Scrutinize the Executive Branch – The Charge for the Legislative Branch: Part 1

In what has become typical and usual, the following stories arrive:

From 2019 to 2021, Ira Westbrook of Bozeman, Montana, served as the fiduciary of an elderly relative who had suffered a stroke and became disabled.  A multi-agency investigation found that, during these 16 months, Westbrook stole more than $57,000 in Social Security and VA benefits and used the stolen funds to purchase personal items, including a Jeep Wrangler, a travel trailer, and other day-to-day expenses.”

From 2016 until 2018, Sloane Signal-Debose of Slidell, Louisiana, served as the fiduciary of a veteran who needed assistance managing his finances.  During that time, she took more than $100,000 from the veteran’s accounts, used it as the down payment on a home in her name, and used additional funds from the veteran to pay contractors working on the home.  Signal-Debose then submitted false records to VA to hide her misuse of the veteran’s funds.  The former fiduciary pleaded guilty to misappropriating funds and faces up to five years in federal prison.  The VA OIG conducted this investigation.

In 2013, Brandi Goldman of Jonesboro, Arkansas, was married to a US Army reservist who suffered a severe traumatic brain injury in a service-connected accident.  As a result of this injury, her husband had many serious physical challenges, and Goldman was appointed as his guardian and fiduciary.  Between April 2015 and November 2017, Goldman received more than $258,600 in VA disability payments and $36,000 in Social Security payments.  During that timeframe, she withdrew close to $200,000 in cash and accrued about $900 in ATM and overdraft fees.  Goldman admitted to spending much cash to fund her methamphetamine habit, spending $150 on methamphetamine two to three times per week.  She also admitted that five other people moved into the residence with her and her husband, none of whom paid rent or contributed to expenses, some of whom she regularly gave cash to.  She also admitted to paying $68,000 in cash for another home, furnishings for the home, multiple vehicles, and a motor home.  Goldman was sentenced to 20 months in prison, three years of supervised release, and $143,000 in restitution after previously pleading guilty to misappropriation by a fiduciary.  The VA OIG and Social Security Administration OIG conducted the investigation.”

Why are these stories of particular interest to the supreme legislative body in the United States of America?  The executive branch has refused to police its branch of government, and crimes like this have become all too familiar.  You, the Congressional bodies of these the United States, are duty-bound and sworn to perform two jobs, scrutinize the executive branch (harshly when necessary), and write laws.  You have recently failed too often in monitoring the executive branch, and this story perfectly represents what happens when the executive branch is not examined minutely!  Tell the US Public who put you in elected office, how these crimes continue and what programs and processes they MUST change to prevent them in the future.

By pleading for the legislative branch to scrutinize and audit the executive branch minutely, I am in no way condoning or diminishing the personal accountability of those who committed crimes.  These three examples are from the October and November press releases of 2022.  The widespread ability to commit fraud is a symptom of a more significant problem at the VA.  Their leaders have consistently been able to boondoggle, evade, and profit from abusing veterans through designed incompetence, criminal neglect, and obtuse actions.  When will Congressional leaders take action to clean up the Federal Government in general and the VA specifically?

The US House of Representatives holds the purse strings for the executive branch; use this leverage to claw back your powers and authority to balance the Federal Government and demand accountability from those empowered to lead their designated branches of the executive branch of government.  Let’s talk about patterns; in less than 45 days, three cases of fiduciary fraud were closed, and the speed of closing these cases has escalated throughout 2022.  The American people will see more, not less, of these fraudsters being underreported by the US Media before the year ends.

Shifting slightly, let’s talk about government employees and the need for more scrutiny of the executive branch.

Bruce Minor, of Philadelphia, Pennsylvania, was sentenced to two years in prison, three years of supervised release, and ordered to pay $462,256 in restitution for his scheme to embezzle money from the Philadelphia VA Medical Center.  Between December 2015 and September 2019, Minor, a former travel clerk, created fraudulent travel reimbursement claims in the names of at least three other VA medical center employees.  He then diverted the funds into bank accounts he controlled.  The VA OIG investigated this case.”

Kyhati Undavia, of Houston, Texas, was sentenced to 27 months in federal prison after previously pleading guilty to conspiracy to commit healthcare fraud.  From December 2012 to December 2018, Undavia hired employees to market Memorial Pharmacy, which she controlled and operated, to physicians as a place to submit compounded drug prescriptions.  Instead of providing prescriptions directly to the patients who could select a pharmacy of their choice, physicians sent the prescriptions directly to Memorial Pharmacy.  Then, Undavia paid the physicians illegal kickbacks for the prescriptions.  Beneficiaries often received medicated creams that they did not need or want.  Undavia received approximately $22 million from TRICARE, Department of Labor Office of Workers’ Compensation Programs, and CHAMPVA for the prescriptions.”

These stories also fall into the same timeframe mentioned above.  But, they are not the only stories from 2022 where VA employees conducted long-term fraud for personal profit.  Here’s the rub: hundreds of additional employees knew of these schemes, were probably running their schemes, and haven’t been caught, and nothing is being done by VA leadership to cease the fraud and abuse of veterans by VA employees.  There is a culture of corruption at the VA, long hidden by scheming and abusive leaders and condoned by previous Congresses, that must be stopped!  What will you, the congressional leaders of the United States, do to halt this insanity, demand personal accountability, and clean house of the designed incompetence that allows these criminal activities to flourish?  The American People are waiting!

The following site holds press releases for the VA specifically, but investigations often cross into Social Security, the Department of Defense, state investigatory bodies, the FBI, and more.  Suppose nothing else is learned from only perusing this site, that more scrutiny needs to be done to every single department of the executive branch.  In that case, we, the American People, might count ourselves lucky.  However, this is not the case.  The rot from poor leadership, criminal mismanagement, and supreme dereliction of duty is etched deeply into the workings of the executive branch operations, and more needs additional discussion.

03 November 2022, the VA-OIG released a report titled, “VHA Progressed in the Follow-Up of Canceled Appointments during the Pandemic but Could Use Additional Oversight Metrics.”  The report only covers the time from 2020 to the present, and regular readers know that the VA has been failing on every measurable metric for over a decade.  To couch in politically correct non-threatening jargon, how designed incompetence continues to hamper and hinder is not surprising.  That the current Congress has bought the excuses hook, line, and sinker, from the inept VA leadership, was not surprising either.  This article is about the future, and the next Congress MUST take immediate and direct action to root cause and improve VA performance!

31 October 2022, the VA-OIG released the following: “Review of VA’s Staffing and Vacancy Reporting under the MISSION Act of 2018.”  This is a report about how the VA continues failing to report improvements in hiring practices to the legislative branch.  The report details VA leadership’s continued failures through designed incompetence.  Tell me, if you were in charge of a report for your business that is essential to receiving funding, would you keep your job if, from 2018 to the present, you still cannot report what is happening and why and be held personally accountable for a report to a legislative body?  Don’t take my word for it; read the report, and be careful of the temperature of your blood boiling!

Unfortunately, this behavior is the normal operating procedure for the VA.  The same can be easily and quickly witnessed in every other Federal Department of the US Government under the executive branch.  As the legislative branch, you are duty-bound to investigate and demand compliance in a timely manner.  Where have you been; more importantly, will you allow these problems to continue or kill them?

Do you doubt designed incompetence is a standard operating procedure?  Let’s discuss another part of the MISSION Act of 2018 that the VA-OIG recently reported on, “Additional Actions Needed to Fully Implement and Assess Impact of the Patient Referral Coordination Initiative,” dated 27 October 2022.  The Referral Coordination Initiative (RCI) is a program to improve timely access to care using community providers.  RCI sounds good in theory, but as usual, in the practical application, the program is full of self-serving charlatans, unsupervised or poorly supervised people, weak policies and procedures, and zero accountability!  Plus, when the veteran runs into problems with local providers, reporting these problems is so time-consuming as to be ineffectual at best!

A personal example that was reported to the VA when it happened, and nothing was done but to issue the provider a check.  Dr. Herekar, Neurologist, clinic: Advanced Neurology Epilepsy & Sleep Center, El Paso, Texas.  A VA Primary Care Provider wrote to my employer on VA Letterhead with a wet signature, declaring my inability to wear a mask.  Dr. Herekar’s office was presented with this letter and hassled me before both appointments for not wearing a mask, becoming hostile, argumentative, and a nuisance over the mask issue, even after I complied with putting on a face shield.  23 September 2021, over Facebook messenger, I was informed that I would be invited to find a different provider due to my refusal to wear a mask.  Imagine that; Facebook Messenger became the medium of choice for ending a patient’s relationship with a medical provider.  What did the VA tell me to do; file endless paperwork with TRICARE and then disregard the problem’s urgency.  Worse, the medical care for the neurological issues decreased, and I have had to wait, sit, and hope for future consideration and possible treatment.  Does this sound like an aberration; it is, unfortunately not!

The VA Leadership realized if community care succeeds, they lose power to control the destiny of veterans.  Thus, they implemented the MISSION Act of 2018 with such feet dragging, designing incompetence into every facet of the program, to promote more complaints to Congress, and hopefully to squash the MISSION Act of 2018 and end community care.  07 November 2022, while waiting to speak to representatives of Community Care Services at the VA Out Patient Clinic in EL Paso, the veteran being served ahead of me was told, “The provider does not fax documents, so you will need to go to the provider, and then walk the paperwork back to us.”

The normalcy of reporting providers not submitting paperwork was beyond the pale.  Not having secure document transfer processes between the VA and local providers is technically abysmal and unacceptable.  Are we in the 1990s, where the cream of technology is sending and receiving a fax?  The designed incompetence includes Luddite-like technical disciplines, and the VA_OIG and the Congress should be furious; I know I am!

Before the MISSION Act of 2018, I was making 5 and 6 trips to local providers to retrieve hard copies of medical records, going to the VA Records office, submitting the documents, and then following up 7-14 days later to find out I had to repeat this process as my VA Providers still had not received the records of my interactions with community providers.  Interestingly, in 2020 I discovered the treatment records still had not been submitted from community providers into my VA eHealth Record, from treatment received from 2012-2016.  Is the pattern of designed incompetence clearer?  Is the VA Leadeship’s intransigence more apparent?  How about the fraud, waste, and abuse of VA resources?

You, the congressional leaders, must take immediate action, not wait, not hold hearings, concrete action to demand compliance from the executive branch leaders to the congressional leaders who are held accountable to the citizens.  America is a representative republic, and it is time the bureaucrats learned the citizens are awake and interested.  You, the congressional leaders, are the people’s tool for correcting government abuses; you have two years to show you are dedicated to that principle, or you will be replaced!

© Copyright 2022 – M. Dave Salisbury
The author holds no claims for the art used herein, the pictures were obtained in the public domain, and the intellectual property belongs to those who created the images.  Quoted materials remain the property of the original author.

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Honest Questions! Spurring Forthright Discussion.

Bobblehead DollThis is not my first rodeo where family members have chosen alternative lifestyles.  One family member was not hostile, quietly adopted a different lifestyle, and lives without bullying anyone.  One family member has just come of age, has chosen to live as a different gender, is passive-aggressive, and is hostile to everyone who refuses to participate in their mental disease.  The first person is an abnormality in the homosexual community where bullying, bullishness, and boorishness are the standard, not the exception.  The second family member has used their unhinged emotional wrecking ball to injure family and friends for the privilege of getting their way.  A wholly childish and selfish spectacle deserving of nothing more than abject derision and scorn.

