Department of Veterans Affairs

The VA Office of Inspector General (OIG) conducted this review to determine whether the Compensation Service complied with accessibility requirements for communicating benefits- related information to veterans with visual impairments. The OIG found that VBA’s Compensation Service did not fully...

This Office of Inspector General Comprehensive Healthcare Inspection Program report describes the results of a focused evaluation of the inpatient and outpatient settings of the Louisville VA Medical Center and associated outpatient clinics in Indiana and Kentucky. This evaluation focused on five...

The Pandemic Response Accountability Committee’s (PRAC) Health Care Subgroup developed this report to share insights about the expansion—and the emerging risks—of telehealth in selected programs across six federal agencies during the first year of the COVID-19 pandemic. The selected programs, which...

VA OIG attorney-advisors conducted two related internal investigations following allegations that a then special agent in charge in the Office of Investigations engaged in inappropriate conduct or sexual harassment that his superiors ignored and that contributed to a hostile work environment. OIG...

This Office of Inspector General (OIG) Comprehensive Healthcare Inspection Program report highlights the results of a focused evaluation of VHA facilities’ high-risk processes. The report describes findings from healthcare inspections performed at 45 medical facilities during fiscal year 2021 that...

The VA Office of Inspector General (OIG) conducted a review of Veterans Health Administration’s lethal means safety (LMS) training, firearms access and safe storage discussions within suicide risk assessments and safety plans, and clinicians’ perspectives on lethal means interventions.The OIG...

This Office of Inspector General Comprehensive Healthcare Inspection Program report describes the results of a focused evaluation of the inpatient and outpatient care provided at the Mountain Home VA Healthcare System, which includes the James H. Quillen VA Medical Center and multiple outpatient...

The OIG reviewed the Veterans Health Administration’s (VHA) progress in monitoring their follow-up of canceled appointments during the COVID-19 pandemic.In 2020, the OIG reported that VHA had not followed up on about 32 percent of canceled appointments. VHA then implemented the Cancelled...

The Office of Inspector General (OIG) Care in the Community healthcare inspection program examines clinical and administrative processes associated with providing quality outpatient healthcare to veterans. This report provides a focused evaluation of Veterans Integrated Service Network (VISN) 15 and...

The VA Office of Inspector General (OIG) assessed VA’s compliance with requirements to report staffing and vacancy data on its public-facing website and the clarity of related explanations. VA is mandated to publicly release this information each quarter under the Maintaining Internal Systems and...