Tag: Leadership Failure

Front Office vs. Back Office vs. Oversight – Additional VA Horror Stories

Lincoln WeepsOh, the bitter tears President Lincoln must weep…

One of the most troubling issues facing many organizations is exemplified perfectly by the VA, specifically the Post 9/11 GI Bill.  Previously I worked for an online university in a position where I saw GI-Bill problems affecting students on active duty, reserve, guard, and veterans, all being treated in wildly different manners.  The school GI-Bill office was expected to be subject matter experts on all things GI-Bill, but they regularly made decisions that harmed the students.  By interpreting the regulations and operating procedures differently from student to student.  Yet, the Department of Veterans Affairs (VA) is just as confused as the universities trying to bill GI-Bill charges for students.

From a recent VA Office of Inspector General (VA-OIG) report, we find the following:

“The Veterans Benefits Administration (VBA) did not always accurately process enrollments.  An estimated 2,500 of 10,000 enrollments from August 1, 2020, through April 1, 2021.  About 790 of the estimated errors involved officials either not reporting or underreporting vacation breaks.  VBA claims examiners often mishandled enrollments even when the correct information was submitted.  The VA-OIG estimated claims examiners incorrectly processed accurately reported vacation breaks for about 1,700 of 2,500 enrollments with errors.”

Why are these enrollments not processed correctly:

“Insufficient training and guidance meant school certifying officials frequently made mistakes.”  The VA takes legislation and writes the processes, procedures, and training materials for universities to use for operations and enrollment of military and veteran students.  Front office workers interact with students, back office workers interact with internal employees, the VA keeps the records current, and the VA forms the universities’ oversight resembling the blind leading the blind.  Yet, the VA cannot write effective training materials, processes, and procedures, conduct training, and support those who support students.

Per the VA-OIG report, the VBA is looking to implement an automated system to prevent these oversight issues from continuing.  I do not expect any automated system created by the VBA to work efficiently because of a simple principle, GIGO.  The garbage the VBA will put into the system will ALWAYS result in garbage coming out, creating more problems, costing too much money, and still creating issues for students and student-facing employees at universities and colleges across the country.  Somehow, the VA-OIG continues to buy these excuses and pipe dreams and reports the same to Congress, which is also purchasing these excuses and poor performances.VA 3

Before someone tries to claim this is isolated to the GI-Bill program, and the GI-Bill program has always been confusing.  Using this logic, the health complications at birth can be blamed on the father alone, and the mother’s behaviors do not influence the baby’s health.  Here the VA-OIG is reporting on another program governing VA employees, overseen by the OMB, and is incredibly useless as this is a repeated complaint between 2020 and 2022.

“Identity, credential, and access management (ICAM) is a set of tools, policies, and systems used to ensure the right individual has access to the right resource, at the right time, for the right reason in support of federal business objectives.  In February 2021, the VA Office of Inspector General (VA-OIG) received a hotline complaint claiming the Office of the Assistant Secretary for Human Resources and Administration/Operations, Security, and Preparedness and the Office of Information and Technology have not agreed since 2016 on roles and responsibilities for VA’s ICAM program.  Failures of ICAM contribute to the VA’s inability to effectively comply with the Office of Management and Budget (OMB) policy.  The VA-OIG reviewed to determine whether VA effectively governs its ICAM program as required.”

What did the VA-OIG find?

      • The VA did not effectively manage and coordinate its ICAM program, not meeting three of the four OMB governance requirements.
      • The VA did not effectively assign roles and responsibilities, implement a single comprehensive ICAM policy, or meet its technology solutions roadmap goals for fiscal years 2020 and 2021.
      • The VA failed to implement updated digital identity risk management requirements.

Why can’t the VA obey OM oversight?

“These issues occurred primarily because leaders of the different offices performing VA’s ICAM functions have not agreed on how it should be governed.  VA risks restricting information from users who need it to perform their job functions without proper governance and leaving information vulnerable to improper use” [emphasis mine].

In this report, the OMB sits as oversight of the VA.  The employees are the frontline, and the leaders continue to fail to provide tools, policies, and resources to employees conducting the VA business.  What is still an incredibly terrible idea allowing the VA to remain self-governing.  Why isn’t the OMB more interested in demanding compliance?  Where is Congress scrutinizing how the executive branch agencies are failing and monitoring to improve conduct?VA 3

The VBA cannot still properly and timely adjudicate claims.  Again, the VA-OIG lambasted the VBA for improperly adjudicating claims, even with “Special-Focused Reviews.”  Essentially the quality assurance (QA) process in claim adjudication continues to fail to help improve claim processing accuracy.  From the report:

“The Office of Inspector General (VA-OIG) reviewed VBA’s design and implementation of its special-focused review process, including applying Government Accountability Office (GAO) standards.  The VA-OIG team assessed ten special-focused reviews completed from January 2019 through April 2021 and identified weaknesses in all five of GAO’s internal control components.  The VA-OIG also found the VBA Compensation Service’s standard operating procedure related to these special-focused reviews does not provide sufficient guidance to support disability claims-processing improvement fully.”

When I worked in QA, root causation was required to prevent future problems.  The VA-OIG found that the QA Special-Focused Reviews do not include root causes or explanations for why the claims were readjudicated, stopped, or delayed in VBA processing.  Do not repeated issues reflect the need to restrict self-governance until compliance can be observed?VA 3

Why should the VA have its self-governance restricted or prohibited?  The following VA-OIG makes clear that the VA cannot govern itself and correct the problems leadership continues to create.  Follow the timeline here, quoted directly from the VA-OIG report:

“The VA Office of Inspector General (VA-OIG) conducted this review to determine whether the Veterans Benefits Administration (VBA) accurately adjusted compensation and pension benefit payments for fugitive felons as mandated by law.  If VBA does not adjust payments, veterans who are fugitive felons will continue to receive benefits during periods of ineligibility.

In April 2012, VBA instructed regional offices to postpone making decisions on fugitive felon cases while it prepared new guidance.  During 2012 and 2013, VBA did not process fugitive felon cases.  In June 2014, VBA updated its definition of a fugitive felon to include only referrals indicating escape, flight, or violation of probation or parole conditions.  Although VBA then resumed adjusting payments, it did not review the unprocessed 2012 and 2013 cases.

In addition, due to inadequate monitoring, VBA did not process about 46 percent of cases referred by the VA-OIG in 2019 and 2020.  Finally, the team found VBA’s notification letters to veterans providing notice of the proposed action and right to a hearing did not always provide the required information.  Most commonly, VBA failed to include the reason for the issuance of the arrest warrant.”

The VA has been informed by the VA-OIG multiple times during the decade this problem has been surviving, and 46% of the cases the VA-OIG told the VA to fix still weren’t fixed in 2022.  How can any oversight agency still permit the VA to govern itself?  The leaders of the VA cannot self-govern, correct course, and make changes timely enough not to create additional expensive problems for veterans.  Each of these cases represents either an overpayment, where the VA is clawing funds back, or an underpayment, where the veteran has been shortchanged and is owed money.