Several friends have embraced different genders and lifestyles, moving from friendly to bully in a relatively short time, and have remained boorish and behaviorally reprehensible ever since.  One colleague was at a party, slipped a mickey, and woke up having been raped while drugged.  In any other community, this would have been a legal offense; in the homosexual community, this was not even worth mentioning.  A sad commentary in and of itself!  Unfortunately, this incident has left my friend degraded and feeling worthless, and unfortunately, we have lost touch over the years and miles since this incident.Question

Many questions remain after having worked around the LGBTQ+ community for more years than I would care to admit.  The number one question remaining is the following: If what you are doing is making you happy and more whole as a person, why the anger, resentment, bitterness, bullying, and boorish behaviors?  To me, this is a simple question; to my friends and family in the LGBTQ+ community, this is a complicated, complex, and nuanced question, where the person asked becomes more boorish, bullish, and obstinate.  So, please answer this question and tell me why this is such a complex and convoluted question.

Dear reader, I now pose the question to you.  I do not care how you choose to identify, the gender you prefer, your sexual preferences, or your religious lifestyle.  I do not care about race at birth or the race you choose to live.  Frankly, all I care about is what you bring to the table regarding talents, skills, abilities, and the attitude you choose.  Essentially, I have onboarded Martin Luther King Jr.’s dream; I judge solely by your character.  I am not racist, homophobic, sexist, ageist, or any other slur you wish to dream of; respect is often offered to resounding silence or aggressive vocal opposition and hatred, yet respect remains.Content of their Character

Religionists, including traditional and non-traditional, I realize the issues you are facing, and I agree with a lot of your concerns.  This does not mean you can be as boorish, bullish, and obstinate in your comments.  My agreement with your concerns does not reduce my respect for both parties.  Anyone abusing the comment section will have their comments moderated.  With that said, any person choosing to abuse the comments section will face the same moderation.  I do not tolerate emotionally charged bloviations.  Be logical, be respectful, and explain your ideas clearly.

Exclamation MarkBear with me for a moment.  I speak for myself.  I do not speak for all homo sapiens; I do not speak for anyone else but me — I research law, science, history, anthropology, psychology, and much more to form my opinions.  Agree or disagree, your choice.  Feel free to express your opinion, just understand I might disagree with your opinion, but I love to discuss topics with people.  Do not bring emotional hyperbole and try to pass it off as fact!  As I have told my wife, I do not care how you feel.

Currently, confusion has set in in global history, and I feel it is time to be truthful and specific.  Women have two XX chromosomes, men have an X and a Y chromosome, and this is the entire amount of genders and sexes in mammalian human science.  While some abnormalities and diseases will produce various (rare) chromosomal variations outside these two genders and sexes, there are absolutely no more than two sexes and two genders.  Recently I was told I was wrong and was informed there are 83 different gender categories, not including those who consider themselves part animal.  I continue to disagree pointedly!Dr. Duke on making good decisions in politics and life - David Duke.com

One of the misnomers in the gender/transgender discussion is that of human choice, which is more easily understood as agency.  The human, as an agent, chooses (exercising agency), and they have the right to choose, but in choosing, their consequences are not anyone else’s problem.  We need this point well understood.  Sexually transmitted diseases are not society’s problem; pregnancy is still not society’s problem; rape, drug addiction, depression, anxiety, etc., are not society’s problem.  How you choose to live your life is your choice; like I have said multiple times in these articles and elsewhere, keep those lifestyle choices in your bedroom and home, and leave the rest of society to live as they choose.

Some of those consequences break a person’s social trust with their chosen society; we call these laws, and breaking laws has additional consequences the agent must bear for exercising agency.  Breaking laws is black and white; how society’s agents apply those laws for enforcing those laws (judges, law enforcement officers, lawyers, etc.) is another topic; however, your lifestyle choices do not allow you to break society’s laws with impunity merely because you do not like a law or because that law interferes with your lifestyle.  It is against the law to picket, rally, or riot in front of a judge’s home to sway that judge’s opinion!  Blocking traffic is not an acceptable or legal method to air your grievances, and there is no such thing as a peaceful protest.  You can either legally protest or riot, media talking heads notwithstanding!

Your lifestyle choices do NOT permit you to groom children, become boorish, bullish, or abrasive in public, nor do your lifestyle choices enable you to change laws and social norms to fit your pleasure.  Everyone sacrifices to belong to society; not getting your way does not mean you have fewer rights than anyone else.  Are we clear on this issue?Founding Fathers Quotes on Justice and Equal Treatment Under the Law

Equal treatment under the law means you do not get a pass on sexual predation merely because your lifestyle is different from someone else’s.  Morals and values a society selects do not twist, morph, or get simply deleted because your lifestyle choices are out of sync with the rest of society.  Frankly, there is nothing new in your lifestyle preferences, so start being a member of society, act responsibly, and cease your incessant whining.  Finally, keep your lifestyle choices in your home; you are not allowed to teach children your lifestyle, you are not allowed to take over city streets for parades and displays, and whether you are hetero or homosexual when in public, act respectfully of others.REPEAL PRWORA PROJECT - GRANT EQUAL PROTECTION UNDER LAW - Bhavanajagat

Let me elaborate on that final statement.  I have been married for 25+ years; in public, I choose not to kiss, hold hands, or do any other action that could cause an observer to be discomfited.  I make these choices from the moral obligation I owe to our country’s social fabric and the respect I have for my partner.  I expect other couples to adhere to a similar standard of public behavior.  Nothing is so disgusting than to be forced to watch two immature people abuse the public square by disrespecting themselves and each other through inappropriate actions in public.  Are we clear, or do you want more specifications?

Having said all of this, why have you decided now is a good time to multiply sexes and genders?  Why now are you demanding “rights” when you already have equal protection under the law?  Why all of a sudden is the push on to change society in a warped image of your lifestyle?  Please answer these questions, and let’s have a discussion.

Knowledge Check!It is time for honest and forthright discussions on these topics.  Argumentative wrangling is not allowed.  Insulting, calling names, and political (emotional) drivel will only end the conversation, for I refuse to put up with sniveling and whining.  You seem to have a point; what is your point?  You want respect, fine, you have respect; please remember respect is earned and is a two-way street.  I will not participate in your mental illness, but I am always willing to discuss real issues honestly, openly, and transparently.

© Copyright 2022 – M. Dave Salisbury
The author holds no claims for the art used herein, the pictures were obtained in the public domain, and the intellectual property belongs to those who created the images.  Quoted materials remain the property of the original author.

Flashes – Conquering Self:  The Best and Last Victory

MumbleMarch 14th is National Pie Day!  I celebrate a lot of life with food.  We begin the second flash with Plato, “The first and best victory is to conquer self; to be conquered by self is, of all things, the most shameful and vile.”  In looking around, the worst things we see originate in failing to accept responsibility and refusing to conquer oneself.  Consider the alcoholic or the smoker; nobody had to pressure them into their vices, nobody poured drinks or cigarette smoke into their bodies, but psychologists declare alcoholism is a disease, and smoking is the fault of cigarette manufacturers.  Really, or are these addictions merely failure to conquer the enemy within.

I am not judging anyone; you are free to believe what you will.  I am making an observation, and the observation is founded upon both personal experiences and the sciences of addiction and addiction recovery.  The best addiction recovery programs teach one how to begin to conquer oneself.  No other changes to a person’s psychology occur, except becoming free from an addictive substance.  Take Da Vinci, who said, “You will never have a greater or lesser dominion than that over yourself!”James Allen Quote: "Self-control is strength. Right ...

Suppose both Plato and Da Vinci are to be believed.  In that case, we can know for fact the truth behind addiction recovery and psychology and the lie behind addictions being a disease — the Hollywood myths being perpetrated against society, that conquering self is old-fashioned, unpopular, or trivial.  Consider your favorite movie or TV show, preferably one glamorizing drinking, smoking, or other behaviors anti-self-control.  Using an example, M*A*S*H 4077th often featured heavy drinking of what was supposed to be alcohol but was water.  One star from the show reported that had they drunk as much as the show reported them drinking, they would have died or been severely injured.

Moving from Hollywood, let us explore other areas where controlling oneself is necessary but is constantly refused.  James Thompson stated, “Real glory springs from the silent conquest of ourselves.”  Look at the capitals of your city, county, state, or nation; what do you find; little to no self-control and worse sarcasm when anyone who practices self-control is spotted.  Catch the latest rant from Biden?113 self control quotes to get you inspired (page 1 of 7)

Florida passed legislation asking teachers to restrain themselves where advanced topics of sex are concerned and teach the subjects they were hired to teach.  What did Governor DeSantis face; scorn, ridicule, and threats of violence.  Where did these bad behaviors originate; from those who practice the least amount of self-control in American society.  King Solomon states without equivocation, “Who then is freeThe wise man who can govern himself.”

Think about the most outrageous members of society, the pains they suffer mentally, physically, and emotionally for their lifestyle choices, which stems from their blatant refusal to practice self-control.  Never forget what Victor Hugo said, “People do not lack strength, they lack will.”  Mirabeau adds that “Nothing is impossible to the man who can will.”  Think of a two-year-old; why are the “Two’s” considered terrible; the child is beginning to exercise personality, and personality is 99% willpower.  The child has tons of will but not the intelligence to know what to do with that personality, thankfully, the child also lacks the size and strength to force their will, or the entire world would tremble.use your mind | Discipline quotes, Self control quotes, Control quotes

Napoleon reported, “A resolute determination is the truest wisdom.”  Olive Wendell Holmes Jr. is quoted as saying, “A mind that is stretched by a new experience can never go back to its old dimensions.”  In these two pieces of wisdom hangs the test for responsible people and the aspirations of a person willing to learn and try.  More to the point, they form a measuring stick for society, especially the American culture.  Are we resolute and determined?  Are we seeking new experiences, even if the experience is nothing more than mastering a habit that has beguiled us for too long?  More, are we expecting resolution and determination from those who aspire to be elected to office?

Over the weekend, America witnessed the lack of determination and spinless lack of resolution in Vice President Kamala Harris, and the world weeps!  That cackling fool must have worn her feather panties for all the laughing she did, and this is NOT the appropriate message to be sending out right now.  The world needs leadership, and we get a clown and a doddering old fool who cheated an election.  We need a Winston Churchill, a Ronald Reagan, an Abraham Lincoln, and we got Biden and his clowns.  Is the distinction clear about who to select for elected leaders?Self Control Quotes (40 wallpapers) - Quotefancy

Is America worth fighting for?  That question is too big to answer and contains a thousand variables.  Let’s ask a fundamental question, are you worth fighting for?  In America, you can change yourself, and in changing, you realize a totally different future than the one your parents suffered.  In fighting for you, you change society in America.  Are you worth fighting for?

In answering this question, you reveal both your hopes and your wishes.  I believe you are worth fighting for; do you believe you are worth fighting for?  What will you do today that makes today different from yesterday, that will make tomorrow different from today?  The second flash is the most personal, reflecting the power inherent in each person to choose.  The freedom of agency is a priceless commodity.  When enshrined in law, the US Constitution, self-control or the lack of self-control will be reflected in society and national discussionsInspirational Quotes On Self Control. QuotesGram.

I cannot emphasize the following enough, the soul sickness America is suffering right now is directly tied to a lack, an absence, and a dearth of self-control.  Open any news program, and the headlines scream problems with the law, war, oppression, all of these social ills find their roots in a lack of self-control.  A woman stabbed her date because of the American Drone strike policy; lacking self-control, her date almost died.  Another woman was hit punched more than 125 times because her attacker lacked the self-control to keep his hands to himself.  Crime waves are sweeping the nation, all from a lack of self-control.  America is sick, and the disease stems from individuals who refuse to exercise self-control.Self-control is strength... | Words quotes, Wisdom quotes ...

