Caught

06.02.14

How to Cut Down on VA Fraud in a Single Step

No, it’s not getting rid of the guy at the top. It’s a straight-ahead report that could uncover many of the secret waiting lists embedded in the system.

Once more, because it bears repeating: VA Secretary’s Eric Shinseki’s resignation last week may have been politically necessary, but it won’t fix the VA’s health-care system or deliver medical care to veterans still in waiting lines. In fact, no one even knows the full scope of the problem yet, including the VA’s new acting secretary. But we don’t need to wait for a full accounting to address imminent needs and start implementing solutions that could keep this from happening again.

After a month of calls for him to step down, it was a report from the VA inspector general that triggered Shinseki’s resignation. The IG report on the Phoenix VA hospital, where the current scandal started, confirmed that employees there used secret waiting lists to hide long delays for veterans seeking medical treatment. The IG found 1,700 veterans who went to the Phoenix VA for medical care were never given an appointment or scheduled to see a doctor. The veterans who did receive appointments waited an average of 115 days before being seen—more than three months longer than the VA’s standard of 14 days.

But the IG’s investigation didn’t only deal with Phoenix; it found the same “scheduling schemes” there were “systemic” across the system. As bad as the findings in Phoenix were, the fact they have been identified has meant immediate attention for veterans there. It meant a high-profile effort to rush in resources and deliver medical care. But at the other VA hospitals across the country, those not under a spotlight, the extent of the damage hasn’t yet been fully assessed.

The VA keeps track of wait times at its facilities and publishes them in annual performance reports. The performance reports are based on information gathered from the 971 medical facilities in the system. Local centers send their numbers up to be reviewed by VA leadership and compiled into a big-picture analysis of trends across the system. In other words, the official record of the VA’s performance is based on the same kind of reporting that was just exposed as a fraud in Phoenix, and the big picture it purports to show may be nothing more than a mirage.

Revealing the real conditions for veterans in Phoenix took an IG team arriving on the ground to interview individual veterans. So far, the IG is conducting similar investigations at 42 other facilities across the country; the VA has its own teams auditing hospitals to determine whether they have been cooking the books and how long veterans are waiting for care. The 1,700 people languishing in Phoenix are likely only a fraction of the thousands or tens of thousands of veterans across the system who are still hidden on secret waiting lists that have not yet been discovered.

As the investigations and audits start to release their findings, we’ll get a better sense of how many veterans are caught up in the scheduling schemes and need immediate medical attention. Getting to the truth in this case has required bypassing the normal reporting system, which is clearly compromised, and going out to interview veterans. But with 9 million veterans enrolled in the system, the VA clearly can’t rely on individual interviews every time it needs basic facts about conditions in its own hospitals.

As many VA employees and observers have noted, an updated computer system—the VA uses software that’s decades old—would cut down on false reports by giving leadership better oversight of the data system. Overhauling the VA’s digital records system is necessary but it’s a massive investment and it won’t happen quickly. In the meantime, VA employees tell The Daily Beast, there are methods that can be used right now to look for irregularities in the current system that could help reveal other potential Phoenixes where veterans are waiting months for treatment.

One VA employee, who is familiar with the scheduling system and asked not to be named to protect his job, explained the available means to detect where wait times were being scammed. In the current scheduling system there are two different wait times listed for each patient, the source said: “There is a wait 1 time and a wait 2 time. The wait 1 is the time from the date the scheduler makes the appointment to the date of the patient’s appointment.” But it’s the wait 2 time that gets reported and counts for the performance measures, according to the source. The wait 2 time “is the time between the patient’s desired date, the day they select for their appointment, and the actual date when they see a doctor. The scheme they’ve been using is to not actually ask the veteran for their “desired date” and instead just assign them whatever date the hospital has available for an appointment.”

What that means, the source said, is “the official reports, based on the wait 2, will never show that you have a three-month waiting time. But your wait 1 time would show the real delay—that it took three months from the day the veteran came and made their date with the clerk until they actually saw a doctor—even though your wait 2 time would show zero days, no wait at all.” 

“If they just ran a report that showed the difference between the two wait times for every clinic,” according to the source, “they would be able to see who was being gamed.”

“What are the odds that everybody picked that the day they wanted to be seen was 90 days after they first came in? It would be very easy for them to see a pattern like that.”

“What are the odds that everybody picked that the day they wanted to be seen was 90 days after they first came in? It would be very easy for them to see a pattern like that,” the source said.

The method the source described would not work everywhere. It couldn’t pick up on cases where veterans were never entered into the system at all or were tracked on manual lists, but it could be a way, short of finding and questioning every veteran waiting for care, of identifying patterns of fraud early before they affect thousands. 

Scheduling schemes and secret waiting lists are the open wounds in the VA that have everyone’s attention now, but they’re really only symptoms of deeper maladies. Phil Carter, a former Pentagon official, wrote an informed piece on the structural issues, like resource allocation and staffing, that underlie the current episode. But while the entrenched issues are being debated and addressed the VA needs to do more now to locate the other Phoenixes and the veterans whose medical needs they have been covering up.