When the VA claws money back from making a mistake that overpaid a veteran, dependent, spouse, or other entity, the VA-OIG has found that even here, the VBA cannot act per their policies, follow procedures, or notify veterans in a timely manner.  A veteran I got to know who served in Vietnam and caught a round in the heart that blew away a large chunk of his heart.  For 50 years or so, this was sufficient to have a 100% disability.  On the day he turned 69, his disability rating dropped to 80%, with a coinciding reduction in monthly benefits.  The VBA investigated this claim decision and found they had made a mistake, but their mistake would not significantly change the rating, so the veteran was stuck with an 80% rating and was told to go back to work.VA 3

To the best of my knowledge, the claim remains stuck in claims appeal hell, awaiting the judgment of the dark and benighted realms to act.  The veteran, who cannot hold a job due to weakness from lacking a significant part of his heart muscles, is driven into bankruptcy.  His heart will not regrow, but because his age has met the age when heart problems are actuarially known, the decision was made.  The decision was made without notification to the veteran, and the veteran only became aware of the situation when he had monies clawed back by the VA.  From the time the decision was made to the date he knew, 18 months had transpired, and the veteran was automatically sent to collections.  While this was never allowed to become a VA-OIG investigation, I have spoken to family members and the veteran while volunteering to help disabled people find employment.I-Care

To add the bitter cherry to this crap sundae, this is not the worst abuse I heard in my volunteer efforts.  Worse, this is not the worst story I have had related while talking to veterans in my travels across the continental 48 United States.  Veterans sit forever in claim hell; they cannot afford to go forward, they are abused when seeking medical help, and every interaction with VA medical providers runs the risk of being the victim of an “adverse medical event.”

To this point, the VA and the VBA have been central to proving that the VA cannot self-govern, oversight is failing, and the back office administrators are hindering the front office operations.  Surely the Veterans Health Administration (VHA), where people’s lives are at risk, would not have a similar problem.  Unfortunately, you would be wrong, and here is one VHA example, of many, to support this conclusion:

“A VA Medical Center (VAMC) community living center (CLC) staff delayed life-sustaining treatment for a patient (Patient A) who experienced cardiac arrest and died.  The VA-OIG also reviewed an allegation regarding a second patient (Patient B) who had resuscitation initiated, despite a do not resuscitate (DNR) order in the electronic health record (EHR).”

Why did one patient die without resuscitation and another get resuscitation without wanting it?  The policies and procedures were complicated, and the use of armbands confused the providers.  The providers (doctors and nurses) overseeing care had a person in the medical records of these patients and still could not properly act for patient care.  The patients had armbands and proper medical documents on file, and the providers still got confused and provided poor care, at best, to the patients involved.

America WeepsIn another long-term care facility under VA operation, the following occurred:

“The VA-OIG found that the day charge nurse’s assessment was delayed and incomplete, and the day charge nurse failed to properly document the resident’s reassessments, treatments, and interventions.  The VA-OIG substantiated that nursing staff failed to document and carry out a telephone order to transfer the resident to the Emergency Department but could not determine if this impacted the patient’s outcome.”

Let’s take a moment to allow this to sink in fully.  Failure to follow a doctor’s orders might have been part of the problem the patient DIED!  Yet, the chain of events is sufficiently blurry to mystify the investigators – this I find HIGHLY SUSPECT!  But, as the Home Shopping Network reports, “There’s more!”

“The VA-OIG determined that following the resident’s death, facility staff failed to conduct a comprehensive review of events leading up to and contributing to the resident’s death and, due to a lack of coordination of care at the time of discharge from the inpatient unit, the resident did not have the needed equipment upon admission to the CLC.”

I accept that a nurse’s role is stressful, the VA policies do not make their jobs less stressful, and the healthcare leadership (overall) is abysmal on the best days.  However, killing a patient is still a BAD thing!  I-CareYet, here we have another dead veteran at the hands of the medical care providers, and the best the VA-OIG can do is make ten (10) recommendations for change.  Does anyone believe the VA can continue to self-govern under its current misguided leadership and convoluted organizational structure?

Ask yourself, would the abuse of the veterans mean more if this was your uncle, brother, father, mother, sister, or aunt?  They are your family members for the problems which they face; we all face in our constitutional republic.  Where is Congress scrutinizing the government?  Please become interested, active, and engaged, or we will lose this constitutional republic to the tyranny of the power-hungry despots.

© Copyright 2023 – 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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“That’s Crazy!!!” – More Chronicles from the VA Chapter 8

I-CareI fully admit I got behind in April.  Dear reader, my apology.  I have been whipsawed between emergency room visits, depression, extreme pain, and other issues.  Not offering an excuse but a tiny peek into my world as a disabled veteran.  Luckily, I have maintained employment because my employer allows me to work from home.  My driving privileges are threatened again with removal due to the neurological issues I suffer, and this will dynamically change my life, but this article is not about me, but the continued catastrophe called the Department of Veterans Affairs (VA) and the Inspector General (VA-OIG) reports published.

We begin with a financial efficiency review reported from the inspection of the Durham VAHCS of North Carolina.  I know the jokes write themselves when we discuss any government agency and financial efficiency, but I digress.  This is a head exploding report of leadership failure in the observation and governance of employees who did not perform the functions they were hired to perform.  The VA-OIG found the following from October 1, 2020, through March 31, 2021:

    • The healthcare system had 309 inactive obligations totaling $81.7 million.
    • Of these 309 obligations, 200 (totaling over $74 million) had no activity for 181 days or more.
    • In a subsample of 20 obligations, VA staff had not reviewed 17, as required.
    • Contrary to VA policy, healthcare system staff used purchase cards instead of contracts for 21 of 40 sampled transactions (53 percent), totaling approximately $328,000. These 21 transactions were missing required supporting documentation to verify that the transactions were approved and payments were accurate, resulting in $308,000 in questioned costs.
    • 105 more administrative full-time equivalent staff than the expected number, all not doing their jobs as required under Federal Law!

While not all of the findings, those mentioned are the most egregious and in need of corrective action.  Would the citizens of Durham, North Carolina, please tell me, has this been reported in the local news?  Has anyone lost their jobs as the VAHCS right-sizes the financial department?  I can find no additional information that this problem has been corrected, and I am really curious!VA 3

Oh, the irony is thick; consider the following:

“The Department of Veterans Affairs Office of Inspector General Training Act of 2021 would help ensure that VA employees continue to be empowered to assist the OIG in improving VA’s operations and using taxpayer dollars to the greatest effect; helping protect patients and improving their care; and ensuring veterans and others receive services and benefits for which they are eligible.”

The above-quoted material originates from Chris Wilber, who testified to Congress’s HVAC Subcommittee on oversight and investigations.  What is the number one failure on every comprehensive healthcare inspection (CHIP); the lack of staff training, the inadequacy of staff training, or adequately trained staff.  Yet, the statement by the VA-OIG indicates that training has met a threshold for providing adequate training.  Let’s talk about a specific action, “the VA secretary signed a directive in September 2021 mandating that all employees complete a one-time training within one year—an important step in improving VA’s culture of accountability.”  It is now May 2022; the VA-OIG is pushing for training directives to be legislated, not dependent upon any single VA Secretary.  Are you freaking kidding me?  Where is the congressional oversight and scrutiny that allows VA training to continue to be subpar and threaten the lives of veterans?

Long have I wondered how the VA could frustrate VA-OIG actions, investigations, inspections, etc.  Guess what; the answer has become available:

“… there have been instances in which the OIG has been informed that staff have been told that they cannot share information with OIG investigators without first clearing it through supervisors or leaders—contrary to the Inspector General Act of 1978 (the IG Act), as amended.  Under that authority, VA employees at all levels have a duty to cooperate with OIG personnel, including providing information and assistance in a timely manner.”