War represents a national lack of self-control.  Russia invading Ukraine is nothing but self-control writ large.  What is the media doing; they are cheering a lack of self-control, “If it bleeds, it leads,” has been the axiom controlling the media’s interest, which is part of the problem.  Self-control does not sell newspapers, but it sure does brag and cheer for the dregs of society to act like two-year-olds in the candy aisle of Walmart.  Ever notice how if the child throwing a tantrum does not get the attention, they stop; guess what happens when public shaming occurs, and no attention is paid to the dregs acting like spoiled children?

Self-control is one of those principles that many will never understand until they are forced to learn self-control.  Others will never believe the problem could be resolved simply as a person exercising self-control to fix this national sickness.  Yet, I promise you the answer is this simple and elegant, plus it is effective.  When more people understand and cast derision and aspersions for those lacking self-control, a massive shift in liberty, rights, freedom will blossom like new dawn over the globe.

Knowledge Check!Try this as a guiding principle in your life, and watch it turn your world upside down for the better.  As a foodie, I will celebrate more responsibly National Pie Day.  I have a hunger to eat an entire pie right now.  But I will practice what I preach and introduce some self-control, for I want, and need, tomorrow to be better than today.  If celebrating National Pie Day, please enjoy responsibly.  All pie recipes are gladly shared.

© Copyright 2022 – M. Dave Salisbury
The author holds no claims for the art used herein, the pictures were obtained in the public domain, and the intellectual property belongs to those who created the images.  Quoted materials remain the property of the original author.

New Year – Same Ol’ Disaster at the VA! – Are You Disgusted yet?

Angry Wet ChickenWords fail to describe how much I detest seeing the same abuses week-after-week, month-after-month, and year-over-year.  To witness the disaster known colloquially as The Department of Veterans Affairs (VA), as told from the Office of Inspector General (VA-OIG).  Not merely witnessing but also being abused by the VA leaves such a bitter taste in my mouth.

Matthew C. McPherson of Olathe, Kansas, was sentenced to two years and four months in federal prison without parole for defrauding the government.  From September 2009 to March 2018, McPherson participated in a conspiracy to obtain contracts set aside by the federal government for award to small businesses owned and controlled by veterans, service-disabled veterans, and certified minorities.  McPherson, who is neither a certified minority nor a veteran, owned and operated construction companies that used the veteran or minority status of coconspirators to obtain federal contracts to which the companies would otherwise not be entitled.  The companies received approximately $346 million in federal contracts.  On June 3, 2019, McPherson pleaded guilty to one count of conspiracy to commit wire fraud and major program fraud.  In addition to his prison sentence, McPherson has forfeited to the government more than $5.5 million, which represents his share of the fraud proceeds.”

Honest question, how is this fraud any different from an elected official using insider trading to profit off the stock market?  On another note, does this sound like a plea deal?  If so, what was the deal, and who is being targeted?  Plea deals used to be rare; now, they are cropping up anytime the government has a shaky case.  Could Mr. McPherson have beaten the entire crime by using a better lawyer or connecting with a more powerful politician; of course, and that is disgusting!

I have applied for these government contracts, and the paperwork burden is immense, the bureaucrats authoritative and disreputable.  When will the bureaucrats face criminal charges for abuse of power in allowing for the defrauding of government?  Simple question, yet one to which no elected official will address.VA 3

Speaking of fraud and the need for bureaucrats needing to be held accountable:

“Dr. David Bellamah, a vascular surgeon who operates vein and surgery centers in Missoula and Kalispell, Montana, has agreed to pay the federal government $3.7 million to settle alleged False Claims Act violations.  According to the civil complaint, from January 1, 2015, to March 31, 2017, Bellamah performed medically unnecessary surgeries based on improper techniques and submitted fraudulent bills for payment to four federal healthcare programs, including Medicare, Medicaid, TRICARE, and CHAMPVA.  The settlement agreement between Bellamah and the US Attorney’s Office for the District of Montana, Department of Health and Human Services OIG, Defense Health Agency, VA, and a third party directs Bellamah to pay approximately $1.9 million in restitution and $1.8 million in additional damages.”

The article link is missing from the VA.gov website, reason unknown as of this writing.  I received an email about this story, which is why I know of it, but cannot link someone else to it.  Still, the questions remain, someone in the VA legion of bureaucrats had to have known and contributed to facilitating this fraud, and they are not being held accountable.  Why?

  • Patsy Truglia of Parkland, Florida, was sentenced to 15 years in federal prison for his role in two consecutive conspiracies to commit healthcare fraud.  According to a multiagency investigation, from January 2018 to April 2019, Truglia and his coconspirators generated medically unnecessary physicians’ orders via a telemarketing operation for durable medical equipment (DME).”
  • Ramón Julbe-Rosa pleaded guilty to 12 counts including theft of government property and introducing unapproved new drugs into the United States.  His multiple fraud schemes included defrauding the Social Security Administration and Medicare by receiving Social Security Disability Insurance benefit payments while working; fraudulently receiving unemployability benefits from VA; and falsely stating that his primary residence—purported to be in Morovis, Puerto Rico—was damaged by Hurricane Maria, leading to the fraudulent approval of a Small Business Administration Disaster loan.”
  • Wayne Bowen of Jacksonville, Florida, has pleaded guilty to aggravated identity theft for using his estranged identical twin brother’s name, Social Security card, and military discharge papers to apply for federally subsidized housing benefits.  Due to his fraudulent use of his twin’s identity.”
  • Matthew Smith of Palm Beach, Florida, has pleaded guilty to his role in a compounding pharmacy scheme that defrauded the Department of Defense’s Tricare and VA’s CHAMPVA benefit programs of approximately $88 million.  Smith admitted to his role in fraudulently billing the two insurance providers for expensive, medically unnecessary compound drugs.  To further the scheme, Smith and his coconspirators paid approximately $40 million in kickbacks to patients, patient recruiters, and doctors in exchange for them ordering expensive pain creams, scar creams, and vitamins without regard to the patients’ medical needs.”
  • Seven Texas doctors have agreed to pay more than $1.1 million to resolve False Claims Act allegations involving illegal remuneration in violation of the Anti-Kickback Statute and Stark Law.  According to a multiagency investigation, from 2015 to 2018, the doctors allegedly received thousands of dollars in illegal remuneration from eight management service organizations (MSOs) in exchange for ordering laboratory tests from Rockdale Hospital doing business as Little River Healthcare, True Health Diagnostics LLC, and Boston Heart Diagnostics Corporation.  Little River funded the illegal remuneration to the doctors in the form of volume-based commissions paid to independent contractor recruiters, who used the MSOs to pay numerous doctors for their referrals.”

?u=http3.bp.blogspot.com-CIl2VSm-mmgTZ0wMvH5UGIAAAAAAAAB20QA9_IiyVhYss1600showme_board3.jpg&f=1&nofb=1Take a moment, read the full articles reporting these crimes, and ask yourself, have ALL the guilty parties been held accountable before the law, or are some parties noticeably missing?  If you reach different conclusions, please note this in the comments, and let’s discuss.  Show me your thinking, I want to learn!

Fraud, to succeed, requires willing people in positions of authority not to do their jobs properly.  Yet, for all the rules, mandates, political attention, and legislation, the fraud continues.  Why; because if you are the approving authority and have a plausible excuse, you are never held accountable!  The situation is untenable; the maze of red tape regulations preclude honest people from participating and opens the doors for nefarious actors to swindle, cheat, steal, and profit.  Simple question, when will those legally responsible for not allowing fraudulent activities be held accountable?VA 3

The VA-OIG conducted a Comprehensive Healthcare Inspection (CHIPs) of the Charles George VAMC in Asheville, North Carolina.  Want to understand more about the quagmire of the VA personally?  Read one of these CHIP reports.  Long have I wondered how leadership could be fully measured when the leader of the hospital leadership team has been in their position for two (2) days.  The VA-OIG couches this by claiming the associate director had been in the role for 18-years.  Do you see a problem?VA 3

Where and how are veterans being abused, staff training, and the “Disruptive behavior committee.”  Some might ask, how is staff training an abuse to veterans?  What do you consider “disruptive behavior?”  Did you know if you ask a doctor questions, that doctor can report you as presenting disruptive behavior to the Federal VA Police and get the veteran charged and fined?  If you request to speak to the administrators and they refuse, you can also be charged with presenting disruptive behavior, hindering hospital operations, disturbing patients, being arrested, and fined?  The bureaucrats have designed a self-fulfilling system in the VA that protects wrong-doing and punishes anyone who dares question the status quo, and this is trained into the employees.  Worse, this is about the only training they receive that is competently delivered!

A CHIP was completed at VISN 8, the Sunshine Healthcare Network in St. Petersburg, Florida.  Congratulations are for passing the CHIP with only two recommendations for improvement.  Honestly issued praise.  My concern is the low bar for success that was surpassed, but this is not the fault of VISN 8’s leadership, but the VA leadership in Washington, DC.VA 3

Long have these articles mentioned and decried the designed incompetence found in every single process, procedure, and action taken by the VA.  It is not surprising then that design incompetence is still seen and cost resources.  Nothing new, but you, the taxpayer, need to be aware of this, for the excuses have run so thin you can read contractual mouse print through the excuses!

The history:

“In October 2017, VA entered into an interagency agreement with the Defense Logistics Agency (DLA) to use its Electronic Catalog (ECAT) to order VA medical supplies and equipment not available through existing contracts.  VA created the ECAT Ordering Guide to describe VA policies and procedures for placing orders and outline the ordering officials’ responsibilities.  As of April 1, 2021, VA had spent approximately $592 million on purchases through ECAT.”

The findings:

“The VA-OIG found that the Procurement and Logistics Office (P&LO) did not govern the ECAT program adequately.

    • The ECAT Ordering Guide excludes the requirement for VA ordering officials to consider the Federal Supply Schedule (FSS) contracts for sales orders; purchasing through FSS could have saved VA up to $4.4 million.
    • The guide also incorrectly describes how to apply the Rule of Two, potentially excluding veteran-owned businesses from contracting opportunities.
    • Ordering officials did not follow documentation requirements in the ECAT Ordering Guide, and P&LO did not conduct required annual reviews of the interagency agreement.”

Do you see the designed incompetence?  The VA gets green-lighted to consolidate ordering to save time and money, then develops the processes and procedures to open the door for fraud, theft, and abuse, providing excuses for the VA-OIG to accept when responsibility and auditing occurs.  Hence, roadblocks are launched instead of saving money and reducing the government’s costs.  Instead of bringing order out of chaos, more logs of chaos are added to the fire.VA 3

Worst of all, the VA-OIG has to invest money to tell the VA common-sense solutions, couched as recommendations, to fix the problems the VA purposefully designed into the process.  That is your tax dollars at work, your neighbors losing opportunities, and your employers getting the shaft intentionally by the VA.  Again, only for emphasis, I ask, “When will the bureaucrats be held accountable for their malfeasance and culpability in abusing people, committing fraud and theft, and refusing to do their jobs properly?”

When discussing malfeasance and designed incompetence, the following inspection at the Carl T. Hayden VAMC in Phoenix, Arizona, is applicable as an example.  The VA-OIG conducted an inspection to assess allegations concerning sterile processing services.  The list of findings reveals a lot of bureaucratic shenanigans, and with my knowledge of the leadership, I deduce the shenanigans were driven by leadership at the hospital.

