Important facts, context on the OIG report on VA’s Health Enrollment Center


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The VA OIG report Veterans Health Administration Review of Alleged Mismanagement at the Health Eligibility Center —  discusses several issues VA has publicly acknowledged to Veterans, Veterans Service Organizations and members of Congress: that our enrollment system management, data integrity and quality are in need of significant improvement.

We have worked hard over the past year to address those issues. VA appreciates the work of the OIG and is working diligently to address the issues their report raised to better serve Veterans. We realize the issues raised about our enrollment process are confusing to Veterans and our stakeholders. It is critical for Veterans and our stakeholders understand what this report says, and what it does not say.

Some news media stories based on the report’s findings claim that “over 300,000 Veterans died waiting for care.” That conclusion is not supportable by the information in the report.

The OIG found 307,000 out of the over 800,000 pending enrollment system records were for individuals the reported as deceased by the Social Security Administration, and that VA OIG could not determine specifically how many pending records represent Veterans who applied for health care benefits or when they may have applied. This was because of data weaknesses within our system which we are working hard to improve. The VA OIG report further determined that many of the 867,000 records coded as pending do not represent Veterans actively seeking enrollment in VA health care.

These stories, similar to the stories over the past year regarding pending records in our enrollment system, wrongly link these pending records with access to care issues for fully enrolled Veterans that have chosen to use, and who are receiving, VA healthcare. They are separate issues. Although VA has repeatedly pointed this out to inquiring media, several media stories and commentary continue to appear with this incorrect information.

Additionally, it is not correct to assume, whether an enrollment application record is complete or not, that all Veterans want to use VA care. Veterans can, and do, choose other healthcare options. For example Veterans who are military retirees can, and do, choose to use TRICARE.

As we have previously stated publicly, VA currently has no authority to move records from a pending status even after VA attempts to contact a Veteran, and the Veteran has not provided financial information or military records required by law to determine eligibility.

There are also situations in which a Veteran’s record transfers to our enrollment system even though the Veteran likely did not apply for enrollment. One example is when Veterans in the past applied for State Home benefits.

The pending enrollment records population also includes records of Veterans had accessed our health care system in some fashion before the congressionally mandated implementation of the current VA health care enrollment process in 1998.

Current regulatory guidelines prohibit us from removing these records, resulting in VA leaving them in a pending status. We retained all of those records with full knowledge that some records are likely not applications for enrollment for health care and some records include Veterans that have passed away, as some of the records go back decades and would put many Veterans’ age at over 100 years.

VA is pursuing several remedies to clean up the enrollment records system. Those changes include revamping deceased Veteran verification processes and regulation changes to not only make it easier to remove incomplete enrollment records from the pending file, but also provide continued opportunities for Veterans to reapply for healthcare enrollment at any time.

If any issues raised in the report require additional review and accountability actions, VA will act as necessary and pursue them and afford all concerned appropriate due process.

VA continues the efforts outlined in previous blogs and public responses to contact Veterans with a record in a pending status (irrespective of whether an application date is present) to determine if they desired to enroll in VA healthcare.

As of July 31, 2015, VA has contacted 310,818 Veterans asking them to submit required documents and has received 36,749 responses, with 34,517 Veterans receiving enrollment decisions of which 25,784 were enrolled. As we continue our work to contact Veterans, our focus remains on improving the enrollment system to better serve Veterans.

Caring for our nation’s Veterans is the highest honor and privilege for the men and women who serve them at the VA. That is a responsibility that we do not take lightly. It is important that we openly discuss how we intend to improve. Our focus remains on improving the enrollment system to better serve Veterans. We continuously share information on enrollment processes with Network Directors and our partners in the Veterans Service Organizations.


About the author: Janet P. Murphy, MBA serves as the Acting Deputy Under Secretary for Health for Operations and Management for the Veterans Health Administration.

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Author

VAntagePoint Contributor

— VAntage Point Contributors provide insight and perspective on a wide range of Veterans issues. If you’d like to contribute a story to VAntage Point, learn how you can submit a guest blog at http://www.blogs.va.gov/VAntage/how-to-submit-a-guest-post/

Comments

  1. Pat jahnke    

    Who give power to the primary doctor nurse to tell the veteran heath care know, I call about headaches she told get get meds , sorry to say the nurse told wrong meds, made it worse. I’ve try to ccc my doctor 4 x. Sorry nurse told she going do this ,that, and I CAN NOT SEE MY DOCTOR!!!!!! Will I hate the back stabing nurse she think she God, give wrong info out she kill the veteran know.