Employees have been caught lying to the VA-OIG regularly, and what action is taken to remove those employees promptly and efficiently from government service?  From direct observation and employee conversations, it is clear that plans are carefully laid before a scheduled VA-OIG visit to present what the VA-OIG wants, but to gloss over the problems, and nothing ever happened to the managers, supervisors, and employees who lied and misdirected the VA-OIG.  All contrary to established Federal Law!VA 3

Want a specific example of employees intentionally misrepresenting information to the VA-OIG?  Look no further than the statement by Chris Wilber, and this incident was covered as a failure of leadership in a previous article.

“Hospital staff at a VA facility in Fayetteville, Arkansas, had concerns about potential substance abuse by the chief of pathology that were not heard and promptly acted on by local management, which allowed him to work while impaired for years.  He misdiagnosed about 3,000 patients with errors resulting in death or serious harm and is currently imprisoned.  The OIG found a culture in which staff did not report serious concerns about the chief pathologist, in part because they assumed that others had reported him, or they were concerned about reprisal.”

From personal experience, I reported problems to the VA-OIG concerning patient abuse, fraud, waste, and other issues.  Never were my concerns acted upon promptly, and I was removed from employment for being a whistleblower.  The culture of corruption at the VA is incredible.  The examples mentioned by the VA-OIG only further sustain the problem with leadership and how sick the VA truly is as an organization!VA 3

We next turn our attention to the VA-OIG report on the inspection of information technology security at the VA Financial Services Center, another head exploding example of leadership failure bordering on criminal!  The findings include:

    • component inventory
    • vulnerability management
    • flaw remediation
    • Identifying 252 vulnerabilities, of which 228 the local IT team could not identify.
    • the VA-OIG team identified access control deficiencies, as 107 of the 278 FSC systems failed to generate or forward audit logs for analysis.
    • the video surveillance system was not fully functional. Ineffective monitoring and recording facility activities supporting information systems minimize the FSC’s incident response capabilities.

How do you spell failure; these findings spell failure to me rather pointedly and dramatically!  Want to laugh; staff training remains a concern, but not a finding, of the VA-OIG inspection team.  Frankly, with this level of incompetence, staff training should have been a finding.VA 3

To be concise and illustrate further the poor leadership, convoluted processes, and brazen noncompliance of VA officials, the following discussion is about two different VA-OIG reports that reached similar conclusions.  First, we have the VA-OIG report on “Noncompliant and Deficient Processes and Oversight of State Licensing Board and National Practitioner Data Bank Reporting Policies by VA Medical Facilities.”  Second is the VA-OIG report on “Concerns with Consistency and Transparency in the Calculation and Disclosure of Patient Wait Time Data.”  Nothing says convoluted processes more than having two written policies, both originating from Washington DC.  The superseded policy does not have an expiration date.  This means that employees have a designed incompetence excuse ready for not adhering to the most current and applicable policy.  Don’t believe me; one of the key findings was, “VHA has presented wait times to the public without clearly and consistently disclosing the basis for their calculations.”  Designed incompetence does not come more blatant than this, and who suffers, the veteran.  Worse, wait time correction and policy clarification has been stalled by COVID-19, the neverending excuse paying dividends to bureaucrats everywhere!Timelines for Wait Time Calculations

However, both reports are substantially summated by the VA-OIG; thus, “The lack of programmatic oversight contributed to the failure of VHA leaders to detect and intervene upon facility noncompliance.”  Meaning that due to COVID-19, the VHA has refused to do their jobs in deference to the pandemic, and since this is a good enough excuse, the VA-OIG has bought the designed incompetence, lock, stock, and barrel.  The VHA leadership is failing; doctors or dentists let go for poor performance were not reported to state and federal boards, so these providers lacking can continue to harm patients.  It is a federal law (42 US Code § 11151, US Department of Health and Human Services, Health Resources and Services Administration Bureau of Health Workforce, NPDB Guidebook, October 2018, chap. A., 8 USC ⸹ 7462(a), 38 USC ⸹ 7401(1), among others) that providers let go for cause must be reported within 7-days to the regulatory boards at the state and federal levels.  Wait times are hidden because they are so bad; the VHA is embarrassed, so the leaders fall back on designed incompetence to shield themselves while looking for another excuse for poor performance!  In both reports, the ramifications of noncompliance are putting people at risk for sentinel events (death, injury, disability, etc.), and the leadership is at best lackadaisical in the performance of their duties.  VA 3

Where are the congressional overseers in ending the abuse?  When will this insanity and bureaucratic inertia end?  How many “sentinel events,” including deaths and permanent injuries, will it take until those tasked with scrutinizing the executive branch finally take committed action and hold people accountable?  When will the elected representatives stop throwing good taxpayer money at problems that money cannot fix?  If these questions are too difficult to answer, please stop running for elected office, for the citizenry is not happy!

We conclude with two related reports so astoundingly obtuse they defy logic and sanity.  The first is the annual CliftonLarsonAllen LLP (CLA) audit of the VA’s information security for 2021.  The second is the continuing failure of the new electronic health record modernization (EHRM) program.  The VA has failed the CLA audit for more than a decade, with many of the hits repeated year-over-year.  In fact, the CLA audit is so bad this year; it has taken my mental breath away and stunned me into a gibbering idiot!  Reading this report was infuriating; describing it as my head exploding is akin to comparing an M-80 to a nuclear bomb.  How in Dante’s Inferno can this level of incompetence be allowed to remain employed?  But, as bad as the CLA audit is, the continued failure of the new electronic health record system pales in comparison.  The new EHRM continues to suffer from reliability weaknesses, which is polite speak from the VA-OIG for the new system fails to do the job.  We are three years from the new extended deadline, we are already past the original deadline, and the system is worthless today than it was a year ago.  With this success rate, the new EHRM will be utterly bereft of value and need replacement before the year’s end.  How many millions (billions, or trillions) of good dollars must chase this ineptitude before the plug is pulled and those involved held accountable?VA 3

Join me in having your head explode:

“Additional deficiencies included known tasks not being reflected on schedules, no risk analysis, lack of longer-term actions scheduled, and no complete baseline schedule or overall schedule that fully integrated individual project schedules. VA also did not comply with federal regulations when it paid its contractor for deliverables before accepting them (reviewing compliance with contract requirements).”

Consider this other gem from the VA-OIG report, “$1.95 billion in cost overruns per year” are estimated, meaning the final tab will be significantly higher and compounded year-over-year.  In plain speak, the contractor is being paid for products delivered that fail, the products offered are not usable, there is no schedule of completion, there is no schedule for deliverables, many of the products paid for have never been delivered, and costs are overrunning like a plugged toilet. Worse, no one is being held personally liable for these problems, which were apparent in the last EHRM update from the VA-OIG a year ago!  Like the CLA Audit, I am thrilled the VA agrees with the VA-OIG findings, but what are they DOING to fix the problems?

