know that one size can't fit all. But in the present, the bleeding needs to be stopped and as many vets as possible need to be treated instead of being put on waiting lists. The future impact of how the Obamacare disaster will affect veteran care cannot be known now, but it has to be very bleak.

A couple things I have learned from listening to FOX talk shows. The GAO report of 2000 described the problems and nothing has been done since then. That means that this was known by Congress during the Bush Administration. And the system had these awful problems BEFORE Iran and Afghanistan.

Senator McCain has one of the problem VA hospitals in Phoenix. How is it possible, that with that many problems, that veterans or their advocates weren't sending him letters, or calling his local and Federal offices? It's the old question of what did he know and when did he know it? How is it possible that only now he understands the depth of the problem?

[q_an_a]

thanks for your update

[PapaBear3625]

For the guy at the top, there is no substitute for actually getting out of the office, visiting the hospitals, and talking with the patients every once in a while. Just doing that would have immediately shown him that the reports he was getting did not correspond with reality.