Thousands of Ineligible Medical Providers Are Enrolled in the VA's Community Care Program

A federal audit found that roughly 1,600 medical providers approved to treat veterans through the Department of Veterans Affairs' community care program were ineligible to participate because their licenses either had been revoked or suspended, or they were dead.

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

Of 800,000 community care providers GAO analysts reviewed, thousands were ineligible, including at least one whose license was revoked in 2019 and others who had engaged in fraud.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 investigative service at the GAO, wrote in the report. "Additionally, VHA [Veterans Health Administration] is at risk of fraudulent activity, as some of the providers GAO identified had previous convictions of health-care fraud."

Providers are supposed to be excluded from participating 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 felony crime considered detrimental to their VA patients.

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

Licensing documents for another provider stated that he or she "posed a clear and immediate danger to public health and safety," according to the report.

The GAO found 216 providers who were on the rolls but their medical licenses had been revoked and 796 whose licenses were surrendered as the result of an investigation.

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

GAO analysts noted that the VA and its community care contractors, Optum Public Sector Solutions and TriWest Healthcare Alliance Corp., did not effectively use databases available to screen those who were deceased.

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

The report follows a previous audit by the GAO released in 2021 that found as many as 227 providers who were dismissed from the VA for providing poor quality care may have entered into the community care system without being flagged as being 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 a need for the department to overhaul its health care culture.

"OIG oversight work has shown that these missed opportunities were nearly always due in large part to the actions and, even more often, inactions, of leaders," Dr. Julie Kroviak, deputy assistant inspector general for health care inspections in the VA's Office of the Inspector General, told members of the House Veterans Affairs Subcommittee on Health last October.

In the most recent report, the GAO made 10 recommendations to the VA to improve the community care program, to include monthly checks of databases and identifying fraud risk and following through on red flags.

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

Following release of the report, a bipartisan group of lawmakers on the House Veterans Affairs Committee wrote Dr. Steven Lieberman, who is performing the duties of the under secretary of health, urging the VA to follow through with the GAO's recommendation and purge all ineligible providers from the community care network.

"While the approximately 1,600 ineligible providers identified by GAO represent a small percentage of the Veterans Community Care Program's roughly 1.2 million active providers, they represent potential threats to veteran health and safety and risks for financial fraud," wrote Reps. Chris Pappas, D-N.H.; Tracey Mann, R-Kan.; Julia Brownley, D-Calif.; and Jack Bergman, R-Mich.

-- Patricia Kime can be reached at Patricia.Kime@Monster.com. Follow her on Twitter @patriciakime.

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