FYI: the image below is a year old, and comes from the last major update to the EHRM.EHR-VA-OIG

?u=https1.bp.blogspot.com-aqaqk18MHoEWRHHsCi_TyIAAAAAAAAAXc7hY4JQuyylIQHYudoR8sbezGZntic4SSwCLcBs640Betrayal2BSayings2Band2BQuotes2Bwww.mostphrases.blogspot.be.jpg&f=1&nofb=1There is no excuse for behaving like the VA’s bureaucratic legions behave.  Bureaucrats, from the city government (including the school board) to the Federal Government, you hold a sacred trust to act better than you are currently performing.  I refuse you any leeway for acting like pompous overlords when you are paid through forced taxation!  You have trespassed upon my patience and kindness long enough, and the day of reckoning has arrived.  You work for me; you work for every taxpayer and citizen in this country, and you have violated our trust, charged us too much and too often, and if you do not begin to show yourself worthy of the sacred trust, we will force you from your cushy jobs and hold you liable for the monies you have squandered!  The law is on our side; you need to begin showing you honor our trust and investment forthwith!

© 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.

“That’s Crazy!!!” – More Chronicles from the VA Chapter 7

Oh, how I wish and long for, and am working for, the day when the VA is cleaned up, cleaned out, and corrected completely!  The Department of Veterans Affairs (VA) – Office of Inspector General (VA-OIG) has been busy reporting more on the failures of the VA to act.  Yet, where is Congressional action in scrutinizing the executive branch’s actions?  Honest question, repeated only for emphasis; we elected you to do two jobs, write fair and equal legislation for all citizens, and scrutinize the executive branch; when are you going to do your jobs?

Let’s begin with some softball issues repeated from previous VA-OIG comprehensive healthcare inspections (CHIPs), specifically how employees report feeling morally distressed while working at the VA.  Moral distress is a leadership failure and is widespread enough to reflect the problem is not limited to a single VAMC/VAHCS.  From Virginia to California, Maine to Florida, and Montana to Arizona, too many VA facilities are poorly led, poorly administered, and poorly executed.  The VA is actively abusing the veterans for political gain; some have asked why I consider the VA is actively abusing veterans; let me see if additional disclosure can explain the problem.

“VHA Directive 1004.08.  VHA defines an institutional disclosure as “a formal process by which VA medical facility leader(s), together with clinicians and others as appropriate, inform the patient or personal representative that an adverse event has occurred during the patient’s care that resulted in, or is reasonably expected to result in, death or serious injury, and provide specific information about the patient’s rights and recourse.”

The above quote is from the regulations governing VA care.  The VA-OIG quotes this directive, which has been published and is openly available, yet repeatedly the VA-OIG finds directors.  Hospital administrators who are informed and able to repeat this directive.  Who repeatedly refuse to follow this directive or train their staff to follow this directive.  When sentinel events occur (death, permanent injury, non-permanent injury, disability, etc.), the families report having no idea what to do because the disclosures were never provided to the veteran or designated caregiver.  Is this not abuse of the patient?  Is this abuse not driven by ideologues who gain from the harm they cause others?  Should this abuse not be scrutinized until it is eliminated?  Please feel free to read some of these comprehensive healthcare inspection reports from the VA-OIG, see the resulting injuries and problems caused by the failures of government medical providers, and then tell me whether these atrocious actions need more or less scrutiny and qualify for the title abuse.

North Carolinian veterans, VISN 6 is all yours, and would you be shocked to learn that even with newer leadership, moral distress remains a persistent problem in the VA employees throughout VISN 6, which just happens to include Durham, Asheville, Fayetteville, Hampton, Richmond, Salem, and Salisbury North Carolina?  Probably this is not unfamiliar as the patient experience survey scores remain persistently below VA averages, reflecting that new leadership is akin to putting lipstick on a pig.  Interestingly, medical staff credentialing remains a significant concern in North Carolina.

Western New York veterans, especially those receiving patient services in the Buffalo VAHCS, do you agree with the VA-OIG report?  The Buffalo VAHCS includes Buffalo, Batavia, Jamestown, Dunkirk, Niagra Falls, Lockport, West Seneca, and Olean, and the comprehensive report is mystifying to me.  For example, the VA-OIG reports that “Patients generally appeared satisfied with their care.”   At the same time, “Employee survey data revealed opportunities for leaders to improve workplace satisfaction and reduce feelings of moral distress.”  This is a combination not generally found in these CHIP inspection reports.  Something is definitely off, and I would love to know what, especially since the leadership needs significant improvement in identifying and reporting sentinel events.  Do you agree with the VA-OIG findings?  Please let me know your firsthand experiences, for the double-talk in this CHIP report is above what I usually observe.

With almost identical findings and recommendations in the Syracuse NY VAMC’s comprehensive healthcare inspection, covering communities of Syracuse, Auburn, Freeville, Potsdam, Rome, Binghampton, Watertown, and Oswego, NY., I am concerned that the veterans in New York are in as bad or worse shape than Phoenix’s veteran community.  Hence, I have to ask the VA-OIG, has something changed in your measurement and analysis tools to report such disparate findings as “Employee survey data revealed opportunities for leaders to improve servant leadership and decrease employees’ feelings of moral distress.  Patients generally appeared satisfied with the care provided?”  The double-talk level is higher in these CHIPs from NY, which is rarely observed outside of Phoenix and VISN 22.  Two final thoughts on the CHIPs, staff training, continues to be a high-risk finding, and this continues to be a leadership failure for every VAMC/VAHCS/VISN in the VA; why has progress not occurred?  Training is a system, and leadership and organizational risk, system redesign, and improvement is a quality, safety, and value problem of the highest importance; why is action never taken by leadership or the congressional representatives who are expected to scrutinize the executive branch?

28 March 2022, the VA-OIG released their long-awaited annual “Comprehensive Healthcare Inspection Summary Report: Evaluation of Medical Staff Privileging in Veterans Health Administration Facilities, Fiscal Year 2020.”  I have been interested to see what, if anything, the VA had accomplished in improving their medical staff privileging.  If I were a congressional representative, knowing that medical staff continues to harm and kill veterans, I would have been anxiously awaiting to see if the repeated hits from past years had finally been rectified.  Unfortunately, the VA continues to live down to expectations (digging the hole ever deeper), suffers from failed leadership, and the veterans continue to die or suffer abuse.

What did the VA-OIG discover?  Understand, “The OIG conducted detailed inspections at 36 VHA medical facilities to ensure leaders implemented medical staff privileging processes in compliance with requirements.  The OIG subsequently issued six recommendations for improvement to the Under Secretary for Health, in conjunction with Veterans Integrated Service Network directors and facility senior leaders.  The intent is for VHA leaders to use these recommendations to help guide improvements in operations and clinical care at the facility level.  The recommendations address findings that may eventually interfere with the delivery of quality health care.”  The OIG identified deficiencies with focused and ongoing professional practice evaluation, provider exit review, and state licensing board reporting processes.  Specifically:

    • use of minimum criteria for selected specialty licensed independent practitioners’ focused professional practice evaluations
    • inclusion of service-specific criteria in ongoing professional practice evaluations
    • completion of ongoing professional practice evaluations by other providers with similar training and privileges
    • recommendation by executive committees to continue licensed independent practitioners’ privileges based on professional practice evaluation results
    • completion of provider exit review forms within seven business days of licensed independent practitioners’ departure from a medical facility
    • the signing of exit review forms by service chiefs, chiefs of staff, and medical facility directors if licensed healthcare professionals failed to meet generally accepted standards of care
    • initiation of state licensing board reporting within seven business days of supervisors’ signatures on exit review forms to indicate licensed healthcare professionals failed to meet generally accepted standards of care.

