Offices that monitor risk management, medical investigations and internal audits within the Veterans Health Administration continue to miss the mark, lacking the muscle needed to improve the system overall, according to a new report from the Government Accountability Office.
Since 2015, the VHA, the Department of Veterans Affairs' medical system, has been on the GAO's "high risk" list, a biennial compilation that names federal programs and operations that struggle with waste, fraud, abuse, mismanagement or need transformation.
This year, the VHA was again placed on the list over concerns with the offices tasked with oversight of the system, which serves 9 million veterans in 170 medical centers and more than 1,000 clinics.
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According to the GAO, the VHA mainly has struggled to implement the goals it set when reorganizing its oversight offices this year, including the one responsible for reviewing investigations into alleged medical malpractice and providing recommendations to improve systemwide safety.
"In 2024, VHA reorganized to eliminate overlap and fragmentation of responsibilities across its [oversight] offices," GAO analysts wrote in their report, released Monday. "Among other things, the reorganization highlighted VHA's need for a workforce plan. Having a plan would help ensure these offices have the staff they need to understand what's working within the health system, and manage any remaining risks."
But the GAO also acknowledged that the department has improved immensely in the past decade in its efficiency and providing services to veterans.
"It has been nearly a decade since we added VA health care to GAO's High-Risk List, and in those intervening years, VHA has taken important steps to improve its oversight of its vast health care system," the analysts wrote.
The GAO found that the department's Committee for Audit, Risk and Compliance, which reviews findings from investigations into adverse medical events and alleged malpractice, did not regularly perform its duties or provide systemwide improvement recommendations -- a shortcoming that could undermine the quality of care at VA health facilities, according to the GAO.
The report also noted that the department's Office of Integrity and Compliance has not implemented what are considered to be the best practices for risk identification and management across its health care system.
"By taking additional steps to fully meet leading practices, VHA can better respond to risks that could potentially interfere with the timeliness and quality of veterans' health care," the GAO analysts wrote.
And the department's Office of Internal Audit, established in 2016 after the GAO first put the VHA on the "high-risk" list, struggles as a result of what the government watchdog described as an "unclear reporting structure and oversight role."
"By clearly defining its purpose, VHA can better ensure its Office of Internal Audit is used effectively, such as to provide VHA leadership information on trends and emerging issues," they wrote.
The VHA was put on the list in 2015, largely as the result of issues with providing timely, quality health care to veterans. That year, the GAO made more than 100 recommendations to improve the administration.
This year, the number of GAO's recommendations has dwindled to four. They include: developing a workforce plan for oversight offices; improving practices for managing risk; defining the purpose of the VA's internal audit efforts; and taking care to ensure that findings from medical investigations and other assessments are used for potential systemwide improvements.
In a letter to the GAO, VA Chief of Staff Meg Kabat said the department concurred with the recommendations and would complete three of the four in 2025, with the last -- the portion regarding risk management -- occurring by September 2027.
According to Kabat, the VA plans to implement a multiyear process to "incorporate a wide range of best practices into the risk framework proposal for the VHA."
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