There were warning signs for almost 10 years of widespread, deliberate falsification of patient-wait times at the Department of Veterans Affairs, thanks to multiple whistleblowers and a series of inspector-general investigations.
Yet the VA IG did not sound the alarm that a “systemic” nationwide fraud was being perpetrated against veterans seeking medical care until earlier this year, despite finding the same schemes at multiple facilities since 2005.
Instead, the VA IG’s low-key warnings were buried deep in a score of bureaucratic reports that typically blamed the errors on clerks and their supervisors not following proper procedures.
Recommended fixes were almost always better monitoring by managers and more training for front-line schedulers.
There was no hint of a broader conspiracy to hide the long waits veterans faced to receive healthcare.
“It does appear that the IG missed the forest for the trees, often labeling what we now know to be systemic and willful manipulation of medical care appointment data as basic procedural problems and breakdowns in training,” said Rep. Jeff Miller, R-Fla., chairman of the House Veterans’ Affairs Committee.
“Given VA’s history of misleading statements regarding a range of issues, I hope the IG will treat the department with much more scrutiny in the future,” Miller said.
The IGs are independent watchdogs fighting waste, fraud and corruption in federal departments and agencies.
The scandal over falsified patient records erupted in April, when Miller revealed whistleblower allegations that a secret waiting list was kept at the Phoenix VA hospital to hide delays in delivering medical care. Miller directed the VA IG to investigate.
Within two months, the IG confirmed that the use of phony lists was nationwide, “systemic,” deliberate and potentially criminal. That investigation has spread to 93 facilities across the country. The final report was issued in August.
Richard Griffin, acting inspector general, said his office has long warned about the improper practices identified in Phoenix and documented them in 18 separate reports since 2005.
But a review of those reports by the Washington Examiner found that even when improper practices were confirmed by the IG, they were dismissed as mistakes that could be fixed with better training and oversight.
Only one of the IG reports said there was possible “gaming” of the system through deliberate falsification of records.
But even that 2007 report, which was ordered by Congress, did not identify it as a widespread problem, and suggested it happened because schedulers at some facilities misinterpreted instructions from their bosses.
The IG “did not investigate whether schedulers were intentionally ‘gaming’ the system,” the 2007 report said. If they were, the scheduling schemes would be consistent with the ruse, it said.
Better training and monitoring were recommended.
All of the improper scheduling practices that led to the Phoenix scandal were also found in a 2005 national audit, the first one cited by Griffin.
Secret waiting lists were kept. Bogus appointment dates were entered. Supervisors instructed staff to use incorrect procedures, the 2005 report said.
What the IG didn’t say was that any of it was being done on purpose. Recommended fixes were better training and monitoring to ensure the waiting lists were accurate.
The case most akin to the revelations in Phoenix happened in 2008, when the VA IG was directed by a Senate committee to investigate a whistleblower’s allegations that patient-wait times were being deliberately manipulated.
The whistleblower claimed the former regional director ordered staff to falsify wait times to make it appear medical centers were meeting agency deadlines on delivering care.
Meeting those goals qualified the director of the region that covers New York and New Jersey for a positive performance review and merit bonus, the whistleblower alleged.
The IG confirmed scheduling procedures were not followed, resulting in more than 12,000 veterans who were waiting for care being omitted from official lists.
It also confirmed unofficial lists were kept and the regional director received a bonus, in part for meeting the goal on patient wait times. Ten percent of schedulers said they were directed by supervisors to use the wrong appointment date.
But, the VA IG found “no evidence that officials willfully manipulated waiting time information.”
In April 2010, a top healthcare official in the VA warned that medical facilities across the country were using administrative and digital tricks to deliberately misrepresent wait times. He ordered that the “gaming strategies” be stopped.
About the same time as that memo was issued, a whistleblower reported to the IG that a paper waiting list was being used to hide delays in Portland, Ore., one of the tricks cited in the internal VA memo.
Orders to do it that way came from the regional director, according to the whistleblower. The VA IG couldn’t confirm any of it.
“No one admitted to either instructing or being instructed to use unauthorized paper wait lists,” the IG report issued in August 2010 states. “We also conducted visual inspections of schedulers’ work areas and found no evidence of paper wait lists. We did not substantiate the allegation.”
Many of the reports cited by Griffin as proof that his investigators were quick to identify the problems seem to have little to do with the issue of falsified waiting lists, focusing instead on unrelated issues such as how to reduce erroneous payments to private contractors and appropriate staffing levels for certain specialties.
Others document unacceptable delays in care.
But no report suggests deliberate and widespread falsification of wait times.
“The IG has been reporting on these issues for a number of years, but it seems as though they looked at these as individual site location issues,” said Roscoe Butler, deputy director for healthcare at the American Legion.
“In terms of gaming the wait times, they did not in any of their individual reports say ‘let’s look at this from a national perspective,’” he said.
Also referenced in the final report on the Phoenix investigation are allegations investigated by the IG in 2008 that employees at the Phoenix medical center altered patient appointments to improve performance measures, the exact allegation that triggered the current scandal.
The IG confirmed it was “an accepted past practice” to alter appointments to avoid long reported wait times, and that some employees still did it, a brief notation in one of the appendices of the final Phoenix report states.
No details are given.
But that report is “restricted” and was not publicly released or widely distributed.
The IG refused to provide a copy to the Examiner, which has filed a Freedom of Information Act request.
The IG refused to answer detailed questions from the Examiner about past reports. Instead, a spokeswoman issued a brief statement that “we are gratified that, after nine years of reporting on this issue, VA and Congress are committed to fixing the problem.”
Griffin has come under fire recently because of an assertion in the final report on Phoenix that investigators could not “conclusively assert” delays caused patient deaths.
Griffin confirmed that line was not in the original draft of the report sent to agency administrators for comment, but insisted it was added by his people, not the agency’s.
During a Sept. 17 congressional hearing, Griffin grudgingly acknowledged delays may have contributed to patient deaths.