  • The VA-OIG found Sterile Processing Services (SPS) staff failed to don personal protective equipment in decontamination areas.
  • The VA-OIG did not substantiate that SPS staff falsified Resi-Tests by documenting the same lot number for endoscopes.
  • The VA-OIG identified missing documentation of Resi-Test results from October through December 2020 but found that the policy was followed. Leading to a question about the effectiveness of the policies and the designed incompetence in those policies and procedures, which the VA-OIG never addressed as this would have been outside the investigatory scope; more designed incompetence?
  • The VA-OIG found no infection concerns associated with inadequate reprocessing of equipment.
  • The VA-OIG did not substantiate that SPS staff failed to follow validation testing requirements for biological indicators and Bowie-Dick tests for sterilizers.
  • The VA-OIG found that SPS staff followed reprocessing steps according to standard operating procedures and instructions for use.
  • The VA-OIG did not substantiate that SPS staff did not have adequate reprocessing supplies.
  • The VA-OIG found that floor-grade instruments received in decontamination areas were discarded and not reprocessed.
  • The VA-OIG found that SPS staff reviewed instructions for loaner trays upon receipt at the facility.
  • The VA-OIG did not substantiate that SPS staff failed to receive documentation for instruments sterilized at another VA facility.
  • The VA-OIG concluded that SPS leaders were knowledgeable of the practice standards.VA 3

Again, a mixed bag of findings.  After a tumultuous year of sterile scandals, it is refreshing (almost) to observe a sterile facility operating at standard.  Draw your own conclusions about the role of the leadership in this inspection.  To me, the most critical part of sterilization of reusable equipment is the proper use of personal protective equipment, but the VA-OIG did not appear to see this as crucial as I do.  From the inspections I have experienced, failing to use personal protective equipment properly is an automatic failing grade, but the VA-OIG only made a single recommendation for improvement.

quote-mans-inhumanity-2While the above are not all the reports from the VA-OIG launching 2022, they present the bulk of the criticisms and reflect the need for greater scrutiny and improved leadership at the VA.  More to the point, these represent the danger the American public is in from a runaway government that keeps biggering (with a nod to The Lorax and Dr. Seuss)!  The VA is abusing your veteran neighbors, and you are paying for it.  Doesn’t this stir in you feelings motivating to action?  If not, please ask yourself why.  Do veterans deserve to be abused relentlessly?  Do you like being complicit in a crime perpetrated by bureaucrats, cheered on by elected officials, and paid for by your tax dollars and the future of your children through forced taxation and out-of-control debt?  The choice is yours, I know my choice, and I WILL continue to resist the government atrocities every step of the way!

© Copyright 2022 – M. Dave Salisbury
The author holds no claims for the art used herein, the pictures were obtained in the public domain, and the intellectual property belongs to those who created the images.  Quoted materials remain the property of the original author.

The Year-End Maelstrom! – More VA Shenanigans! (Where is the accountability?)

2021 has finally ended, but before it ended, the Department of Veterans Affairs (VA) – Office of Inspector General (VA-OIG) increased the pace, and the following is but a taste of the year-end insanity foisted into my inbox.  With more than 45 emails to sift thru, some of the topics had to be culled, and I regret that I had to cull the emails.  Each and every VA-OIG report deserves to be scrutinized, evaluated, and the actors punished, many times with criminal court.  I don’t know what’s worse, summating these stories or getting hit with a truck; seeing as I have been hit by a truck, I think the truck is easier.

We begin the recount of VA-OIG stories with another veteran, deceased because the VA Medical Center refused to do their job and provide continuity of care after a 33-day hospital stay.  Leaving me wondering if this was intentional malpractice due to the cost of the veteran to the VA.  Listen to the findings of the VA-OIG, then make your own decision.

The Malcom Randall VAMC’s interdisciplinary team (IDT) failed to develop a discharge plan that adequately ensured patient safety and continuity of care.  The Malcom Randall VAMC did not have a discharge planning policy that outlined IDT membership, communication expectations, or roles in discharge planning.  The OIG found that the occupational therapy provider did not verbally communicate a new recommendation for a home safety assessment or take action to stop the discharge until the safety concerns were addressed.  Additionally, an attending physician failed to review written recommendations for home healthcare services from consultative and ancillary providers before composing the discharge plan for the patient.  The social worker, who had significant responsibility for ensuring the adequacy and safety of the patient’s discharge plan, also failed to incorporate recommendations by the occupational therapy provider and failed to discuss and offer home health services to manage the patient’s venous leg ulcer and monitor infection of the right leg.  The OIG also found that social workers did not consistently complete thorough and detailed psychosocial assessments that would be pertinent to discharge planning.

Remember when the media became hysterical when then VP Candidate Gov. Sarah Palin suggested ObamaCare would institute “Death Panels?”  Bureaucrats decided that the government had invested sufficient money into a patient and was going to stop providing medical care.  When this media hissy-fit was going on, I claimed that the VA had been exercising this right to discontinue care for a long time.  Several people took umbrage at this commentary; yet, what do we find from the VA-OIG, a dead veteran, five recommendations by the VA-OIG to do the job these “providers” were already hired to perform, and I am left thinking, “Death Panel in action.”

What else should I conclude with no accountability, responsibility, and consequences?

On the topic of holding a job with responsibility and not being held accountable, we find another hit to the VA and their lack of IT/IS security.  Desiring brevity but passing along factual information, the following summary has been condensed:

The Federal Risk and Authorization Management Program (FedRAMP) standardizes security and risk assessments for cloud technologies for federal agencies, including VA.  In April 2019, the VA Office of Inspector General (VA-OIG) received allegations that VA’s Office of Information and Technology’s (OIT’s) Project Special Forces (PSF) was not following FedRAMP policies or VA policy for deploying software-as-a-service (SaaS) applications.

      • The VA-OIG found that OIT granted security authorizations for applications FedRAMP did not authorize.
          • Eight of the nine applications cited by the complainant were used on the VA network—some without FedRAMP or VA authorization.
          • Another three applications were approved to operate on VA’s network without FedRAMP authorization.
      • The OIG did not substantiate that PSF-developed applications were improperly managed outside the VA Enterprise Cloud group.
      • PSF did not follow VA security requirements in developing interfaces that allow third parties to “plug into” the VA to send and retrieve data.
          • OIT personnel stated, “no formal OIT authorization process until April 2019.” After that date, the review team did not find instances of VA-authorized applications without FedRAMP authorization.
      • OIT staff “apparently” misunderstood the FedRAMP authorization requirements for SaaS applications containing data classified as less sensitive.

Please note if you think the VA IT/IS performance has improved since April 2019.  You are sadly mistaken, as in 2021, there have been three major VA-OIG reports declaring how IT/IS systems at the VA remain insecure, failing legislative mandates for basic security, and are hopelessly too expensive and useless.  I have two VA-Apps on my phone, both of which work “sometimes,” and never sufficiently support the end user.  Worse, these apps do not interface with the old software the VA is helplessly tied to while the new software continues to prove its uselessness and security problems in real-world beta testing.

Tell me, would you trust the government, any of the alphabet agencies, with your child to babysit?  If not, why do we trust the government to secure our identity?  If so, please elaborate, for I would love to know of a government/NGO operating with trust and efficiency.

Continuing under the heading of failure to perform the job hired for, we find the VA-OIG issuing a total of 20 recommendations to Vet Centers.  The Vet Centers included record keeping of suicidal veterans seeking mental health support as a point of reference.  Not for the first time, but I keep hoping it’s the last.  The VA continues to fail veterans, abuse veterans actively, and take advantage of veterans, and I remain unconvinced this torture of their customers is not intentional.  Maybe not all employees, for I have met some great employees, but the leadership appears hellbent on killing as many veterans as possible.

Why isn’t this big news, huge headlines, and a major story to the corporate media?  Where is the coverage?  You cannot convince me that 1)You are not aware of this story and 2) That you are unfamiliar with its implications.

VA statement on GPO printing and mailing delay

WASHINGTONDue to supply chain and staffing shortages, the vendor contracted by the Government Publishing Office to provide printing services for the Department of Veterans Affairs is experiencing delays in printing and mailing notification letters to Veterans and claimants.  The disruption may impact the ability of some claimants to meet required deadlines via written correspondence with the VA.

In response to the mailing delays and to protect the best interest of claimants, the Veterans Benefits Administration is extending its response period by 90-calendar days for claimants with letters dated between July 13, 2021, and Dec. 31, 2021.

For those not aware, everything in the bureaucracy abbreviated as the VA is time-sensitive.  Miss a deadline, and you have no opportunity to recoup lost time without investing significant amounts of resources.  Since I continue to be in an embroiled battle with the VA over not receiving a proper decision in 2004, time delays represent problems untold due to budget cuts and bureaucracy, and the VBA and VHA bureaucracies will do everything they can not to help you.  Then we add the time delays, and the consequences can be disastrous.  Think veterans dying with an active application for benefits, and you come close to how big this story is, and not covering it with wall-to-wall coverage is the epitome of lackluster asininity!

It took dead veterans on waiting lists to get bad press through the Media fawning over President Obama; what will it take to penetrate the media quilt for Biden?  Continuing under the heading of failing to do the job you were hired to perform, we find another VA-OIG comprehensive healthcare inspection (CHIp).  Guess what; this one is beyond utterly dismal and flagrantly reprehensible!

The administration and delivery of care to female veterans continues at its expected and atrocious, slovenly pace, being outstripped by one-winged butterflies.  How can the VA Leadership continue to keep their jobs when they allow such incorrigible behavior from lower staff members?  Would the elected Representatives and Senators address this question?  You were hired to scrutinize the government; that is the only other job you have after writing fair and equitable legislation to all citizens.  Why should you be re-elected when this behavior abounds, and you refuse to scrutinize the executive branch officers?

Consider the following,  “The VA-OIG audit team estimated that improper payments for acupuncture and chiropractic care amounted to about $136.7 million during fiscal years 2018 and 2019.”  Continuing, “The audit team also found that VHA did not always follow guidance when reauthorizing acupuncture and chiropractic care.  Not documenting assessments of prior treatments before authorizing additional care may interfere with veterans’ treatment.”  Failure to ensure your underlings have established proper processes and procedures that are effective and followed is a prerequisite to holding a leadership position.  Where is the leadership at the VA?  Where is elected representative scrutiny?  What are the consequences for doing a poor job of cleaning the house and protecting the taxpayer?

How big is this problem?  Try upwards of $341 Million, on top of the $136 Million already discussed, and before the full force and cost are known on delays in properly notifying veterans in a timely and efficient manner.

The VA-OIG audit team found that some providers are billing VA at a significantly higher rate for high-level evaluation and management services than their peers in the same specialty.  The team determined that in fiscal year (FY) 2020, more than 37,900 non-VA providers billed and were paid for significantly more high-level evaluation and management codes than were all providers in that specialty on average.  These non-VA providers received about $39.1 million (13 percent) of the approximately $303.6 million paid for all non-VA evaluation and management services.

Additionally, some providers billed separately for evaluation and management services when the global surgery package was in effect.  This package is supposed to cover all surgery-related services for a set period.  The review team identified more than 45,600 providers were compensated about $37.8 million in FY 2020 for these evaluation and management services.

Improper payments were not easy to detect because VHA staff did not retrospectively audit medical documentation as required.  Additionally, the OIG found no evidence that VHA or contractors trained non-VA providers on documenting evaluation and management services, similar to how VA providers are qualified.  The OIG determined VHA risked overpaying for evaluation and management services by about $19.9 million in FY 2020.”

