Federal Reports

The OIG conducted this audit to determine whether medical facilities followed VHA’s process to plan, request, and approve nonexpendable medical equipment purchases. Nonexpendable equipment typically has a useful life of two years or more and costs at least $300. Ventilators, radiology equipment, and vital sign monitors are examples. VHA’s process requires facilities to use the Strategic Equipment Planning Guide and Enterprise Equipment Request portal, designed to support streamlined planning and expedite approval of equipment orders. From FY 2022 through May of FY 2024, VHA staff entered requests into the guide to buy about $2.1 billion in medical equipment.

The OIG found that VHA facilities did not effectively plan for, request, or approve nonexpendable medical equipment purchases as required. This aligned with supply chiefs’ own finding that facilities did not use the process during FY 2024. Specifically, medical facilities did not use the required process for all planning and approval, and some VHA facilities still had not fully implemented the process (mandated in FY 2017) as of FY 2024. The OIG identified two reasons for the noncompliance: VHA had developed guidance but lacked a requirement for staff to use the material, and staff were unclear on what equipment needed to be entered and approved.

A lack of proper planning and approval increases the risk of staff buying items that facility leaders are not aware of or that do not fit in the desired location. The latter scenario happened when the VA medical facility in Tampa, Florida, purchased $500,000 scrubEx machines in June 2021. Consequently, staff have stored and not used the equipment.

The OIG made five recommendations to increase use of VHA’s process and achieve its purpose.

VHA staff use nonexpendable equipment—durable items that can be continuously used for two years or more—to deliver patient care and operate medical facilities. This equipment must be inventoried annually if it is valued at $5,000 or more, sensitive in nature, or capitalized property. These inventories minimize the risk of mismanaged or lost property and help ensure items are adequate for patient use. The OIG conducted this audit to determine whether VHA managed accountable nonexpendable equipment in accordance with policy.

Overall, the OIG found VHA’s management of nonexpendable inventory can be improved. The OIG estimated that VHA medical facilities could not account for at least 75,500 items (5 percent). These items had a collective value of at least $210.9 million, which the OIG considered as funds VA could have better used. During site visits, the audit team searched for equipment and did not find an estimated 537,000 items (33 percent) at their last inventoried location. Finally, the audit team found an estimated 62,500 items that facilities may not need.

These concerns were created, in some cases, by staff’s use of the “inventory by exception” process. This means that if an item was accounted for since the last annual inventory—because it needed maintenance, for example—it does not need to be included in the next scheduled annual inventory. However, this process weakens facilities’ assurance that the equipment is accounted for and in good condition because it extends the interval between physical inventories. The OIG also found that the reports of survey processes for missing or damaged items have not been conducted as required, and general oversight of inventories could be strengthened.

The acting under secretary for health concurred with the OIG’s six recommendations to improve the nonexpendable equipment inventory process and related oversight.