The OIG found ongoing issues from the fiscal year 2019 CHIP summary report that warranted repeat recommendations for improvement.  The OIG issued three repeat recommendations related to the following:

    • inclusion of minimum specialty criteria for focused professional practice
      evaluations
    • inclusion of service-specific criteria in ongoing professional practice evaluations
    • recommendation by executive committees of the medical staff in continuing licensed independent practitioners’ privileges based on professional practice evaluation results.

Boiling the findings of the VA-OIG down, essentially, the administrators and leadership are not weeding out poor and horrible practitioners, reporting these underperforming practitioners, and not acting in the best interests of the veterans seeking care at VAMCs and VAHCSs across the country.  I repeat, only for emphasis: Is this not abuse of the patient?  Is this abuse not driven by ideologues who gain from the harm they cause others?  Should this abuse not be scrutinized until it is eliminated?  Please feel free to read some of these comprehensive healthcare inspection reports from the VA-OIG, see the resulting injuries and problems caused by the failures of government medical providers, and then tell me whether these atrocious actions need more or less scrutiny and qualify for the title abuse.  The link to the full report is available; please feel free to make your conclusions and post your thoughts in the comments section.

On a final note for today, consider with me the problems of the Atlanta VAHCS with pallets of unopened mail containing patient health information, community care provider claims needing payment, and a plethora of other unopened mail.  Understand that when community care providers cannot obtain compensation from the VA, they go to the veterans, who then send in correspondence, which is unopened, thus causing more problems, concerns, and issues for an already abused veteran community!  Want your head to explode?  Look at the pictures the VA-OIG helpfully sent along with this VA-OIG report, and ask yourself if any other business or organization could get away with this type of abuse of the customer.

What did the VA-OIG find?  Well, prepare for your head to explode, again:

    • VA Leadership should have established a formal agreement explicitly detailing each office’s responsibilities.
    • VA HCS leaders did not include responsible managers in decision-making discussions and lacked a clear understanding of the volume of mail processing work they were accepting.
    • Atlanta VA HCS did not ensure mailroom staff was adequately prepared or trained to handle or sort the influx of mail. POM (Payment Operations Management) officials were later reluctant to help, citing the verbal agreement.

Buried in the report is this tidbit, “POM is implementing similar transitions at sites across the country; POM and medical facilities need to ensure adequate staff with sufficient training to handle the mail processing workload.  VA concurred with the OIG’s five recommendations.”  Meaning that in a VAMC/VAHCS near you, unopened mail due to verbal agreements will soon add more distress and disgust to the veteran experience.

I have documented in these articles how verbal agreements, verbal standards of work performance, and verbal processes and procedures are the problem and way of life in too many CHIPs and observed practices at the VA.  Yet, these verbal shenanigans are more apparent than in the dilemma Atlanta faces due to unopened mail.  Payment operations to community care providers are on a controlled and fixed timeline.  Failure to process these payments according to the required timeline leaves providers unpaid, which diminishes the community care provider pool of providers.  Talk to a community care provider, and they will discuss the risks of doing business with the VA and the real possibility of not being paid timely enough or being caught in sufficient red tape never to receive payment.

I know of a provider who called me three years after receiving care and was still trying to appeal and correct the paperwork to receive payment.  A provider recently contacted me who wanted to ruin my credit for failing to pay the balance due from care received, and they are charging interest.  Correcting this problem cost me 48 business hours, 20 calls, and frustrations galore.  By the way, the problem still has not been rectified, an appeal is in process, and we have to wait for the VA to make a decision; this incident was caused by the VA changing the process and the paperwork.  The provider told me they are not accepting any more veterans seeking care, the risk is too significant, the timeline to receive payment is too long, and the VA never pays what is charged.  For example, I recently received a declaration declaring payment to a community care provider.  The VA sent me to this provider, which means they knew the prices beforehand and agreed to the fees.  The declaration declared the VA was charged $2,000 and paid $120, not actual amounts, but close enough to communicate the problem.  With inflation, or without inflation, if you were paid less than 1/10th of what you billed (invoiced), would you continue to conduct business with that company or organization?  Now add the unopened mail problem to the mix.  Would you continue to conduct business with this entity?

America, the Department of Veterans Affairs is sick.  All of the other alphabet agencies in the Federal Government are sick.  We continue to elect people who actively refuse to care enough to act according to their mandated duties.  We cannot afford the government we currently have, which is part and parcel of the problem with inflation in America right now!  Debt is entered into to pay for this bloated feckbeast called government; from the city to the federal government, the bloat is too great to be sustained!  Why is the VA able to skirt responsibility, accountability, and improvement?  They can hide behind the size of their convoluted and twisted organizational shield.  Why can the Post Office and the IRS get away with deplorable, at best, customer service?  They are protected by the congress refusing to scrutinize and hold people accountable.  When your head is done exploding, please remember and act in the ballot box to hire better representatives!

© 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.

“That’s Crazy!!!” – More Chronicles from the VA Chapter 6

I-CareI promised a follow-up article after Chapter 5; it took me the better part of 48 hours to cool down sufficiently to write coherently to effect an update.  On 18 March 2002, I wrote about an appointment with my Primary Care Provider (PCP) being tardy, unprepared, and bureaucratese in supposedly holding a phone appointment with me.  01 April 2022, not an “April Fools Joke,” at 0731 hours, lasting 9 minutes, my PCP called me to get my approval to have me changed from her PACT team to another provider’s team.  Apparently, in the highly red taped world of PCPs at the El Paso VAHCS, there must be an hour-long handoff call when a provider initiates a change of PACT team.  I have my doubts and smell designed incompetence!

Let me pause here for a moment.  I generally need two hours to write an article after conducting research.  18 March 2002, it took a bit longer to draft that one due to the need to blow off steam with some choice words and choke down the urge to beat a few brick walls with my fists.  I am generally a very controlled person, and the fact that this PCP was so stunningly incompetent, rude, and HIPAA clueless, I admit I lost my cherub-like demeanor!  That the patient advocate was able to get my secure message, upload the comments into the electronic medical record, and contact the provider before the provider had even logged the patient notes, speaks volumes about the ineptitude of the PCP.  Worse, in the call on 01 April, the PCP was still on speakerphone, still disregarding HIPAA security, and quoted lines out of context from my message to the patient advocate.  Speaking volumes about the processes and procedures of the patient advocate’s office to investigate patient claims without breaching confidentiality.  Another topic for another day entirely!PACT_model

28 March 2022, I received the following from the patient advocates office, quoted completely:

“We have received your secure message addressing your concerns.  I will be sending a Patient Advocate Tracking notification with your concerns to our Primacy Care Service for review.  They will be contacting you via telephone to discuss your concerns.”