While discussing audits, failed processes, and the lack of consequences for senior leadership, we must break and wish a “Happy Birthday” to the audit hits turning 10, 12, 15, 21, and older.  It never ceases to amaze me how these financial failures can continue to age, and nobody is held accountable!  May you age out and finally be corrected!  Would the elected leaders of America like to know why the VA is consistently failing financial audits?

VA continued to be challenged in consistently enforcing established policies and procedures throughout its geographically dispersed portfolio of outdated applications and systems.”

Now, explain why we should re-elect any elected official to office?

Elected officials, your job is to scrutinize and write legislation; that is what we, the electorate hired you to do.  Do you realize the far-reaching consequences of your failure to perform your job?  Let me introduce you to an example:

Anthony Medrano, a veteran of the US Marine Corps and former employee of VA, admitted that between approximately November 2015 and May 2020, he submitted claims to VA in which he purported to be disabled to obtain caregiver benefits for his wife, when he was actually able-bodied and even participated in fitness challenges and coached youth sports.  Medrano was sentenced in federal court to eight months in custody for defrauding VA out of more than $183,000.  He executed this scheme while employed by VBA as a veterans service representative, a position in which he explained benefit programs and entitlement criteria to veterans applying for VA benefits.”

Or the following:

Barry Wayne Hoover of Tampa, Florida, a veteran of the United States Navy, exaggerated the extent of his visual impairment to receive VA disability benefits to which he was not entitled.  Specifically, Hoover manipulated the results of subjective tests of his peripheral vision to reflect that he had only a five-degree visual field and was legally blind.  VA found that Hoover was 100 percent disabled based on those manipulated tests.  Hoover was found guilty of theft of government funds and making a false statement to a federal agency.  He faces a maximum penalty of 10 years in federal prison.  His sentencing hearing is scheduled for March 2022.”

How about this:

Professional Family Care Services, Inc. (PFCS), a home health services company based in Fayetteville, North Carolina, has agreed to pay more than $45,000 to settle civil False Claims Act allegations related to fraudulent billings for work by a recently convicted felon under their employ.  During 2015 and 2016, PFCS billed VA for home health services provided to W.R., an Army veteran, even though, at that time, W. R. was residing with the company’s employee, Certified Nurse Aide Tracey McNeill.  PFCS based its billing for those services on falsified timesheets provided by McNeill, who failed to provide both the time and quality of care required under the VA program.  After several months living with McNeill, purportedly receiving home health services provided by McNeill through PFCS, W. R. had to be admitted to the hospital.  He was extremely malnourished and ultimately died within a few days of admission.  Earlier in 2021, McNeill was convicted of wire fraud for her misconduct related to W. R., sentenced to 12 months and one day in federal prison, and ordered to pay over $90,000 in restitution.”

Morality is exemplified by leadership and then exercised under scrutiny.  Because you, the elected officials, refuse to be morally upright and scrutinize the government, the executive branch officers and employees have become careless, irresponsible, and taken the American Taxpayer for a ride!

Each time the VA-OIG reports an investigation beginning with the death of a veteran, the root cause is always a failure of people to do the job they were hired or contracted to perform, and the casualty is a dead or severely injured veteran.  The culling of the email included a urologist who performed procedures, puncturing internal organs, and not notifying the patient.  Several other CHIp summaries reflected the egregious and despicable leadership hidden at VHAs and VAMCs across the country.  Other Vet Centers possess failing bureaucrats just trying to hide until they reach retirement and escape.

America, you deserve better from the alphabet agencies representing the executive branch!  Fellow veterans, please do not give up hope; we can still help protect this country from those enemies domestically located who make your lives a living hell.  Please pass the word, these VA-OIG investigations deserve to be read, and questions asked!  Elections are coming; join the fight as a citizen and run for office.

© Copyright 2021 – M. Dave Salisbury
The author holds no claims for the art used herein, the pictures were obtained in the public domain, and the intellectual property belongs to those who created the images.  Quoted materials remain the property of the original author.

That’s Crazy!!! – More Chronicles from the VA (CH 4)

Angry Wet ChickenHave you ever been so embarrassed by something that any mention seems to depress you?  I am in this position right now; the Department of Veterans Affairs (VA) – Office of Inspector General (VA-OIG) has released more investigation reports and analyses of the VA.  Analyses that should be cause for the most profound concern by congressional representatives, and instead, they act like nothing is wrong, nothing to see here, go away.  Well, I am too embarrassed to “go away,” and I demand action to clean house and curb this atrocious behavior!

Courage involves pain and is justly praised, for it is harder to face what is painful than to abstain from what is pleasant.” – Aristotle

Too often, I am left asking where the Federal Government Employees are and what their responsibility is in fraudulent schemes.  For example, we begin with a $50 Million scheme that had to have been suspicious to employees at Medicare, TRICARE, CHAMPVA, and many other health benefit programs.

  • Nicholas Defonte and Christopher Cirri, both of Toms River, New Jersey, and Pat Truglia of Parkland, Florida, pleaded guilty to conspiracy to commit healthcare fraud. Each defendant played a role in defrauding healthcare benefits by offering, paying, soliciting, and receiving kickbacks and bribes in exchange for completed doctors’ orders for durable medical equipment, specifically orthotic braces. The defendants then fraudulently billed Medicare, TRICARE, the Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA), and other healthcare benefit programs. Cirri, Defonte, and their conspirators owned and operated multiple call centers where they obtained prescriptions for compound medications and other medical products reimbursable by federal and private healthcare benefit programs. The defendants caused losses to Medicare, TRICARE, and CHAMPVA of approximately $50 million.VA 3

Next, we see another case where Federal employees should have been aware, vocal, and the problems fixed before the scheme turned three years old.

  • Matthew Camera of Erie, Pennsylvania, pleaded guilty to violating federal drug laws. From January 2017 to June 2020, while employed as the pharmacy chief at the VA medical center in Erie, he unlawfully obtained multiple dosage units of hydrocodone and oxycodone from pill bottles awaiting delivery to VA patients. Sentencing is scheduled for March 22, 2022.
  • Michael Nolan of Tampa, Florida, and Richard Epstein, of Aurora, Colorado, were sentenced in a conspiracy to defraud two federal health benefit programs, Medicare and the Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA). From October 2016 through April 2019, Epstein and Nolan ran a telemarketing company in Tampa called REMN Management LLC that targeted the elderly to generate thousands of medically unnecessary physicians’ orders for durable medical equipment and cancer genetic testing. Epstein and Nolan also created and operated Comprehensive Telcare LLC, a telemedicine company through which they illegally bribed physicians to sign the orders regardless of medical necessity. They then illegally sold the signed physicians’ orders to client-conspirators to support false and fraudulent claims submitted to Medicare and CHAMPVA. The conspiracy resulted in the submission of at least $134 million in fraudulent claims and approximately $29 million in payments. Nolan was sentenced to six years and six months in federal prison, followed by three years supervised release and was ordered to pay $2.1 million. Epstein was sentenced to five years and three months in federal prison, followed by three years supervised release and was ordered to pay $3 million. The court ordered Nolan, Epstein, and other conspirators to pay over $29 million in restitution.
  • Twenty people, including the two founders of Hertel & Brown Physical & Aquatic Therapy and 18 of its employees, were indicted in Erie County, Pennsylvania, of conspiracy to commit wire and healthcare fraud and healthcare fraud. According to the indictment, the defendants engaged in a multifaceted conspiracy from January 2007 to October 2021 that involved a range of fraudulent activities. These included allegedly using unlicensed technicians to provide therapy and then billing for the treatment as though licensed therapists had performed it, regularly billing for treatment using the name and credentials of physical therapists who were on vacation, recording, and billing for time that exceeded the actual treatment time, among several other allegations.
  • Robin Calef of Brockton, Massachusetts, pleaded guilty to one count of theft of public funds. Calef shared a bank account with her sister, a veteran receiving monthly benefits from the VA. Her sister passed away in 2006, and Calef failed to report her death to the VA. Through September 2017, Calef stole approximately $102,289 in VA funds from the shared bank account. Sentencing is scheduled for March 1, 2022.
  • Lisa Hoffman, a former pharmacy procurement technician at the East Orange VA Medical Center in New Jersey, pleaded guilty to theft of government property. From October 2015 to November 2019, Hoffman was responsible for ordering medication, including large quantities of HIV medication, for the center’s outpatient pharmacy. She stole approximately $10 million worth of HIV medication and sold it to Wagner Checonolasco of Lyndhurst, New Jersey. Hoffman is scheduled to be sentenced on March 9, 2022. Checonolasco previously pleaded guilty and is expected to be sentenced on December 15, 2021.
  • Thirteen defendants, including three compounding pharmacy owners, three physicians, two pharmacists, and three patient recruiters, pleaded guilty to a years-long, multistate scheme to defraud the Department of Labor’s Office of Workers’ Compensation Programs (OWCP) and TRICARE. The defendants submitted false and fraudulent claims to the OWCP and TRICARE for prescriptions for compounded and other drugs prescribed to injured federal workers and armed forces members. The defendants paid kickbacks to patient recruiters and physicians to persuade them to prescribe the drugs. Medications were selected based on the reimbursement amount and not on the patients’ needs. The drugs were then mailed to patients, even though they often never requested, wanted, or needed them. The defendants were indicted in June 2018 and are scheduled to be sentenced in February 2022.
  • Andrew Ziacik of New Kensington, Pennsylvania, was sentenced to one day of imprisonment followed by three years of supervised release and was ordered to pay $4,000. Between 2013 and 2017, Ziacik was an appointed federal fiduciary for his older brother, a service-disabled veteran. Ziacik was responsible for receiving his brother’s VA income and paying his brother’s debts. However, Ziacik admitted that he violated the terms of his fiduciary agreement by using the VA funds to purchase a Harley Davidson motorcycle, a diamond ring, and a GMC Sierra truck. As part of his sentence, Ziacik will pay restitution to his brother of $75,000.I-Care

When it comes to incompetence, neglect of duties, and abuse of veterans, the final entry in today’s chronicles of shame reflects blatant criminality, and repercussions and remunerations are only a small part of serving justice.  Never forget the following fact, “overpayments should have been considered an administrative error and the debt waived since veterans are not responsible for repaying overpayments that are found to be the result of administrative errors” [emphasis mine].  The VA-OIG investigation reflects the following:

        • April 2021, the VA Office of Inspector General (VA-OIG) discovered the VBA had incorrectly created a debt of about $210,000 for a veteran.
        • Because of the size of the debt and VA’s plan to withhold the veteran’s entire monthly compensation benefits (over $1,100), and given the veteran’s history of treatment for mental illness, a prior suicide attempt, and suicidal ideation, the VA-OIG review team promptly contacted VBA for corrective action.
        • When contacted by the veteran at four different VA offices, staff assured the veteran all was good, the overpayment was not his to pay, and it would be worked out administratively.

These are the investigation facts; to get this administrative error corrected, the problem had to percolate to the VA-OIG instead of any number of the checks and balances, quality assurance measures, and other in-house processes to catch the VBA from damaging a veteran.  The VBA failed!  How many hundreds of employees were responsible for this disaster and leadership failure?  When will those employees be held accountable?  The case presented is but one of thousands of cases every year where the VBA makes a mistake.  The veteran, their family, and the taxpayer are abused, robbed, cheated, and responsibility shirked and avoided by the employees.VA 3

Imagine for a moment, you wake up, got to the mailbox.  You find the VBA will take your monthly benefit, the money you need to live on because they made an error, but you have to pay for their mistakes unless a power greater than the local agency exerts sufficient force to correct the problem.  Assurances from the VBA are pie-crust promises, easily made, easily broken, and crumby!  The final statement in this charade from the VA-OIG is priceless.

