Federal Reports

OIG evaluated whether the Veterans Health Administration (VHA) effectively managed providers’ primary care panels to maximize access to primary care providers by evaluating new enrollee processing into panels as well as the panel sizes. Provider panels define both VHA’s capacity to provide managed outpatient care and provider efficiency based on the number of veterans managed for primary care.In the first seven months of FY 2015, VHA had not effectively managed provider panels to maximize access. VHA facilities’ methods for processing and scheduling veterans into panels varied, and veterans encountered an average wait of 29 days from the date they enrolled until the facility scheduled their appointment. The average of 29 days was not included in VHA’s wait time calculation. VHA facilities had panels below VHA’s panel size recommendations with six of the seven facilities showing panels 13 to 30 percent below the model. This occurred because VHA lacked standard procedures for processing new enrollees, did not track the wait-time from the enrollment to scheduling, and did not ensure compliance with recommended panel sizes. As a result, VHA’s recorded wait times did not accurately reflect the wait experienced. VHA’s recorded wait time showed about 8 percent of newly enrolled veterans waited more than 30 days when OIG determined about 53 percent of newly enrolled veterans completed their first appointment more than 30 days past the determined eligibility date.Lower panel sizes equated to almost $169 million in underutilized provider salaries paid in fiscal year 2015. OIG recommended the Acting Under Secretary for Health establish standardized new enrollee scheduling procedures that properly track wait times and ensure facilities either set panel sizes at VHA’s model goals or justify deviations. The Acting Under Secretary for Health concurred with the recommendations and OIG will monitor VHA’s progress until all proposed actions are completed.

This report contains Sensitive But Unclassified information. To obtain further information, please contact the OIG Office of Counsel at OIGCounsel@oig.treas.gov, (202) 927-0650, or by mail at Office of Treasury Inspector General, 1500 Pennsylvania Avenue, Washington DC 20220.

OIG has conducted numerous audits, evaluations, and investigative work involving personal care services (PCS) and offered recommendations for improving program oversight. Medicaid Fraud Control Units (MFCUs or Units) investigate and prosecute Medicaid provider fraud and patient abuse or neglect under State law. We conducted this study to provide data on MFCU investigations, indictments, and convictions involving fraud and patient abuse in Medicaid PCS.

The objective of our evaluation was to determine whether all Military Services Law Enforcement Organizations (LEOs) had submitted fingerprint cards and final disposition reports for Military Service members convicted by court-martial of qualifying offenses, as required by DoD instruction. We reviewed these submissions for the period from January 1, 2015, to December 31, 2016.

OIG received an anonymous allegation that Veterans Service Center (VSC) staff at the Roanoke VA Regional Office (VARO) combined appeals to lower the pending inventory and achieve production goals by entering incorrect data into VA’s electronic system. OIG reviewed 331 appeal records that were closed indicating they were withdrawn by appellants. OIG determined 278 were improperly closed because the electronic record did not contain any evidence of a withdrawal request by the appellant. In 276 of the 278 closed appeal records, the pending issues were merged with other open appeal records. In two cases, appeals management and staff failed to add all pending issues to other open appeal records. Both of these appeal records were reactivated as a result of OIG’s review. Merging issues into one record was a longstanding practice at the Roanoke VARO to reduce the pending workload. VARO and VSC management were unaware of this practice, and appeals managers knew of it but were unaware of its full impact. Merging appeal records gave a false impression that the appeals inventory decreased. Subsequently, the reported statistics for the number of pending and completed appeals at the Roanoke VARO were inaccurate, and the associated timeliness measurements were unreliable. OIG could not determine what the VARO’s actual statistics should have been since staff appeared to have been following this guidance from at least September 2008. OIG recommended the Roanoke VARO Director conduct a review to identify prematurely closed appeal records and confer with appropriate Veterans Benefits Administration officials to determine the proper corrective actions to take, if any. OIG also recommended the Director confer with regional counsel to determine what steps to take, if any, with regard to management or staff involved in the conduct discussed in this report. The VARO Director concurred with our recommendations and planned corrective actions are responsive.