A Prohibited Default in the Clinically Indicated Date Field Limited Some Veterans’ Eligibility for Community Care at the Omaha VA Medical Center in Nebraska

The OIG conducted this review to assess the merits of two hotline complaints—one in March 2024 and one in April 2024—alleging Omaha VA Medical Center leaders manipulated the clinically indicated date for consults, thereby limiting veterans’ access to community care. The OIG substantiated the allegations, determining that from March 7, 2024, through April 11, 2024, facility leaders implemented a prohibited 29-day default for the clinically indicated date field that applied to referrals for specialty care and for some primary and mental health care. The default was implemented because clinically indicated dates for many specialty care consults were, in the chief of staff’s and medical facility director’s opinion, sooner than the patient’s condition warranted.

Before implementing the default, both the medical facility director and the chief of staff were made aware that there should not be a default. After implementing, they were also notified by an Omaha VA Medical Center employee that the default was not allowed and should be removed, but facility leaders took 19 days to remove the default. Furthermore, the OIG found providers were not given training on clinically indicated dates. In early November 2024—more than six months after the default was removed—training was provided.

The OIG made four recommendations: to clarify that automatically prepopulating the clinically indicated date field is prohibited; to determine whether any administrative action should be taken; to direct the medical facility director to provide education and training on the consult process; and to assess the actions the medical facility has taken to review consults potentially affected by the default and ensure veterans received the care they needed.