Submitting OIG:
Report Description:
The VA Office of Inspector General (OIG) reviewed a former VA surgeon’s eligibility to provide health care as a participant in VA’s Community Care Network (CCN) and the Marion VA Health Care System’s (facility) management of community care patient safety events.
The OIG identified multiple failures by third-party administrator (TPA), Optum, and VA Office of Integrated Veteran Care (IVC) that undermined credentialing and oversight processes, and ultimately allowed the subject surgeon to practice in the VA community care program. First, Optum failed to address concerns identified by a third-party certified verification organization in the surgeon’s 2018 credentialing file. Second, imprecise language in the VA’s contract with the TPA did not provide adequate guidance for Optum in determining whether to exclude the surgeon from the CCN. Additionally, IVC failed to identify inconsistencies in the surgeon’s credentialing file that should have impacted credentialing decisions. Finally, misapplication of privacy rules prevented Optum’s leaders from releasing important information to IVC relevant to the surgeon’s voluntary relinquishment of the Florida medical license. The OIG concluded that the facility’s patient safety training did not include completing patient safety event reports for events in the community and the patient safety manager was unaware of the ability to contact the TPA for updates on the status of patient safety concerns reported to the TPA.
The OIG made two recommendations to the Under Secretary for Health related to review of the surgeon’s eligibility to participate in the CCN and CCN contract; four recommendations to the IVC Executive Director related to ensuring Optum’s sufficient review, documentation, and compliance of CCN providers; one recommendation to the VISN Director to review all community care provided by the surgeon; and one recommendation to the Facility Director related to patient safety event report education and follow-up.
Date Issued:
Thursday, January 4, 2024
Agency Reviewed / Investigated:
Submitting OIG-Specific Report Number:
22-02294-42
Location(s):
Agency-Wide
Type of Report:
Inspection / Evaluation
Questioned Costs:
$0
Funds for Better Use:
$0
Number of Recommendations:
8
Report updated under NDAA 5274:
No
View Document:
Attachment | Size |
---|---|
vaoig-22-02294-420.pdf | 1.47 MB |
Additional Details Link: