VA Scheduling Scandal Investigation Reveals Troubling Data Integrity Practices, Takes Down Secretary
A government report on Veterans Health Administration (VA) scheduling practices have uncovered much more than a deeply flawed patient management system. It also revealed lapses in data integrity and information governance and has led to the resignation of Veterans Affairs Secretary Eric Shinseki.
An investigation by the Veterans Administration Office of Inspector General (OIG) found that VA administrators deliberately manipulated appointment and scheduling records to give the appearance of shorter waiting times for veterans seeking medical care. Many HIM professionals are closely watching the case, as it raises health information ethics and health record accuracy questions.
Though initial news reports have focused on whistle-blower accounts and subsequent investigations at Phoenix VA Health Care System, the interim report released Wednesday—with a final report due out in August—states that the manipulation of patient data to hide egregiously long wait times is “systemic throughout” the VA system.
While an investigation into scheduling practices in other VA facilities is ongoing, the OIG report found that the average waiting time for an initial primary care appointment in Phoenix was 115 days. This directly contradicts the number hospital administrators reported to national VA officials, which was 24 days.
The report also addressed allegations of “secret wait lists,” which are alleged to be separate from official electronic waiting lists (EWLs) patients are placed on when they schedule an appointment.
“Our reviews have identified multiple types of scheduling practices that are not in compliance with VHA policy. Since the multiple lists we found were something other than the official EWL, these additional lists may be the basis for allegations of creating ‘secret’ wait lists,” the report states.
“Having an information governance program that is monitored, audited, and enforced may have at least ensured all veterans were accounted for and showing true wait times and ensuring they were in line for treatment,” said Diana Warner, MS, RHIA, CHPS, FAHIMA, a director of HIM practice excellence at AHIMA.
News of Shinseki’s resignation came Friday morning due to mounting public pressure to step down.
HIM Ethics, Data Integrity Concerns
The OIG report also makes clear that concerns about lengthy wait times and the OIG’s attempts to remediate these issues have been ongoing and well-documented for several years. The report establishes a timeline going back to 2005.
Of particular concern to health information management (HIM) professionals is the lack of data integrity controls in VistA, the VA’s electronic health information system.
“During our review at Phoenix HCS we determined that certain audit controls within Veterans Health Information Systems and Technology Architecture (VistA) were not enabled,” the report states. “This limited VHA and the OIG’s ability to determine whether any malicious manipulation of the VistA data occurred. To ensure our future oversight ability is not compromised, we requested VA to immediately enable this audit trail capability at all VA medical facilities. VA completed this action.”
Warner agrees that the data in the VA’s system was “tainted.” Since VA scheduling practices were not followed, they were not in compliance. She adds that when an information governance program is implemented and followed, non-compliance can be detected and corrected.
“However, this is deliberate wrongdoing by supervisors and even strong information governance programs can’t always catch this,” Warner said.
Data and billing processes at other non-VA hospitals could be put under further stress in dealing with the overflow of VA patients seeking alternative care. Federal officials announced over the Memorial Day weekend that in areas where VA providers are not able to provide timely services, VA beneficiaries will be referred to outside providers, according to an article in Modern Healthcare.
But problems with timely reimbursement for services provided outside the VA have raised concerns from healthcare groups as well as the US Government Accountability Office (GAO).
“We found that VA lacks sufficient oversight mechanisms and data to ensure that VA facilities do not inappropriately deny claims,” the GAO report states. When private hospitals were not reimbursed by the VA, the hospitals billed veterans directly, the GAO noted.