Breadcrumb

VHA Needs to Establish Controls for Its Ambulatory Care Budget Estimate

Report Information

Issue Date
Report Number
23-01624-243
VA Office
Veterans Health Administration (VHA)
Report Author
Office of Audits and Evaluations
Report Type
Audit
Report Topic
Financial Management
Major Management Challenges
Healthcare Services
Stewardship of Taxpayer Dollars
Recommendations
4
Questioned Costs
$0
Better Use of Funds
$0
Congressionally Mandated
No

Summary

Summary

Ambulatory care, which refers to medical services performed in outpatient settings, is the basis by which most care is delivered within the Veterans Health Administration (VHA) healthcare system. Because over half of VHA’s medical care budget is for ambulatory care (about $65.1 billion for FY 2023), the VA Office of Inspector General (OIG) conducted this audit to determine whether VHA has adequate controls over its budget formulation process to ensure its ambulatory care budget estimate is reliable. The OIG found that VHA could strengthen internal controls over its budget formulation process to provide reasonable assurance that the ambulatory care budget estimate is reliable. VHA lacks documented procedures, including assigned roles and responsibilities, for developing the ambulatory care budget estimate. VHA also did not establish a data governance structure with clearly defined authoritative data sources and designated data stewards. Documented procedures and a data governance structure could help maintain organizational knowledge of the process and provide reasonable assurance that VHA’s internal controls over operations, reporting, and compliance are effective. The OIG made four recommendations to strengthen internal controls over the budget formulation process.

Open Recommendation Image, SquareOpenClosed and Implemented Recommendation Image, CheckmarkClosed-ImplementedNot Implemented Recommendation Image, X character'Closed-Not Implemented
No. 1
Open Recommendation Image, Square
to Veterans Health Administration (VHA)

Establish and implement guidance for quality assurance measures over the data used to develop and justify the ambulatory care budget estimate.

No. 2
Open Recommendation Image, Square
to Veterans Health Administration (VHA)

Ensure the deputy under secretary for health provides oversight and holds the Office of Finance accountable for developing, documenting, and implementing standard operating procedures to include defining roles and responsibilities and requirements for oversight and quality assurance for development of the ambulatory care budget estimate.

No. 3
Open Recommendation Image, Square
to Veterans Health Administration (VHA)

Implement the Veterans Health Administration Data Governance Council, to include developing policies and processes for data management across the Veterans Health Administration.

No. 4
Open Recommendation Image, Square
to Veterans Health Administration (VHA)

Ensure the Veterans Health Administration Data Governance Council identifies authoritative data sources and nominates data stewards for approval by the VA Data Governance Council.