Federal Reports

The VA Office of Inspector General (OIG) conducted this audit to determine whether the Veterans Benefits Administration (VBA) Loan Guaranty Service provided required oversight of the default resolution process for VA-guaranteed home loans. VA’s reported default resolution rate has steadily increased each year for the last four fiscal years from 2015 to 2018. The Loan Guaranty Service monitors loan servicers and intervenes as needed to ensure delinquent VA home loan borrowers have all available alternatives to foreclosure. The OIG found the Loan Guaranty Service did not always provide sufficient oversight to ensure borrowers in default received the needed assistance. The audit team estimated, based on a sample review of 200 loans, that 14 percent of loans had at least one oversight deficiency. Specifically, the OIG team found the Loan Guaranty Service was sometimes unaware servicers were not reporting loan status, and at other times did not ensure loan servicers sent borrowers the required loss mitigation letters. The OIG team also found that the Loan Guaranty Service did not conduct quarterly monitoring of loan servicing and did not implement a mandatory tier-ranking system for loan servicers. The OIG team and the Loan Guaranty Service also identified potential loan servicing risks to borrowers in disaster areas. The Loan Guaranty Service director said upgrades to the VA Loan Electronic Reporting Interface (VALERI) system implemented on May 28, 2019, were to provide the missing capabilities. The OIG recommended that the under secretary for benefits implement controls to identify and address unreported monthly loan statuses in VALERI, make certain loan servicers report when loss mitigation letters are sent and cite them for infractions when required, ensure key loan servicer performance statistics are generated, and develop a plan to implement a formal tier-ranking system for loan servicers.

The VA Office of Inspector General (OIG) conducted a healthcare inspection to evaluate concerns regarding deficiencies identified in the practice of a fee basis radiologist (subject radiologist), and the facility’s oversight of the subject radiologist’s performance during the six month tenure in 2014. Facility leaders did not complete the credentialing and privileging of the subject radiologist per Veterans Health Administration requirements. Specifically, the references used to approve the subject radiologist’s request for privileges did not include a reference from peers and a most recent employer. Facility managers did not provide adequate oversight of the subject radiologist and did not timely complete a focused professional performance evaluation. Facility leaders did not take timely administrative action in response to inaccurate interpretations of radiology imaging and clinical documentation. Facility managers and leaders failed to timely complete the subject radiologist’s Exit Memorandum, required by Veterans Health Administration to comply with state licensing boards reporting requirements, during the mandatory reporting period of seven days after the employee’s separation from the facility; and failed to report the results to the facility professional standards board until August 2018, three years after the assigned target date. The Patient Safety Manager was never notified while the review of cases was being conducted, nor after the results were issued. Facility leaders did not timely submit an issue brief to the Veterans Integrated Service Network, as is required for significant clinical incidents negatively affecting patients. On January 25, 2019, the Facility Director issued notices to eight state licensing boards citing that the subject radiologist failed to meet generally accepted standards of clinical practice. Two disclosures were made to patients. The OIG made four recommendations related to credentialing and privileging requirements, state licensing board reporting, reporting of adverse events, and potential administrative actions.

Pursuant to the VA Choice and Quality Employment Act of 2017, the OIG conducted a review to identify clinical and non-clinical Veterans Health Administration (VHA) occupations experiencing the largest staffing shortages at each VA medical facility. In this sixth staffing report, the OIG team evaluated facility leader-identified severe occupational staffing shortages and compared them to last year's data. The team also explored the impact of medical center director vacancies on VHA facilities. The OIG found that 96 percent of VHA facilities identified at least one severe occupational staffing shortage. The most frequently cited shortages were in the Medical Officer and Nurse occupations. The lack of qualified applicants and non-competitive salary were the two most frequently noted reasons for severe occupational staffing shortages. As with last year’s report, Psychiatry was the most commonly reported medical specialty in the Medical Officer occupational series. Human Resources Management was the most commonly reported non-clinical occupation with severe staffing shortages. Effective and stable leadership at VA medical centers is critical to the overall success of the facilities. The OIG found more than 46 facilities annually experienced at least one change in medical center directors since 2015. Both VISN and medical center directors expressed the view that vacancies in the medical center director position negatively affected facility operations. Directors also shared concerns about the non-competitive salary and career risks associated with that position. The OIG made two recommendations to the Under Secretary for Health to ensure completion of all open action plans related to recommendations from previous staffing reports and to identify a plan of action that will address the underlying causes of severe occupational staffing shortages as discussed in this review.

Our report contains 20 recommendations directed to the post and headquarters. We recommend that the post improve processes related to bills of collection and Volunteer payments and improve controls over property management, PSC contracts, purchase of medical supplies, and fuel and toll costs. Additionally, we recommend that the post comply with policies and guidance related to sub-cashier advances and system access roles.

Our report contains 12 recommendations directed to the post and headquarters. We recommend that the post reassess the country agreement. We also recommend that the post monitor and document the accountability-of-funds transfer to the alternate cashier, as well as liquidate interim advances and issue BOCs in a timely manner. In addition, we recommend that the post ensure the Volunteers’ pro-rated living allowance calculations are accurate and that lease agreements contain necessary information.