VBA should consider steps to avoid this type of error in the future.”

Angry Grizzly BearSeriously, the VBA’s internal processes failed and would have continued failing if the VA-OIG had not stepped in and demanded immediate action on the veteran’s behalf!  How many other veterans are not so lucky; too many!  America, the shame of the VA is beyond the pale, and a complete reckoning and corrective action should be the action of Congress as the President refuses to clean house in the Executive Branch, the Legislative Branch MUST step up and do their constitutional duties!  The legislative and the executive branches must answer to us, the taxpayers and citizens, for the continual debacles displayed by recalcitrant and intransigent federal employees.  In front of real judges, real people must answer and be held accountable for the crimes of neglect of duty demonstrated!

© Copyright 2021 – M. Dave Salisbury
The author holds no claims for the art used herein, the pictures were obtained in the public domain, and the intellectual property belongs to those who created the images.  Quoted materials remain the property of the original author.

What do we DO? – I have an Answer – Several, in fact!

Dont Tread On MeRegularly, after I write an article, I am asked, “What is a person to do?”  The question is generally followed by the following, “The enemies are vast, the criminals are legion, the forces entrenched, and the allies are too few in number to matter.”  As Rogers and Hammerstein would relate, I am not a “Cockeyed Optimist;” however, please allow me to relate and offer some suggestions.

Earlier this past week, I was in Walmart after an ER visit, never pleasant.  What was worse about this visit was that some toddler was being teased mercilessly by an older child to scream hysterically.  At this point in my day, my cherub-like demeanor is on life-support, and I am crying, “For the love of mud and money, make it stop.  Parents end the torture, stop this child screaming!”  The parents were immune to the screams, the public refused to intervene, the store refused to manage the parents, and I was left to suffer, along with every other person, to the sounds of this child screaming.

Foghorn Leghorn - MedicationI wandered from the pharmacy to other parts of the store, looking for anywhere I could hide to escape the onslaught of this child’s screams and could find no place safe from the sounds and attacks on my nerves.  I went looking for this child to offer gold, silver, food, anything to silence this detestable decibel desecration and end the onslaught.  That is when I discovered how uncaring and useless the parents were in controlling their children and realized the minority could not be bribed into obedience.

In the agony of this experience, but worse after several days of recollection, I have learned some valuable lessons.

      1. The child screaming is not the majority of children. Worse, the children are not the majority of people in the population.  The ones screaming are such a small percentage that with minimal adults banding together, caring, and taking action, the child and the weak-kneed adults could easily be overpowered and sanity restored.
      2. While some suffering is good for the soul, other suffering requires action, commitment, and dedication to principles of freedom to overcome.
      3. How do you tell the difference – There is NO difference! There is no distinction between one type of suffering or another.  All suffering can be fought against and won if the individual has strong enough intestinal fortitude and can gather enough like-minded people willing to care and act!

Sharing is CaringHow do I know this is correct?  I talked to people; I observed people suffering under the hellacious onslaught of this toddler screaming, these parents’ indifference, and understood a common principle for Republican Societies, gather enough like-minded people dedicated to a common cause, and blessed change can occur.  I kept asking, why didn’t the parents demand the older child stop teasing, the younger, and can only surmise they desired this public spectacle for personal gain, attention, and because they like sharing the power they have over society when their children misbehave.

Character List

Angry Wet ChickenIt is common knowledge George Soros has invested a LOT of money into the criminal justice system, especially into city district attorneys, to win criminal justice and abuse victims.  If George Soros is akin to the parents, and his ilk are those paying for the toddlers and older children to tease for personal gain when the toddler screams.  We have a pattern and reasoning for the toddlers raising rhubarbs in the Walmart societies called “America.”

Having identified the parents, who are the toddlers screaming and throwing a fit?  May I suggest we look to the evening news for characters screaming.  Paid actors who raise their cackles at the drop of dimes annoy the populace every time they open their mouths.  ANTIFA, BLM, LGBTQ+ communities, Communists, Leftists, Extremists on both sides of the political spectrum, Labor Unions, AOC and her band of merry idiots in the US House of Representatives, Pelosi, Biden and his bucolic band of bumblers, other politicians, and those who consider themselves of the “political class,” “peaceful protestors” which are nothing but terrorists burning cities and towns across America, and so many more.  Never forget, some of the worst people screaming are those reporting the screamers themselves, the corporate media!

Angry Grizzly BearWho is the older child relentlessly teasing, on the urging and the silent approval of the parents, the toddler?  Would it surprise anyone if the first and most potent teaser are the bureaucrats who refuse to be governed and scrutinized?  How can we know this is a fact; how did “peaceful protestors” burn down a police station?  How did police officer defunding grow into such a cohesive movement in such a short time?  How did funding move so quickly from city to city across America, and delivery of bricks and other riot supplies mysteriously appear in riot zones, without anyone noticing?  The bureaucrats across this nation are up to their collective eyeballs in protecting their power from the citizens from catching wise of their crimes.  Why do you think so much money was pumped into the races of those who count ballots!

Who else is teasing the toddlers?  Big tech is playing a supporting role.  Big pharmaceutical is playing a supporting role.  Both receive considerable windfalls in investment support, and the evidence can be found when you play simple games of “Follow the money.”  Corporate media in 2020 was caught on camera teasing the toddler and participating as a toddler in the screaming, and nothing was done to punish the press.  Hollywood, many of the most lurid and detestable of Hollywood, are paying considerable sums to practice low-intensity conflict (LIC) from the comfort of their living room for personal gain and private glee.

Realization

How big is the population of toddlers?  Tiny, all but insignificant.  Want to know a secret; like all terrorist organizations and toddlers around the world, they know how small they are, how insignificant they are, and they know their only weapon is NOISE!  Why are the terrible two’s and three’s called “Terrible,” because the child has learned how small they are and have realized they can affect the world through obnoxious NOISES!  Gaining attention through NOISE.  Being discovered, having fun, getting rewards, all this and more through NOISE!  What do responsible parents do to correct behavior in toddlers to make the “terrible” two’s and three’s less terrible, behavior modification!The Duty of Americans

What is the first step?  The responsible parent stops the older child from teasing the toddler!  Usually through behavior modification of the older child!  If the older child persists, the behavior modification increases until that child learns teasing will NOT be tolerated!  At the same time, the responsible parent is also correcting the noise the toddler is making and correcting the child to use words or signs until communication skills catch up with mental abilities, making clear that abject NOISE is NOT tolerated – also increasing behavior modification until the lesson is learned and NOISE is stopped!

Suggestions

      1. Band together. I cannot emphasize this enough!  Like-minded people built America, and until like-minded people reband to rebuild, nothing is going to change!
      2. See something, say something!
      3. Ridicule is a powerful tool! Laugh at the stupidity and the inanity of those who would abuse our tolerance.
      4. Record the toddlers acting the fool. Post those recordings.  Share the recordings with others.  Mock, ridicule, and publicly shame!  Public shame is not harmful, nor is it discriminatory.  Until the toddlers learn to use logic and words, they deserve to be mocked, scorned, and humiliated!
      5. Every time the toddler’s teasers are discovered, post, share, like, and ridicule!
      6. Take decisive ACTION! – The toddlers gain power when action is not taken. Simple lesson parents learn.  Retake the power from the toddlers, and this also is not discriminatory.  Society belongs to those willing to sacrifice for it, and the toddler will not sacrifice; thus, the toddler has no place in society.
      7. The toddler’s good behavior cannot be purchased with gifts, bribes, shiny baubles, and other transitory items. The toddler is appetite incarnate; the only thing that works to curb a toddler’s appetite is to teach behavior modification!  Behavior modification is NOT discrimination!
      8. Understand LIC. Know LIC.  Fight using the principles of LIC.  It cannot be understated; this is war, LIC is WAR!  The toddlers have waged war, and right now, they think they are winning because they are not finding any opposition.  If you need a refresher on LIC, check out the links, read up, and learn!

Final Comments and Thoughts

LinkedIn ImageIt does not matter if the entire house is full of toddlers and mischievous boys hell-bent on teasing the toddlers into an army of NOISE bombs!  The adults are always in charge, always outnumbering the toddlers, and always in command!  Use this knowledge to strategize, organize, think, layout tactics, and begin today to out-think, outsmart, and outmaneuver the teasing older children to reduce the toddler noise!  You and I, we outnumber these pestilential reprobates, and the rule of law IS sufficient to the task of curbing this obnoxious behavior.  We need to begin to show up in strength, marshaled for war, and ready to curb the toddlers!  Join me!

© Copyright 2021 – M. Dave Salisbury
The author holds no claims for the art used herein, the pictures were obtained in the public domain, and the intellectual property belongs to those who created the images.

“That’s Crazy!!!” – More Chronicles from the VA – Chapter 2

I-CareAs bad as the last several months have been, I hate adding more bad news; but the Department of Veterans Affairs (VA) – Office of Inspector General (VA-OIG) keeps reporting, and I keep summating.  Due to the absolute overabundance of incredible bureaucratic insanity, today’s article format will necessarily shift to report more and comment less.  Don’t worry, I will still comment on the more egregious examples, for some of these VA-OIG reports are scarier than Joe Biden dressed as a mall Santa at a Fourth of July celebration feeling up little children!

  • 2020 Pre-award reviews of contracts totaled $81 million; guess what:
      • 24 of the 31 contracts awarded contained conflicts of interest.
      • 25 of the 31 contracts had problems with overcharges for hourly rates of services rendered.
      • 6 of the 31 price gouged Medicare.
      • 25 of the 31 contracts, if they had adequately followed the contract process, would have saved taxpayers $16 Million. – Would it shock anyone to hear this is just the “tip of the VA-OIG” report iceberg?

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  • Financial Efficiency Review of the Southeast Louisiana VAHCS in New Orleans; guess what:
      • The VAHCS in New Orleans scored 75% out of 90%. The VA does not try to get a 100% because they regularly fail financial audits as a fact.
      • Actual costs are difficult to relate in dollars and cents because the leaders intentionally hid costs from the VA-OIG, then blamed the new medical center director.
      • Avoidance costs, Purchase card abuse, prime vendor program abuse, and more were employed to avoid proper fiscal practices.
      • Audit, FAILED! No accountability, no person held responsible, and the taxpayer is left holding the bill!

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  • Followup to VAHCS Ozarks Pathology Failures From Dr. Levy Scandal; guess what:
        • Levy Scandal for those who do not remember. – Intentional misdiagnosing, VA coverup, refusal to discuss with patients affected. The report is ghastly!
        • 5% of the patients have now been contacted, and the VA-OIG considers this a “success.” I sure hope you are not part of the 24.5% patient population.
        • Here’s the rub in the 76.5% notification, “an absence of a clearly defined process for clinical providers to alert the Clinical Review Team if later changes in a patient’s health required reconsideration of institutional disclosure.” Does the VA-OIG still want to cheer about that notification rate?
        • Less than 5% of the severely sick patients have been notified of the scandal and the problems created by Dr. Levy. Is this how the VA admits culpability, waiting for the patient to pass?
        • Now, here’s the real kick to the balls; “The VA-OIG determined facility processes related to disclosure of the pathology errors and amending patients electronic health records generally met Veterans Health Administration policy requirements, but opportunities for improvement existed.” – Are you KIDDING ME?

