Department of Veterans Affairs

The VA Office of Inspector General (OIG) conducted a healthcare inspection to review circumstances surrounding a Residential Rehabilitation Treatment Program patient’s death from heroin overdose at a Veterans Integrated Service Network (VISN) 1 medical facility (facility). The OIG determined that...

The VA Office of Inspector General (OIG) substantiated an allegation that the VA Southern Nevada Healthcare System’s (System) prosthetics laboratory did not provide timely and cost-effective services to veterans for frequently prescribed compression garments and orthotic shoes. The laboratory showed...

The VA Office of Inspector General (OIG) conducted a focused evaluation of the quality of care delivered in the inpatient and outpatient settings of the VA Hudson Valley Health Care System (Facility). The review covered key clinical and administrative processes associated with promoting quality care...

The VA Office of Inspector General (OIG) conducted a risk assessment of the three types of charge cards used by VA—purchase cards (including convenience checks), travel cards, and fleet cards. Office of Management and Budget Memorandum M-13-21, Implementation of the Government Charge Card Abuse...

The VA Office of Inspector General (OIG) conducted a focused evaluation of the quality of care delivered at the Memphis VA Medical Center (Facility). The review covered key clinical and administrative processes associated with promoting quality care—Leadership and Organizational Risks; Quality...

The Office of Inspector General (OIG) conducted a healthcare inspection at the Colmery-O’Neil VA Medical Center (Facility) in Topeka, Kansas, regarding an anonymous complainant’s allegations that physicians were practicing beyond their clinical privileges and expertise; physicians failed to seek...

The VA Office of Inspector General (OIG) conducted a review in response to newly established requirements in the VA Choice and Quality Employment Act of 2017. The law requires the OIG to report a minimum of five clinical and five nonclinical VA occupations that have the largest staffing shortages at...

The VA Office of Inspector General (OIG) received allegations that a senior manager at a VA medical facility abused their position and VA resources. The senior manager allegedly instructed a subordinate to provide the senior manager’s family member with additional daily Home-Based Primary Care (HBPC...

The VA Office of Inspector General (OIG) conducted a focused evaluation of the quality of care delivered at the Phoenix VA Health Care System (Facility). The review covered key clinical and administrative processes associated with promoting quality care—Leadership and Organizational Risks; Quality...

The VA Office of Inspector General (OIG) conducted a healthcare inspection regarding a complainant’s allegations of inadequate colorectal cancer (CRC) screening, timely performance of colonoscopies, and Intensive Care Unit (ICU) physician coverage at the James H. Quillen VA Medical Center, Mountain...