Veterans Health Administration’s Failure to Properly Identify and Exclude Ineligible Providers from the VA Community Care Program

The VA Office of Inspector General (OIG) conducted a focused national review to assess concerns with Veterans Health Administration’s (VHA’s) process to identify providers who have been removed from VA employment due to violations of policy “relating to the delivery of safe and appropriate care” and exclude those providers from the VA Community Care Program (VCCP), as required by the VA Maintaining Internal Systems and Strengthening Integrated Outside Networks Act of 2018 (MISSION Act).

The OIG found that VHA’s process failed to identify all healthcare providers removed from VA employment. The OIG determined that VHA’s process also failed to accurately identify personnel actions that indicate healthcare providers were removed for violating policies relating to the delivery of safe and appropriate care. Furthermore, VHA did not consider whether a provider was removed for reasons related to delivery of safe and appropriate care. These process failures resulted in both inclusion of ineligible providers and exclusion of eligible providers from the VCCP.

Deficiencies in VHA’s process to identify providers who should be excluded precluded a complete evaluation of the exclusion process. As a result, this inspection focused on the initial steps to identify ineligible providers for exclusion. The OIG remains concerned about VHA’s inability to exclude and prevent ineligible healthcare providers from delivering care to veterans through the VCCP. The OIG issued this brief report to provide timely oversight and share concerns to facilitate VA action.

The OIG made two recommendations to the Under Secretary for Health related to the criteria and processes used to identify and exclude ineligible healthcare providers from the VCCP, and to review previous personnel actions to determine whether the reason(s) for those removals were for violation of policy related to the delivery of safe and appropriate care.