Review of Resident and Part-Time Physician Time and Attendance at Oklahoma City VA Health Care System

The VA Office of Inspector General (OIG) assessed the effectiveness of the Oklahoma City VA Health Care System’s (Health Care System) oversight of its disbursement agreement and time and attendance for part-time physicians. The OIG found that Health Care System managers did not monitor resident participation to ensure they were performing VA work as scheduled or ensure part-time physicians met their employment obligations. This occurred in part because former leaders of the Health Care System did not establish an effective governance environment. The OIG also found the Health Care System lacked required local policies and procedures for resident educational activity record keeping, did not adequately monitor resident participation in educational activities, and did not reconcile educational activity records with invoices submitted by the University of Oklahoma College of Medicine—the affiliated medical school. In addition, former Health Care System directors did not appoint a team to conduct required periodic audits of the disbursement agreement. As a result, the Health Care System could not provide adequate supporting documentation to substantiate its reimbursement payments for residents. Therefore, the Health Care System’s approximately $6.9 million in reimbursements to the medical school during academic year 2015–2016 are considered improper payments. In addition, there was no assurance the Health Care System received all of the resident services that it paid for. Health Care System managers also did not effectively oversee time and attendance for part-time physicians because they did not monitor time and attendance and ensure part-time physicians recorded work hours daily in the system. Because the Health Care System did not reconcile payments made to part-time physicians on adjustable work schedules with their actual work performance, it made approximately $507,000 in improper payments and there was no assurance that these physicians were fully meeting their VA employment obligations.