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  • Speaking of fiscal inefficiency and audit failures. The VA continues to overspend and under-deliver on prosthetic devices, especially for shoe inserts.
        • In the fiscal year 2019, such items—artificial limbs, shoes, shoe inserts, and compression garments—accounted for about $318.8 million, or about 9 percent of prosthetic spending.
        • Oversight of prosthetic spending was ineffective, resulting in medical facilities sometimes reimbursing vendors at unreasonable rates.
        • Medical facilities spent about $10 million more than reasonable rates in the six months from October 2019 through March 2020.
        • Rates and data in databases remain unreliable, no oversight, and those in charge of oversight are missing in action. Yet, the VA continues to spend pell-mell.  Does this sound like fiscal responsibility to you?

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  • VA-OIG double-speak lives, and is blatantly observable in the following report, the “Contracting Officer Warranting Program.”
        • For those unfamiliar, a simple explanation: “A warrant gives federal contracting officers the authority to obligate taxpayer dollars. VA’s contracting officers help serve our nation’s veterans by procuring the goods and services required for their care and support.”
        • Never forget – There have been long-standing concerns (Never Resolved) with VA’s contracting officer warrant program. Since 2015, the VA Office of Inspector General (VA-OIG) has issued multiple reports [describing how] warranted contracting officers exceeded their authority and made decisions that put veterans and VA facilities, resources, and information systems at risk.
        • Never forget – The VA-OIG has documented multiple times, and the VA has never resolved, that the VA’s acquisition management has been included on the Government Accountability Office’s (GAO’s) high-risk list for fiscal impropriety and poor contractual adherence.

BUT…

        • The VA-OIG found that while VA’s contracting officer warrant program complied with Federal Acquisition Regulation requirements, opportunities exist to strengthen the program and that the VA lacked assurance that all contracting officer warrants were justified and necessary. – Essentially, this is bureaucrat double-speak for, continue to lie, cheat, steal. We like our job and want to continue, and since Congress doesn’t care, neither do we!

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  • The VHA continues to suffer from employee shortages. I have written about this shortage until I am blue in the face and my fingers ache.  I am fed up telling the VHA how to fix this problem.  If they want answers, call me!

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  • Nurse Bethann Kierczak of Southgate, Michigan, was charged with theft of government property and theft or embezzlement related to a healthcare benefit program. She allegedly stole authentic COVID-19 vaccination record cards from a VA hospital—along with vaccine lot numbers necessary to make the cards appear legitimate—and then resold those cards and information to individuals within the metro Detroit community. – Frankly, with the way the Federal Government is acting, this theft is almost understandable and acceptable.
          • No! I am not condoning an illegal action!  I am simply stating that Pelosi and her ilk do 10-times worse hourly by Congressional standards and get away with those crimes!

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  • Donald Peter Auzine of Baton Rouge, Louisiana, pleaded guilty to conspiracy to commit health care fraud. Bonnie Jean Lawless Diaz of Slidell, Louisiana, pleaded guilty to misprision (or knowing concealment) of the commission of a felony. From March 2014 through October 2016, Auzine, the marketing manager at Prime Pharmacy Solutions, defrauded TRICARE and other benefit programs. Diaz concealed the fraud by knowingly submitting compounded medications for which there was no medical necessity. Both will be sentenced on January 4, 2022.

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  • Amanda Dawn Rains of Fayetteville, Arkansas, pleaded guilty to conspiracy to commit mail, wire, and healthcare fraud, obtaining federal employees’ compensation fraudulently, and paying kickbacks. Rains, a former executive with a Rogers medical supply and billing company, participated in 2013 to 2017, defrauding the US government and private insurance companies.

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  • Robert Seifert of Utica, New York, was sentenced to two years in prison for making telephonic threats to Albany Stratton VA Medical Center employees. He admitted that on January 14, 2021, he made successive calls to three separate employees and left each of them threatening voicemails in which he used demeaning and offensive language. Seifert’s threats caused the employees to fear for their safety and property. He will also serve one year of post-imprisonment supervised release.

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  • Patsy Truglia of Parkland, Florida, pleaded guilty to two counts of conspiracy to commit healthcare fraud and one count of making a false statement in a matter involving a healthcare benefit program. From January 2018 through April 2019, Truglia and other conspirators generated medically unnecessary physicians’ orders via their telemarketing operation for orthotic devices like knee, back, and wrist braces. Truglia, co-defendant Ruth Bianca Fernandez, and other conspirators caused approximately $25 million in fraudulent durable medical equipment claims to be submitted to Medicare, resulting in approximately $12 million in payments.

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  • Larry Ray Bon, 62, was sentenced to over 16 years in prison for shooting a firearm inside the West Palm Beach VA Medical Center in Florida. Bon brought the firearm to the emergency room, and after becoming frustrated with medical staff, he retrieved it from his wheelchair and fired several shots. In March 2020, he pleaded guilty to three counts of assaulting, resisting, or impeding federal employees and one count of possession of a firearm in a federal facility with the intent to commit a crime. At that time, Bon was committed to the custody of the US Attorney General for 25 years of mental health care and treatment at a suitable medical facility. However, Bon was determined to no longer need psychiatric hospitalization and was recently sentenced accordingly.

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Finally, if you want a really good reading, you can visit the VA-OIG page and see the lowlights of the VA-OIG’s reports for yourself by visiting the page here.  Excluded from this list are the usual reports of malfeasance and misfeasance captured in the comprehensive healthcare inspection (CHIp) reports, where we find the exact carbon-copied hits from report to report.  We find moral distress, problems in staffing, continued refusals by leadership to train staff, and the ever-present refusal to attend disruptive committee meetings.  Also omitted from this summation were the inspection of veteran centers and the myriad of failures, bureaucratic ineptitudes, and abysmal behaviors.  Frankly, I could not stand being depressed more by writing and analyzing another moment’s detestable and criminal behavior.Angry Grizzly Bear

What curdles the food in my stomach, this is just the VA.  What about all the other official and unofficial government agencies in the alphabet of the executive, legislative and judicial branches of what we collectively call “the government.”  To all the freedom-loving people in America, please awake and arise; we need you!

© 2021 M. Dave Salisbury
All Rights Reserved
The images used herein were obtained in the public domain; this author holds no copyright to the images displayed.

 

Chronicling the VA, One Ignominious Story at a Time!

I-CareAs we catalog the VA, occasionally, local services providers must be recognized for their service or their deficiencies.  In the spirit of fairness and transparency, it is time to discuss one of those community providers, Advanced Neurology Epilepsy & Sleep Center (ANESC), Dr. Aamr A. Herekar M.D.  Also, in the spirit of fairness and complete transparency, I have tried to settle my problems through the VA Community Services Offices and an appeal to the management and doctor of ANESC, all to no avail!  Regular readers know I have been in a multi-year battle with the VA over arresting me for not wearing a mask because when I wear a mask, I become a medical emergency.

I possess a note from my doctor, a VA Primary Care Provider, written to my employer on VA Letterhead with a wet signature, declaring my inability to wear a mask.  The VA did not accept this letter and arrested me three times.  Well, Dr. Herekar’s office was presented the same letter, and hassled me before both appointments for not wearing a mask, became hostile, argumentative, and a nuisance over the mask issue, even after I complied with putting on a face shield.  Today (23 September 2021), over Facebook messenger, I was informed that I would be invited to find a different provider due to my refusal to wear a mask.VA 3

Imagine that; Facebook Messenger has become the medium of choice for ending a patient relationship with a medical provider.  How very inappropriate!  How very unprofessional!  How very typical of some of the providers I have been sent to in the community by the VA.  Apparently, the abuse of veterans is spreading from the VA providers to the community providers.  If you are in the El Paso area and receive a referral to Dr. Herekar, please be cautious of his staff.  I have no idea of the efficacy and quality of the doctor, but his staff is absolutely third-rate or less!  The shame of the entire episode, the taxpayer is on the hook for my being abused by the staff.  How deplorable!Foghorn Leghorn - Medication

In reviewing different results reported from the Department of Veterans Affairs (VA) – Office of Inspector General (OIG) comprehensive healthcare inspection (CHIp) of VAMC’s, I am finding some interesting trends.

      1. Why the sudden, as of July 2021, focus on attendance and staffing in behavioral committees? More to the point, why are the behavioral committee’s processes and procedures so draconian?  More specifically, the following is a unique passage too often see in CHIps.
          • High-Risk Processes
            • Disruptive behavior reporting and tracking
            • Disruptive Behavior Reporting System
            • Order of Behavioral Restriction and patient notification documentation
            • Staff training – Isn’t this interesting, staff training is a “High-Risk Process?”
      1. When reporting that patient experience scores are similar to “VHA Averages,” isn’t this like saying a VAMC is as good as another pig in a pile of slop? Why accept averages that are comparable to other VAMC’s?  The leadership at the VAMC’s across the country is failing the veterans, yet the VA-OIG is accepting average performance compared with other VAMC’s.  It sounds like pathetic designed incompetence, wrapped in weak excuses, and deep-fried in a pity party!
      2. Training continues to be a fundamental excuse for failing, and even the VA-OIG seems to have given up and thrown in the towel.VA 3

An example of how training continues to be a fundamental excuse for failing and designed incompetence lies in another CHIp, specifically reporting reusable medical equipment (RME) and sterile processing services (SPS).  The VA-OIG reported the following weaknesses:

      • Standard operating procedures not aligning with manufacturers’ guidelines.
      • Annual risk analysis reporting to the VISN SPS Management Board.
      • SPS chiefs developing, implementing, and enforcing a daily cleaning schedule for all SPS areas
      • Equipment storage, cleaning, and usability.
      • Completion of Level 1 training within 90 days of hire, competency assessments for RME, and monthly continuing education for SPS staff.

All this after the VHA has already been caught with poor cleaning of reusable medical equipment on multiple occasions, where the training of cleaning staff was the primary reason for failing the CHIp from the VA-OIG.  The cycle continues unabated, and training is central to correcting and ending the process.  Yet, even the VA-OIG refuses to address the leadership failures and be part of the training corrective action behaviors.VA 3

In other CHIp reports, we find that completion of training is a high-risk process.  Leading to interesting questions about why and what is involved in staff training to make training high-risk.  What boggles my mind, much of last year, the CHIp reports found moral distress from leadership, this year, nothing; why?  Did the VA-OIG stop asking about this issue?  Certainly, the VA has not corrected this problem.  Am I merely suspicious, or is there a correlation between less focus on employees feeling morally distressed at work and increased focus on patient disruptive behavioral committees?

From other CHIp reports, we find more questions and logic that make no sense.  For example, how can patients be receiving care that meets VHA averages in acceptable care, but the employees reflect severe moral distress?  Does this not indicate that the averages for patient care are set too low?  Would not this be an indicator that leadership is not held to a sufficiently high enough standard of performance?  Worse, on these CHIp reports, we find greater mention of disruptive behavior committee actions, paperwork, training, and actions taken.  Thus, there appears to be a correlational data relationship between disruptive patients, moral distress in employees, failing leadership, and the abuse of the disruptive behavior committee process.  Where are the elected officials asking questions and drawing substantive conclusions regarding the data presented by the VA-OIG?  Heck, where are the VA-OIG data analysts raising alarms and red flags over correlational data points for investigators to act upon?VA 3

As a person who has been fallaciously labeled and erroneously called “disruptive,” this particular topic strikes home.  The system is ripe for abuse by egotistical leaders hell-bent on power-tripping!  When I asked how do you appeal the decisions, I was told lies, given wrong information, and forced to pay fines that I should not have had to pay.  Worse, the Federal Marshals at the courthouse remarked that there had been a significant uptick in veterans in the same situation as mine being fined erroneously by the VA.  Thus, the abuse of the veterans is both widespread and decidedly egregious!

