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Source Id
324

VBA’s and NCA’s Personnel Suitability Programs Need Improved Governance

2024
23-02890-209
Audit
Department of Veterans Affairs OIG
Department of Veterans Affairs

In March 2018, the VA Office of Inspector General (OIG) reported on deficiencies within the Veterans Health Administration (VHA) personnel suitability program, concluding that neither VA nor VHA effectively governed the background investigation process to ensure requirements were met at medical...

Inspection of Select Vet Centers in Pacific District 5 Zone 2

2024
24-00388-266
Inspection / Evaluation
Department of Veterans Affairs OIG
Department of Veterans Affairs

The VA Office of Inspector General (OIG) Vet Center Inspection Program provides a focused evaluation of aspects of the quality of care delivered at vet centers. The OIG inspected four randomly selected vet centers throughout Pacific district 5 zone 2: Corona and Temecula, California; and Kauai and...

Inspection of Select Vet Centers in Pacific District 5 Zone 3

2024
24-00389-267
Inspection / Evaluation
Department of Veterans Affairs OIG
Department of Veterans Affairs

The VA Office of Inspector General (OIG) Vet Center Inspection Program provides a focused evaluation of aspects of the quality of care delivered at vet centers. The OIG inspected four randomly selected vet centers throughout Pacific district 5 zone 3: Phoenix and West Valley, Arizona; Antelope...

Mismanaged Mental Health Care for a Patient Who Died by Suicide and Review of Administrative Actions at the VA Tuscaloosa Healthcare System in Alabama

2024
23-02393-250
Inspection / Evaluation
Department of Veterans Affairs OIG
Department of Veterans Affairs

The OIG evaluated allegations related to the care of a patient who died by suicide six days after a mental health appointment at the VA Tuscaloosa Healthcare System (facility). Concerns regarding appointment scheduling, supervision of a posttraumatic stress disorder (PTSD) clinic social worker...

Alleged Mismanagement of Contracts for Wheelchair-Accessible Transportation Services by the Health Administration Service at the Dallas VAMC in Texas

2024
23-03128-213
Review
Department of Veterans Affairs OIG
Department of Veterans Affairs

VA’s Veterans Transportation Program offers travel solutions for veterans to get to and from VA healthcare facilities at little or no cost to veterans. One travel option is transportation by wheelchair van. VA’s Health Administration Service is responsible for administering the contracts that...

VA Needs to Strengthen Controls to Address Electronic Health Record System Major Performance Incidents

2024
22-03591-231
Audit
Department of Veterans Affairs OIG
Department of Veterans Affairs

The VA Office of Inspector General (OIG) conducted this audit to determine whether VA and its contractor had sufficient controls to prevent, respond to, and mitigate the impact of major performance incidents affecting the electronic health record (EHR) system.In May 2018, VA awarded a 10-year...

Action Needed to Ensure VA Meets Staffing and Vacancy Reporting Requirements under the MISSION Act of 2018

2024
24-01170-232
Review
Department of Veterans Affairs OIG
Department of Veterans Affairs

The VA Office of Inspector General (OIG) assessed VA’s compliance with mandated reporting of staffing and vacancy data on its public website and its clarity in related explanations. The MISSION Act of 2018 requires VA to publicly release this information each quarter to promote transparency in...

VBA Needs to Improve Oversight of the Digital GI Bill Platform

2024
23-01252-175
Audit
Department of Veterans Affairs OIG
Department of Veterans Affairs

In March 2021, the Veterans Benefits Administration (VBA) began transitioning to a Digital GI Bill platform designed to improve education benefits delivery. The original plan called for implementing the new platform through a contractor for 10 years at a projected cost of $453 million. The VA Office...

Inspection of Continental District 4 Vet Center Operations

2024
22-04108-235
Inspection / Evaluation
Department of Veterans Affairs OIG
Department of Veterans Affairs

The VA Office of Inspector General (OIG) Vet Center Inspection Program provides a focused evaluation of aspects of the quality of care delivered throughout Readjustment Counseling Service (RCS).This inspection evaluates four review areas within Continental District 4 including leadership stability...

Failures by Telemetry Medical Instrument Technicians and Leaders’ Response at the VA Eastern Colorado Health Care System in Aurora

2024
23-03531-218
Inspection / Evaluation
Department of Veterans Affairs OIG
Department of Veterans Affairs

The VA Office of Inspector General (OIG) conducted a healthcare inspection at the VA Eastern Colorado Health Care System (facility) in Aurora to review telemetry medical instrument technician (MIT) actions and leaders’ response to allegations that an MIT (MIT A) changed patient alarm settings and...

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