Veterans Health Administration Audit of Community-Based Outpatient Clinic Management Oversight

The Office of Inspector General conducted an audit of the Veterans Health Administration’s (VHA) management oversight of Community-Based Outpatient Clinics (CBOCs). This audit evaluated the effectiveness of VHA’s management oversight of CBOCs. The audit objectives were to evaluate VHA CBOC monitoring and evaluation policies and processes and examine CBOC management controls related to the Primary Care Management Module (PCMM) and the completion of required traumatic brain injury (TBI) and military sexual trauma (MST) screenings. VHA lacks a comprehensive CBOC management control system with which to effectively evaluate and manage CBOC performance and address operational problems. As a result, VHA lacks reasonable assurance that CBOCs adhere to VHA’s one standard of care and provide consistent, quality care in accordance with VA policies, regulations, and procedures. Problems identified during our evaluation of CBOC PCMM data and the completion of TBI and MST screenings at CBOCs demonstrate the need for VHA to establish CBOC-specific monitors and evaluations that can identify systemic problems and deviations from the standard of care. We found that CBOC PCMM data maintained by medical facility and CBOC staff and used to make VHA budgetary and resource management decisions contained significant inaccuracies. Moreover, Network and CBOC staff did not ensure the prompt completion of required TBI and MST screenings, and in some cases, allowed the improper billing of veterans for MST related care. In the audit report, we made six recommendations to establish comprehensive CBOC management controls and monitoring mechanisms and strengthen CBOC PCMM data management, TBI and MST screening, and MST billing management controls. The Under Secretary for Health agreed with the findings and recommendations. We consider the planned actions acceptable and will follow up on their implementation.