Inappropriate Community Care Consult Edits Unsubstantiated at the VA Puget Sound Health Care System in Seattle, Washington

The VA Office of Inspector General (OIG) conducted a review to assess the merits of a January 2022 hotline allegation concerning inappropriate edits to community care referrals, known as consults, at the Puget Sound VA Health Care System in Seattle, Washington. The VA MISSION Act of 2018 allows veterans to receive care from non-VA healthcare providers in their area (known as community care) under certain circumstances. Community care schedulers are required to notify veterans of their eligibility, including if veterans are eligible to make such appointments themselves, called self-scheduling. The complainant made three allegations: (1) a leader at the Puget Sound facility inappropriately edited community care consults to reduce backlog; (2) a community care scheduler enrolled patients in self-scheduling without asking them; (3) and facility leaders encouraged staff to inappropriately edit consults to reduce backlog and improve wait times. Though a facility leader made approximately 5,300 edits to about 4,400 community care consults between June and December 2021, the review team did not substantiate that the edits were inappropriate and intended to improperly reduce backlog. Records show a scheduler registered veterans for self-scheduling on 1,158 consults during a two-week period in June 2021, but evidence was insufficient to substantiate whether the scheduler spoke with veterans or sent them letters before converting them to self-scheduling. A requirement to document notification was not in place at the time of the scheduler’s actions, and the team could not interview the scheduler, who left VA employment before an interview could take place. The team reviewed more than 3,800 VA email records and interviewed leaders and staff but found no evidence that facility leaders encouraged staff to inappropriately edit community care consults to reduce backlog and improve wait time metrics. Given the lack of substantiation, the OIG made no recommendations to VA for corrective actions.