I never heard anything from this mysterious “Primary Care Service” group/team.  01 April 2022 was the first response, and that was from the PCP.  Sourcing the Department of Veterans Affairs (VA) and the Office of Inspector General (VA-OIG), the PCP is the second most important member of the Patient-Aligned Care Teams (PACT) at the VA; the patient is the essential member and an actively engaged and knowledgeable patient is preferred.  I promise the VA-OIG has not even scratched the surface of the problems with recalcitrant, snowflake, and bureaucratic PCPs endangering patient health with the VA.  Not my first run-in with an inept PCP; I sincerely hope it is my last!PACT 3

In returning to the 01 April call, we find another interesting piece of data.  The PCP affirmed that abdominal pain could radiate from, say a hernia, to other parts of the abdomen, but this is for a specialist to diagnose, not a Family Practitioner.  Get that; the PCP is directly reversing all the published documentation by the VA and the VA-OIG by declaring that a specialist is the only person who can adequately decipher and detail why pain is occurring—putting all the PCPs in the VA Health Administration under the bus as merely button pushers and drug dealers.  Then the PCP has the temerity, nay the chutzpah, to suggest a trust deficiency existing between myself and the PCP.  Is it any wonder that people are detested, forlorn, melancholy, madder than a wet chicken with a raging case of hemorrhoids with the care they receive from VA healthcare providers?

Again, I repeat, only for emphasis, when any updates arrive on this issue, I will publish them in their entirety to allow the VA the opportunity to rebut, refute, or explain.  Like the ongoing saga with VISN 22, the Phoenix VAMC, and being arrested and injured three times by the VA Police, I am not holding my breath and awaiting a logical response.  If this were the only problem in the two weeks since the PCP shenanigans, the VA would be in pretty good shape.  Alas, we know, dear readers, that the VA is in dire condition, and the elected leaders need to be scrutinizing the VA a LOT more closely than they are.VA 3

We begin the latest chapter of VA-OIG reports with yet another physician bilking the government:

“Robert Clay Smith, a Louisiana physician, pleaded guilty to conspiracy to commit healthcare fraud, wire fraud, and illegal remunerations (taking kickbacks).  According to court documents, the scheme, which ran from 2013 until 2017, involved individuals associated with a medical supply and billing company recruiting Smith to dispense pain creams and patches to his workers’ compensation patients by offering him a split of the profits.  The company acted as the billing agent for Smith, handling all the paperwork and submitting the allegedly fraudulent claims to the US Department of Labor, Office of Workers’ Compensation Programs, and private insurers.  In exchange, the company paid Smith 50 to 55 percent of the profits collected from successfully billing insurers, at markups of 15 to 20 times what the medications cost.”

Plus the following:

“Robert Schneiderman of Langhorne, Pennsylvania, admitted to participating in a massive compounded-medication kickback scheme that he and others ran out of a pharmacy in Clifton, New Jersey.  Schneiderman pleaded guilty in federal court to one count of conspiracy to commit healthcare fraud and one count of conspiracy to violate the Anti-Kickback Statute.  From 2014 through 2016, Schneiderman and his coconspirators used Main Avenue Pharmacy, a mail-order pharmacy with a storefront in New Jersey, to run a fraud and kickback scheme involving compounded drugs like scar creams, pain creams, migraine mediation, and vitamins.  Schneiderman was the president of Main Avenue Pharmacy and was a founder and CEO of its corporate parent.  Main Avenue Pharmacy received over $34 million in reimbursements from healthcare benefit programs on compounded medications alone.  Approximately $8 million of that total was paid by federal payers.  Schneiderman himself earned over $400,000 through the course of the scheme.  This case was investigated by the VA OIG, FBI, Department of Defense OIG, Defense Criminal Investigative Service, and Department of Health and Human Services OIG.”

Don’t forget this one:

“Dr. Harry Doyle, a psychiatrist from Philadelphia, Pennsylvania, and his wife, Sonya Doyle, have agreed to pay $3 million to resolve alleged violations of the False Claims Act.  The alleged violations include submitting false billing to the US Department of Labor Office of Workers’ Compensation Programs (OWCP) for psychiatric services that were not provided and upcoding and double-billing patient claims.  The Doyles have also agreed to be voluntarily excluded from federal healthcare programs for 25 years as part of the settlement.  This is the largest recovery against a single psychiatrist in the history of the OWCP.  A multiagency investigation of Dr. Doyle’s practice revealed that from January 2013 through April 2021, the Doyles allegedly billed for services not rendered, some of which occurred when they were not physically present in the United States.  This case was investigated by the VA OIG, the Department of Labor OIG, and the United States Postal Service OIG.”

More is coming on this one:

“Ten Texas doctors and a healthcare executive have agreed to pay more than $1.68 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.  The MSO payments to the doctors were disguised as investment returns but were based on and offered in exchange for the doctors’ referrals.  As part of their settlements, the defendants have agreed to cooperate with the Department of Justice’s investigations of other parties involved in the alleged law violations.  To date, 17 doctors and two healthcare executives involved in this scheme have agreed on settlements totaling more than $2.7 million.  The civil settlements resulted from a coordinated effort between the VA OIG, Department of Health and Human Services OIG, Defense Criminal Investigative Service, and the US Attorney’s Office for the Eastern District of Texas [emphasis mine].”

Elected officials, the next time you are asked about the incredible amounts of fraud in government-provided healthcare and insurance, do not buy the media talking points that the fraud is minimal, contained, or anything but designed incompetence on the part of the bureaucrats to act as a jobs program for investigators!  The same investigators who are refused sufficient tools to investigate shenanigans by employees in the Federal Government adequately.?u=http2.bp.blogspot.com-fGEUjJsJ2h4VcJgswaisnIAAAAAAAABcsoFqEewPF_E4s1600quote-if-the-freedom-of-speech-is-taken-away-then-dumb-and-silent-we-may-be-led-like-sheep-to-the-george-washington-193690.jpg&f=1&nofb=1

Frankly, all of these cases need the government workers to be held accountable, and the myriad of red tape loopholes CLOSED!  I remember an election; I forget who and the exact when, but a significant election plank in the platform was healthcare reform, promising to clean up the swamp and bring accountability to Washington and the government.  The public is still waiting, and I know enough of you have run on this topic from both parties to repaper the walls (inside and outside) of the White House.

Yet, even if only outside providers and executives were scheming, the VA might not be in too bad a condition.  Except for the employees of the VA, VHA, and VBA, which continue to be caught up in ethics violations at a minimum:

“The VA-OIG conducted an administrative investigation that included a congressional request to look into allegations that Charmain Bogue, former executive director of the Veterans Benefits Administration’s Education Service, committed ethical violations arising from her spouse’s consulting work for Veterans Education Success (VES).  VES is a nonprofit advocacy group that regularly had business before the Education Service.  The allegations also pointed to possible incomplete financial disclosures by Ms. Bogue concerning her spouse’s consulting business.  In their work, investigators uncovered evidence of other potential conflicts of interest and related misconduct by Ms. Bogue [emphasis mine].”

VA-OIG finding:

    1. Bogue participated in Education Service matters involving VES without considering whether it raised an apparent conflict of interest and acted contrary to the ethics guidance she received from her supervisors.
    2. Bogue sought résumé feedback from the president of VES to aid in her search for career advancement without considering whether this raised apparent conflict of interest concerns in subsequent VES matters. VES also endorsed Ms. Bogue for presidential nominee positions.
    3. Bogue provided insufficient detail about her spouse’s business in 2019 and 2020 public financial disclosures; VA ethics attorneys had found them compliant. She remedied the subsequently identified deficiency in her 2021 disclosure.
    4. The OIG found that Ms. Bogue refused to cooperate fully in the OIG’s investigation by refusing to complete her follow-up interview. Her husband and VES president also refused to participate in OIG interviews, and the OIG lacks testimonial subpoena authority over individuals who are not VA employees.   Bogue resigned from VA in January 2022.VA 3

UPDATE: 14 April 2022 – Sen. Grassley was hoodwinked by the VA on this issue and The Daily Signal (linked) has more of this report.  I covered this before, I repeat only for emphasis, when you are discharged from the VA, you lose your ability to be a “whistle-blower.”  As a point of fact, this is how the VA is able to hide a lot of their shenanigans, get rid of the person rocking the boat, invent the paperwork, cover the whole incident over as a “bad-apple” and keep you collective heads down and mouths shut until the VA-OIG investigation concludes.  The VA’s ability to abuse whistle-blowers is further compounded by Federal Attorneys who cherry-pick the cases they know they can win.  Which further protects the VA’s shenanigans and disheartens and mystifies those who have been wrongly terminated.  The Daily Signal reflects this pattern of corruption perfectly citing the records obtained by Empower Oversight.

