Thousands of ineligible medical providers are enrolled in the VA’s community care program

A federal audit found that about 1,600 medical providers licensed to treat veterans through the Department of Veterans Affairs’ Community Care Program were ineligible to participate because their licenses had been revoked or suspended. or that they were deceased.

A Government Accountability Office report released Jan. 13 found the VA failed to thoroughly vet providers supporting a program that allows veterans to see private doctors in certain circumstances.

Of 800,000 community care providers reviewed by GAO analysts, thousands were ineligible, including at least one whose license was revoked in 2019 and others who had engaged in fraud.

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“These vulnerabilities potentially put veterans at risk of receiving care from unqualified providers,” Seto Bagdoyan, director of audits, forensic audits and investigation service at GAO, wrote in the report. “Furthermore, VHA [Veterans Health Administration] risk of becoming a victim of fraudulent activity, as some of the providers identified by GAO have previous convictions for health care fraud. »

Providers are supposed to be excluded from participation in the VA Community Care Program if they have been removed from VA employment, are under investigation by their state licensing boards, or have lost their licenses, or have been convicted of a crime considered harmful to their VA patients.

The GAO investigation uncovered at least one case of a provider working with an expired nurse’s license who was arrested for assault in October 2018 and convicted of patient abuse and neglect in mid-2019 , to enter the community care program later that year.

Another vendor’s licensing documents said it “posed a clear and immediate danger to public health and safety,” according to the report.

The GAO found 216 providers who were on the lists but had their medical licenses revoked and 796 whose licenses were returned following an investigation.

Of those identified as ineligible for the program, GAO identified 1,069 as deceased, including 601 who were listed as active claimants and eligible for referrals.

GAO analysts noted that the VA and its community care contractors, Optum Public Sector Solutions and TriWest Healthcare Alliance Corp., were not effectively using available databases to trace deceased persons.

The GAO also identified 37 vendors with fraud-related judgments or convictions.

The report follows a previous GAO audit released in 2021 which found that up to 227 providers who were fired from the VA for providing substandard care may have entered the community care system without being flagged as ineligible.

An October 2021 GAO investigation also found that VA facilities’ handling of events resulting in patient harm or death indicated a systemic failure of leadership and the need for the department to overhaul its healthcare culture.

“The OIG’s monitoring work has shown that these missed opportunities were almost always due in large part to the actions and, even more often, the inaction of leaders,” said Dr. Julie Kroviak, Assistant Deputy Inspector General for health care inspections at the Office of the VA. the inspector general, told members of the House Veterans Affairs Health Subcommittee last October.

In the most recent report, the GAO made 10 recommendations to the VA to improve the community care program, include monthly database audits, and identify fraud risks and track red flags.

VA officials agreed with most of the recommendations and said they expect to complete the work by next year.

After the report was released, a bipartisan group of House Veterans Affairs Committee lawmakers wrote to Dr. Steven Lieberman, who serves as undersecretary of health, urging the VA to follow the GAO’s recommendation. and to purge all ineligible vendors. of the community care network.

“While the approximately 1,600 ineligible providers identified by the GAO represent a small percentage of the approximately 1.2 million active providers in the Veterans Community Care Program, they represent potential threats to the health and safety of veterans and risk of financial fraud,” Rep. Chris Pappas, DN, wrote. H.; Tracey Mann, R-Kan.; Julia Brownley, D-California; and Jack Bergman, R-Mich.

— Patricia Kime can be reached at [email protected] Follow her on Twitter @patriciakime.

Related: Hundreds of VA-licensed doctors can still treat veterans, GAO says

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