  2. Ralph Nicolay    

    I don’t see any mention of VA personnel being fired for negligence. Actually, I don’t see too many personnel being fired at all. How can an institution like the VA justify the fact that their hospital Director in Phoenix, was transferred from Spokane, WA for hiding a list of the numbers of suicides while she was Director at the Spokane VA? Then they sent her to Illinois and then, transferred her again to Phoenix in 2012. Does that make any sense to anyone? This is ridiculous. I know my local VA has fired 7 of its doctors, but how about the millions of other workers answering phones, copying records, etc. have been let go for negligence or simply not working at all. Ignorance of poor administration practices and even worse customer service from these employees is unacceptable. She should have been fired for her stupidity at the Spokane hospital. That would have been a step in the right direction….

  3. Ramona Young    

    My husband has served this country since he was 17 years old and joined the Marine Corps. Then changed to Army Special Forces, and retired in 2010 as CW3. We have claims in the VA that over 10 years old. WE have been represented by the DAV and so far we have gotten no where. All his injuries are service connected. They gave him hearing aids admitted he had Sensorium hearing loss, but say they cannot say it SC. He received a Soldiers Medal for Heroism for going into premature explosions to save Jordanians. That blew out his ear drums and caused TBI. Then he has for 3 documented TBIs with deficits documented through the Poly Trauma Clinic with memory deficits and was denied his claim. At the VA in Little Rock , Ar. the physician who did his C&P for his TBI admitted he had three documented TBIs but falsified his claim. I am a Neuro RN and I was sitting there through this whole exam. He refused to take a letter from the first soldier on the scene at the parachute accident where he had a positive loss of consciousness, hit his head and neck , broke his shoulder and collar bone. No on ever did a CT to his neck. but now he has deficits with from this. He has had to have surgery on both his knees, severe herniated disk in back which they only continue to inject. I am outraged at the care these men do not receive. We file claims , they deny them, then you appeal them, then the claim just disappears. I reported the falsified C&P exam to the OIG and they sent me a letter stating that was not their responsibility. I called the VA in Little Rock and they refused to let me speak to anyone. I am a neuro, ortho nurse and I can tell you he is not receiving the care that he served this country for. You said you had all your claims except 100,000 paid, where’s ours. His PTSD was documented back to 1999 when we first filed. and it is service connected. We finally got it in 2013 and only paid to 2010. They stated they only gave him 30% because he could still go to IRAQ to work. Do you know why he goes to IRAQ to work, that is where he feels comfortable. In that war zone, is that normal No. I know people, I will not call them soldiers who have lied to get benefits. You pay a person 60% for PTSD because he had smoke blown in his face during training. Being Special Forcers it is not in their creed to complain. I will continue this fight till someone admits their wrong and helps us.

  4. Dan Flesh    

    You people don’t get it. If it was 1% of that 300,000 it would still be 300 vets died while waiting for care. Your millions of dollars a year propaganda do not change the facts. We know – The VA is Lying and Vets are Dying. And we are coming after all the incompetence, cronyism, mismanagement, malpractice and illegal things the VA has been up to for years. We are not going to take it anymore. I know you won’t publish this. But, for whoever reads this, tell your buddies you are on notice. We are mad as hell.

  5. VA VERITAS    

    “The VA OIG report further determined that many of the 867,000 records coded as pending do not represent Veterans actively seeking enrollment in VA health care.”

    I would venture to guess many of these veterans were naive and didnt understand how things work and that you have to be a pitbull to get thing sometimes. Im sure many of them applied, didnt hear back so they figured they were denied or ‘didnt deserve’ healthcare.

  6. VA VERITAS    

    May I ask why it is that the VA can very easily backdate to the day a reduction in ratings for compensation goes back to to determine how much i owe them, but cannot know when they received an application for health care?

    It seems to be one of the first and very easily available pieces of data, when you got it. Could this not easily be figured out and generally estimated based on the dates of the paperwork, when they signed it. In my experience ever single piece of paperwork in the VA and the government as a whole has multiple dates in the form and definitely next to the signature line.

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