VHA provides outpatient services to veterans at community-based outpatient clinics (CBOCs) nationwide. The VA OIG conducted this review to assess contract oversight of staffing and appointment cancellation performance measures at five Loma Linda Healthcare System CBOCs in California.
The OIG found that VA leaders in the Loma Linda healthcare system did not ensure contractor compliance with performance standards for staffing or for the number of appointments canceled by the clinics during FYs 2022 and 2023. Specifically, Loma Linda officials did not effectively monitor contractor-staffed primary care Patient Aligned Care Teams to ensure contract compliance. The contractor did not meet required staffing levels at any of the five contracted CBOCs for at least 22 of 24 months in FYs 2022 and 2023; two CBOCs were noncompliant 100 percent of the time, and the remaining three were noncompliant more than 90 percent of the time.
The contractor also did not consistently meet the appointment cancellation performance standard regarding appointments canceled by clinics at contracted CBOCs. In FYs 2022 and 2023, all five CBOCs under the contract were noncompliant with appointment cancellation standards at least 79 percent of the time, and two CBOCs were noncompliant 100 percent of the time. Finally, the OIG found that the contracting officer’s attempt to recover government funds associated with using VA personnel to cover shortages at the contracted clinics was insufficient.
Contract noncompliance occurred, in part, because the assistant director did not provide effective oversight of the contracting officer’s representative (COR) or the CBOC nurse coordinator. The OIG also found that the assistant director did not effectively coordinate with the COR and the contracting officer to ensure that the contractor’s contingency plan requirement was sufficiently enforced during staffing shortages. The OIG made nine recommendations for VA to improve oversight of CBOC contracts.