Another recurring issue from the CHIp reports is remarkable from recent VA-OIG investigations, especially since multiple veterans have recently died over the issue, care coordination.  Care coordination includes completing paperwork, filling out the electronic health record, and signing the electronic health record, so the notes are available for other providers to use for follow-on patient treatment, nurse-to-nurse communication, and medication transmission, but most importantly, monitoring and tracking patient whereabouts on the facility’s grounds.  Yet, even with dead veterans with these issues as root causes, the VHA continues to fail in care coordination.  How do you define appalling, detestable, and disgraceful?  Where are the elected officials?  Where are the veteran service organizations in raising rhubarbs about the abuse of veterans at the hands of the VHA?VA 3

Finally, the most astounding and absurd continuous hit point from CHIp to CHIp report is found under the heading of “Quality, Safety, and Value.”  Under this heading falls a lot of topics, but imperative to improvement is the leadership failure to hold meetings attended by the primary audience.  Tell me, in the private sector; your boss calls a meeting of all department heads and their number two person.  If these people are no-shows, how long will they keep their jobs?  Yet, the VA-OIG finds repetitive missed meetings, no follow-up, no remediation, no punitive measures, no corrective actions, and these people are still employed!

Knowledge Check!One of the most bothersome things about reading three weeks’ worth of CHIp reports has been the consistency of the reports.  Too often, the reports read like they were copied.  Maybe this is due to the consistency of failed leadership; perhaps this is due to the lack of originality in thinking in the VHA, VBA, and the VA in general.  Regardless, the CHIp reports raise some concerning issues, specifically around the potential for abuses found in the disruptive behavior committee process and what disruptive behavior is at the VHA and VBA.  For example, if a patient is throwing furniture, this is obviously disruptive.  But, if a patient disagrees with a policy and is politely asking to speak to administration, this is not disruptive, but the patient is treated as disruptive, and that is abusive of the disruptive patient policies.

© 2021 M. Dave Salisbury
All Rights Reserved
The images used herein were obtained in the public domain; this author holds no copyright to the images displayed.

Compliance Problems and Dead Veterans – More Shameful VA Misconduct Chronicles

Angry Grizzly BearThe Department of Veterans Affairs (VA) – Office of Inspector General (VA-OIG) is filling my inbox by mid-week again, and the volume never ceases to amaze and mystify.  Over the last 10+ years of reporting on the VA-OIG reports, I have learned that when the volume is exceedingly high by mid-week, there are reports the VA-OIG is hoping to get overlooked in the crush.  Luckily for them, I am here to ensure nothing gets overlooked; you’re welcome!

We begin with more fiscal insanity and the failure to comply with regular auditing and business financial practices that would see a private company’s owners in prison.  Let’s be clear; Congress passed specific legislation to single out government agencies to demand they comply.  One of these unique pieces of legislation is called the Payment Integrity Information Act (PIIA), which audits the VA regularly fails.

Please note, last year, the VA failed two programs on the PIIA; for the fiscal year 2020, the VA failed two of the programs, consistent failure is a leadership problem.  Yet, the VA-OIG claimed the following:

To VA’s credit, it noted a decrease in improper payment estimates two years in a row and a decrease in its improper payment rates for nine programs and activities.”VA 3

Consistent with the previous fiscal year’s PIIA reports, yes; still a leadership problem, yes.  But I am not so generous as the VA-OIG, for I know many a non-profit and for-profit organization that has been fined heavily, bankrupted, and put into conservatorship over the same actions.  Nothing ever happens to the leaders at the VA failing to do their jobs!  12 programs and activities totaling $11.37 Billion, and never are the leaders held accountable for failure; let that sink in for a minute or two.  Read the report, you tell me, should real people be held responsible for failing to follow the law?

Gravy Train 3The VA-OIG conducted a comprehensive healthcare inspection (CHIp) of the Roseburg VAHCS in Oregon; for the regular readers, I bet you can guess what was found.  Yup, the employees feel morally distressed in how they are being pressured to treat the veterans.  Are you surprised; I am not, but there still might be some people, somewhere in America, surprised that the VA abuses the veterans they are honor-bound to serve.  The most tenured leaders have been in place since 2016.  I wonder if the moral distress and the leadership hiring are correlational data points, for I know that from 2012 to 2017, there was a lot of shuffling of VA leaders at the local VAMC/VAHCS level due to dead veterans in Phoenix from death list scandals.

The VA-OIG claimed the following:

The VA-OIG identified concerns with root cause analysis action implementation and outcomes measurement. Leaders were knowledgeable about employee satisfaction and patient experiences. However, they had opportunities to improve their knowledge of VHA data or system-level factors contributing to specific poorly performing Strategic Analytics for Improvement and Learning measures.”VA 3

Tell me something, how can you have a job for more than four years, be rated as knowledgeable about the measurement analytical methods, but not be knowledgeable about root cause analysis, action implementation, and systems-level factors contributing to poor performance?  To gain your position, you had to grow professionally through the bureaucracy and the various sub-levels of VA leadership to lead a VA Hospital.  Yet, somehow, after all this time and experience, you have inadequate knowledge about the essential functions of your job.  Quoting Colonel Potter here: “HORSE HOCKEY!”  Does this sound remarkably akin to designed incompetence to anyone else?cropped-bird-of-prey.jpg

Meaning, I do not believe your lies!

Traveling to Fayetteville, Arkansas, and the case of Dr. Robert Dale Bernauer Sr. (74), who has pled guilty to workers comp fraud and four other charges of fraud, where the total amount of fraud existed from 2011 to 2017 and more than $1 Million.  Co-Conspirators and the insurance company are not named but should be.  Worse, this scheme involved workman’s compensation insurance for Federal and State employees, Federal agencies, State agencies, and private employers.  While the lawyers and attorneys all crow about catching a doctor who committed fraud, and I am glad he was caught, where are all the state and federal employees who had to know this was going on and did not do their jobs?

Through the insurance company, the doctor was charging 1500-2000% higher for medication marked up. Indeed, this should have raised some eyebrows and questions somewhere in the six years this fraud lasted.  Who is asking why this did not raise red flags at the state and federal levels?VA Seal

Weep America, another veteran, has died by suicide, and the VA is culpable due to bureaucrat inertia and outright failure to follow the guidelines and rules as established.

The VA-OIG found that staff did not adequately evaluate the patient’s condition when reviewing the patient’s high-risk status.  Facility staff did not assign a Mental Health Treatment Coordinator (MHTC) prior to discharge or establish a facility MHTC policy, as required.  The Recovery Engagement and Coordination for Health – Veterans Enhanced Treatment (REACH VET) provider did not outreach the patient as required.  Facility staff did not comply with Veterans Health Administration suicide risk assessment procedures and did not notify facility leaders or suicide prevention staff of the patient’s death by suicide” [emphasis mine].VA 3

Why was the staff allowed to fail so severely here; they were not appropriately trained.  Staff failures and training failures are symptoms of leadership failures, and a veteran is dead!  Which staff has been fired for their failures?  Which leaders have been fired without retirement or potential for rehiring for a deceased veteran as the final act in a chain of events that began with failing to perform their job?  How many times will this story have to repeat before Congress acts to reflect the interest and the responsibility invested in their office by the electorate?  How many times is this story repeating without the benefit of the VA-OIG doing a full-blown investigation?Angry Wet Chicken

Unfortunately, the following report involves the abuse of an intimate partner and bureaucratic inertia.  While the complete record is not revealed (thankfully), what is revealed is detestable to the Nth degree and includes 214 days of spousal abuse, bureaucratic inertia, and mental health failures to protect the spouse and help the veteran, ending with the veteran’s suicide.  The saddest part of this story, it took almost three years for this suicide to be investigated by the VA-OIG (2019).

“The VA-OIG found that despite the patient’s and spouse’s intimate partner violence (IPV) reports, inpatient mental health unit staff did not consult with the IPVAP point of contact or ensure the spouse felt safe with the patient returning home upon discharge. The inpatient psychiatry resident did not timely complete a progress note addendum, which resulted in other clinicians not having access to critical IPV-related information for 34 days. Facility staff failed to consider a consultation with the Office of Chief Counsel, although the Veterans Health Administration (VHA) advises employees to “work with your Office of Chief Counsel” regarding state reporting requirements for victims of IPV. Outpatient mental health staff did not consult with the IPVAP point of contact or document discussion of IPV resources or treatment options, as the OIG would have expected. The Facility Director did not ensure the development of an IPVAP protocol, as required. Although a licensed independent provider was appointed as the IPVAP coordinator, facility staff and leaders did not identify the assigned IPVAP coordinator as a resource at the time of the patient’s care in 2019. The VA-OIG also found that VHA guidance about IPV training responsibilities was unclear.”VA 3

Let’s talk about some realities of mental health.

      • 50% of the patients seeking mental health see no improvement.
      • 10% of the patients seeking mental health support will be injured by the mental health provider.
      • 33% of the mental health patients choosing a pharmacological solution experience harm or no relief.

If you add these numbers up, that’s 93% of the population seeking mental health support not being helped or being harmed by mental health providers.  This does not mean that mental health providers need to give up, but they need to work harder to find solutions and meet their patient’s needs.  It means timely provider notes are mandatory!  It requires providers to have a plethora of options for treatments, obtain patient buy-in, and follow up with the patient.  It involves treatment facilities to write procedures and operating policies that allow for rapport between a patient and a provider that is not disturbed as long as that relationship is healthy and progress occurs.

Knowledge Check!America, it is time, and past time, for the Department of Veterans Affairs to be overhauled from stem to stern.  To be held up to scrutiny, transparent audits and the leaders held accountable and responsible for the failures and abuse of veterans, their spouses, and dependents.  These last two stories, especially, have left me spiritually sick and mentally angry!  There is no excuse for the inertia evidenced, no excuse for the designed incompetence, and no excuse for the abuse to continue!  Where is Congress?  Where is the US President?  Where are the House and Senate speakers (Major and Minor) raising a rhubarb and demanding hearings, opening Department of Justice inquiries into misconduct and malfeasance when these egregious VA-OIG reports are brought before them?  Where is the media in demanding the politicians pay attention?

Satire? Obama ISIS Speech Depresses Nation | Hooper's War - Peter Van BurenWeep America!  Those who have defended you and me are being fed into the machine of bureaucratic inertia and spat out as broken or dead constructs — bereft of hope, lost in red tape, and denied solutions and care.  Pets and farm animals are treated better than veterans, and I cannot help but wonder if this was designed purposefully to satisfy the whims and fancies of the politicians currently in office.  Treat an animal like a veteran is treated, and you will be publicly shamed on national TV faster than a snake can shed its skin.  You will receive more media attention, more lawyers and politicians will hound you, and consequences galore will fall all over you.  Shameful!  Utterly shameful!

References

American Psychological Association. (2012, August). Recognition of psychotherapy effectiveness. Retrieved from http://www.apa.org/about/policy/resolution-psychotherapy.aspx

Corbett, L. (2013, December 17). Psychotherapy based on depth psychology is a superior approach [Video file]. Retrieved from https://youtu.be/e4JQamcq24c

Lilienfeld, S. (2007). Psychological Treatments That Cause Harm. Perspectives on Psychological Science, 2(1), 53-70. Retrieved from http://www.jstor.org/stable/40212335

Smith, B. L. (2012). Inappropriate prescribing. Monitor on Psychology, 43(6), 36. Retrieved from http://www.apa.org/monitor/2012/06/prescribing.aspx

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