Some commentators have claimed that blaming elected officials for not scrutinizing or not providing tools to investigate entirely is unduly unfair to the congressional representatives.  Really?!?!?!  The VA-OIG conducts an investigation, the people being investigated refuse to comply, and the VA-OIG is toothless to enforce a full and complete investigation to initiate Attorney General and FBI investigations and actions to recompense the defrauded taxpayer.  Ms. Bogue and the VES have invalidated any trust the taxpayer should have in their respective activities, but this, like so many other investigations into VA employees, will die of apathy before anyone is held accountable.  Even though a congressional representative demanded an investigation, nobody is being held liable.  Nobody is forced to compensate the defrauded taxpayer, yet the taxpayer is still expected to elect the same old representatives to their jobs.  Blaming the congressional representatives (legislative branch) for not scrutinizing the executive branch, one of only two jobs these people have, is somehow unfair?  NO!Exclamation Mark

Remarkably, between the 18 March disaster with the PCP and 01 April’s compounding idiocy, the VA-OIG published an ironically titled investigation report.

“Improved Governance Would Help Patient Advocates Better Manage Veterans’ Healthcare Complaints.”

Imagine that, more designed incompetence negatively impacting the veterans seeking care at a VA medical facility, stating the obvious by the investigators.  Who on earth would be responsible for seeing that regulatory agencies had the tools needed to scrutinize and demand corrective action?  Calling all elected officials, did you notice that one of the prima facia tools a veteran has to report problems, conveniently called “patient advocates,” does not have the sufficient authority, adequate oversight, and tools to execute their jobs?  The VA-OIG reports the following:

“The Patient Advocacy Program helps advance the Veterans Health Administration’s (VHA) efforts to improve customer service, support veterans’ access to quality care, and provide a mechanism to resolve healthcare issues.  Patient advocates document veterans’ concerns, communicate the resolution, provide follow-up and feedback, and identify trends for potential opportunities to improve medical facilities.  In FY 2020, VHA tracked about 162,000 serious complaints in its patient advocate tracking systems.”

Angry Wet ChickenOn a side topic, VA-OIG, how do you define a “significant complaint” and separate it from other types of complaints?  Honest question, the information was, to quote my PCP, “remarkably” missing from your investigation report!  Would the VA-OIG like to know why so many veterans’ complaints have risen to a “serious” level?  You reported the exact problem:

“A complaint is considered resolved when the complainant communicates the outcome, and the record is closed in the tracking system.”

Maybe, the VA-OIG merely overlooked the logic problem, but complaints increase when the solution pushed down the throats of the veterans does not fix the actual situation.  Honest question, no sarcasm involved.  Is a “serious” complaint one where significant harm or death to the patient has occurred?  Is a serious complaint one that breaks federal laws, EMTALA, comes readily to mind??u=https3.bp.blogspot.com-fYRTNk48SCwT8ua0IRDWPIAAAAAAAAFZUpexSmJsN2Kos1600overcoming-adversity-help-yourself-believe-cubby-motivational-1289878102.jpg&f=1&nofb=1

Having had “solutions” forced down my throat, speaking only for myself, I am thoroughly sick of having the patient advocates bureaucratize my complaint, then fail to act, and then compound the problem by quoting policy to me as a reason to close the complaint, when the VHA never have written policies and procedures!  Maybe, you might want to look into the root causes of some of those “closed” complaints and ask root causation questions!

What did the VA-OIG find when they investigated the patient advocates?

    • VHA lacked adequate governance of the Patient Advocacy Program.
    • VHA did not effectively issue and implement adequate policy, monitor complaint practices, and provide guidance to medical facility directors responsible for local program management.
    • Patient advocates did not always enter complaints into the system.
    • Even though complaint records generally appeared to be closed on time, patient advocates did not always document the communication of the outcomes to the complainants.
    • The VA-OIG substantiated an inadequate program policy to identify clear expectations and responsibilities.
    • The VA-OIG found that they (patient advocates) did not always adhere to the documentation requirements to show full complaint resolution.
    • At the local and VISN levels, responsible personnel did not consistently analyze patient advocate tracking system complaints about trends.

Feel free to read the complete abomination of designed incompetence for yourself.  Essentially the VA-OIG concluded that the VHA has been burning taxpayer money in a patient advocacy program, and the designed incompetence is so apparent it can be tracked from L2, where the James Webb telescope is located!  Worse, you won’t need the James Webb telescope to see the designed incompetence!James Webb Space Telescope

Unfortunately, I could have guessed the first three findings without looking.  Every VA program is designed so ineptly, reprehensibly led, criminally incompetent, and with such dastardly deceptive doings that fiction writers’ storylines have to be written better to sell books.  You cannot make this stupidity up and make a profit.  Hollywood would run screaming into the night if they made a true story about the ineptitude found at the VA!

Knowledge Check!Elected officials, where are you?  The VA-OIG presents copies of their findings to you, and I have yet to witness a single one of you holding the VA Leadership criminally responsible for the failures at the VA.  Even when the VA is killing hundreds of veterans, the US Congress refuses even to act upset, let alone scrutinize for a change!  Remember how many veterans were intentionally killed in Phoenix waiting for treatment?  How many VA employees lost their jobs and pensions or were forced in front of a judge for murder?  It is a fair question, where are the elected officials in the legislative branch working to end the criminal “fraud, waste, abuse,” and designed incompetence in the executive branch?

© 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.

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.

Revisiting No Neutrality – Today is a Day of Choosing, Tomorrow a Day of Action!

Why The Safe Path Is Dangerous - Tri-Peaks Life CoachingOn 01 July 2021, I first wrote an article regarding how there are no more safe paths, no more neutral zones, no more areas of peace to rest upon.  After the last 15-days, the world has witnessed this reality, and I revisit this topic to issue a plea.  Today, make a choice.  Tomorrow go to work implementing that choice.

In mentioning the following, I am not discussing religion but social history.  The Church of JESUS CHRIST of Latter-Day Saints holds sacred “The Book of Mormon: Another Testament of JESUS CHRIST” as holy scripture.  The book contains a record of a civilization ruled by kings; then, the king proposes a society ruled by judges where their own conscience and written laws govern every person.  Both systems of government worked well.  The reign of the judges ends in chaos when the chief judge is murdered, and the people break up into separate tribes.  That is a couple of hundred years of history boiled into a few brief words; however, the pattern holds true for several other societies not recorded in books considered holy scripture.  I find the following fascinating as a template for the current time the world finds itself facing.

Why do societies fail?

