VA facility managers warned about practices

Associated Press

WASHINGTON

Fake appointments, unofficial logs kept on the sly and appointments made without telling the patient are among tricks used to disguise delays in seeing and treating veterans at Veterans Affairs hospitals and clinics.

They’re not a new phenomenon. VA officials, veteran service organizations and members of Congress have known about them for years.

The “gaming strategies” were used to make it appear veterans were getting appointments within target times set by the department, according to a 2010 department memo to VA facility managers aimed at fighting the practices.

The memo from William Schoenhard, then the VA’s deputy undersecretary for health operations and management, said that when a medical appointment wasn’t available within the 30-day target time then used by VA, some schedulers would:

Make a fake appointment within the 30-day period but not tell the patient. The appointment would be canceled later, and a new appointment would be made to meet a new 30-day target.

Note on a paper log the actual distant date of an appointment, but not enter it into the computer until within 30 days of the date.

Give the patient an appointment at whatever date was next available, but log it in the computer as the date the veteran had asked for.

Schoenhard’s nine-page memo ordered the practices stopped and instructed managers on how to detect them. Then he added:

“Please be cautioned ... additional new or modified gaming strategies may have emerged, so do not consider this list a full description of all current possibilities of ... practices that need to be addressed.”

Or as Sen. Patty Murray, D-Wash., put it at a hearing this month: “As soon as new directives are put out, they’re torn apart to find out how to get around the requirements.”

“Cooking the books” at VA hospitals has exploded into public view since allegations arose that up to 40 patients may have died at the Phoenix VA hospital while awaiting care. The department’s inspector general said he’s found no evidence so far that any of those deaths were caused by delays. He’s widened his office’s probe to include 26 VA centers but hasn’t specified just what is being investigated at the newly added locations.

There are some 1,700 VA health facilities nationwide, including hospitals, clinics and residential rehabilitation centers. Investigators are trying to determine how widespread the practice of falsifying records is. But the fact it is a problem has been detailed in VA inspector general reports and Government Accountability Office reports to Congress going back a decade.