Insufficient Oversight for Issuing Prosthetic Supplies and Devices

This audit assessed the Veterans Health Administration’s (VHA) oversight of the issuance of prosthetic supplies and devices to veterans. VA’s Prosthetic and Sensory Aids Service (PSAS) is the world’s largest provider of prosthetic devices and sensory aids. Prosthetics include not only artificial limbs, but any device that supports or replaces a body part or function such as wheelchairs and pacemakers. Sensory aids include hearing aids, optical prescriptions, low vision and mobility aids, or speech and communication aids. The cost of PSAS services increased from over $2.9 billion in fiscal year (FY) 2016 to nearly $3.5 billion in FY 2019. The VA Office of Inspector General (OIG) found weaknesses in VHA oversight contributed to PSAS staff cloning (copying) consults improperly that also affected its ability to track fulfillment times. Consequently, VHA improperly issued an estimated $15.8 million in prosthetic supplies in 2017. However, 94 percent of transactions related to deceased veterans were proper. The remaining 6 percent were improper, but the OIG did not identify evidence of fraud with respect to these errors. VHA also maintained adequate oversight of duplicate supply issuance. The OIG made four recommendations with which VHA concurred to improve oversight of the clone consult function. Specifically, the OIG called on VHA to ensure PSAS business practice guidelines include requirements for conducting and documenting reviews of cloned and pending consults; staff develop a process to verify that consults include accessory and consumable supplies for prosthetic items before issuance; establishes field consistency requirements for program reviews and evaluations, and complies with existing policy for reviewing program assessments and evaluations, and communicate the results to the regional prosthetic representatives.