Image - John Wayne QuoteMost societies fail because leaders have violated the core fundamental principles those societies were built upon. The people have lost the way to hold the leaders accountable to the fundamental principles that originally built the society.  In modern societies, these principles are codified laws from founding national documents, and holding the leaders accountable would involve lawyers and judges, as well as time and other leaders committed to holding together the system to ensure those who broke the system are held liable and accountable before the law, and not a mob.

Pick an empire, Rome, Greece, Israel, Egypt, Nephite, etc., all of them suffer the same fate as they crested the height of their time and slid into failure and ruin.  The leaders failed the people.  The government decided they did not have to perform their only job, to look out for the safety and security of the people, and the people died, and the government fell into ruin.  What have we witnessed across the globe, governments not listening to their people, refusing their people, and denying rights and liberties to their people in the name of personal power, wealth, and highly temporary fame.Finest Hour

Australia and New Zealand, the COVID measures are so beyond the pale horrific, and totalitarian that the government is doing more harm than the disease the government proclaims to be fighting.  China has blatantly broken the treaty with Hong Kong.  Nobody outside of Hong Kong appears to care enough to issue strong demands, let alone support Hong Kong’s citizenry in reclaiming that which is their right by treaty.  North Korea continues to vacillate and sway to whatever music China plays in the hopes of catching scraps, as their people suffer and die from malnutrition, disease, and neglect.Patriotism

Head into the Middle East, and that powder keg is going to blow again real soon.  Terrorists in Afghanistan never stay in Afghanistan, and now with a pipeline to China, money, and weapons from America, and new ways and means to launder money, how soon before the Middle East becomes a free-fire zone, the European mainland becomes a terrorist free-for-all shootout to rival America’s Wild West, and Africa descends into more tyranny and villainy?The Duty of Americans

Where are the leaders of government?  Where are the government representatives?  Our globe has changed since 2000; the hoped-for peace from the end of the last century has turned into a blood bath of terror on a global scale fed by low-intensity conflict (LIC).  Just as major international conflicts dominated the previous century, this century is being dominated by small brushfire LIC conflicts.  Our modes of war must change, our governments must adapt, our societies must change, and we are 20+ years into the new century.  The government still thinks this is 1995, money is free, music is 1980s good, and the future is bright and happy!

The Decisions for Today

QuestionWhat do you want most?  What government is most important to you?  Is your government system sufficiently powerful enough a motivator to propel you to action to save it and pass it along to the next generation?  America has had leaders who have been quoted as saying something to the effect of, “The blood of current generations must renew the tree of liberty to remain free.”  What will you sacrifice for liberty today, for your children to experience freedom tomorrow?

LIC is here to stay.  LIC will be the “gentlemen’s war” of this century.  Where the wealthy pool resources and purchase mayhem and destruction for their pleasure.  If society does not change, all representative governments will be lost in the turmoil created by these “children having fun.”  Worse, those little fracases could become full-blown international conflicts with nuclear weapons very easily — all based on the WWI model of human ineptitude and our human weakness for killing ourselves.LIC 2

The decisions are yours, and yours alone to make.  Collectively, your choices will move you into one of two groups, those fighting for representative government and those opposed to representative government.  Truthfully, do not expect to experience peace; there are no safe paths, no routes through tulips and rainbows on gossamer wings of spun sugar plums.  The enemy is awake; the enemy has prepared a legion of useful idiots and ivory potentates to give orders.

But, the decisions must be made, and the sooner the decision is made and communicated, the easier life becomes, for then you know your purpose!

The Actions for Tomorrow

ToolsAct with haste, prepare with confidence, and move with speed.  Get loud!  Stand like a rock!  I was told standing is not an activity.  The person proclaiming that has never stood still and faced down an enemy, or they would know just how arduous standing can be!  Seek learning through study, discussion, questions, and faith.  Seeking learning through faith means that you will actively believe until you can prove otherwise, even if it means waiting patiently for a while to learn more.

I learned this principle in the US Army.  I fully did not expect to learn this lesson, but learn it I did.  I believed in the chain of command.  Basic Training and Advanced Individual Training did nothing to dissuade that the chain of command needed to be accepted, supported, and obeyed unquestioningly.  Then I got to my first duty station and began learning my role in the chain of command as an active participant.  First, I refused to believe, then I believed in faith, then I tested and learned, then I acted above and beyond my rank and got swatted down for breaking the chain of command.  Always the same counsel, you are a great soldier/sailor, but you make decisions above your paygrade, and this rubs higher ranking people wrong.  My response, how am I responsible for the choices and consequences of those higher in rank choosing to be offended?

Knowledge Check!Everyone is now in the same boat; the chains of command cannot be trusted.  We must each think and act for ourselves for the betterment and security of our country, families, homes, freedoms, and the next generation.  We must each choose to throw off the shackles of the past, learn the lessons of history not taught in school, and then act to save the best in our societies before the wolves of terrorism steal everything.  We each must become the sheepdogs of war!

© 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.

Teaching the President Responsibility – I Never Thought I Would See the Day!

Angry Wet ChickenPresident Biden, you, and your administration disgust me!  I did not vote for you, but I was willing to support you as president back in January and show you respect.  Even though I continue to have reservations regarding the veracity of the 2020 Elections, the transparency of the election counts, and the skullduggery witnessed, I was willing to give you a chance.  Your actions in Afghanistan have sundered my cherub-like demeanor and turned the extended olive branch into a torch for your pyre!

Let me be perfectly clear, the blood of every soldier, sailor, airman, Marine, who has served, is serving, or will serve in Afghanistan is on your hands for your ineffective and wholly useless policy in that country!  Worse, the tears and blood of children being abused, murdered, raped, and assaulted are also on your hands.  You allowed a mostly peaceful situation to become an open and festering warzone, again, and it is all your fault!  You cannot blame Congress, you cannot hide behind the media, you cannot shirk accountability behind generals and pentagon officials, you are the Commander in Chief, and it is your sole responsibility to lead the armed forces of these United States.

Sure, we in the service swear an oath to the U.S. Constitution and the officers appointed over us, but the first officer we pledge obedience to is the U.S. President.  You, sir, need to learn responsibility for the men and women you lead.  I plan to teach you and every American who is privileged to read this article the power of the office and the responsibility of the office you hold.  How will I instruct you; through the U.S. Presidents who came before you!Angry Grizzly Bear

The power of Commander in Chief is derived from the U.S. Constitution:

“Article II Section 2 of the U.S. Constitution, the Commander in Chief clause, states that “[t]he President shall be Commander in Chief of the Army and Navy of the United States, and of the Militia of the several States when called into the actual Service of the United States.”

Mr. President, you need to take two lessons from President General George Washington.

      1. “But lest some unlucky event should happen unfavorable to my reputation, I beg every gentleman may remember it in the room that I this day declare with the utmost sincerity, I do not think myself equal to the command I am honored with.”
      2. “In politics as in philosophy, my tenets are few and simple. The leading one of which, and indeed that which embraces most others, is, to be honest, and just ourselves and to exact it from others, meddling as little as possible in their affairs where our own are not involved. If this maxim were generally adopted, wars would cease, and our swords would soon be converted into reap hooks, and our harvests be more peaceful, abundant, and happy.”

Do you understand these two fundamental principles of being the Commander in Chief?  Humility is not a weakness but an inner strength to know and do what is right in exercising your command.  You were given the greatest honor possible, to lead men, and women, into battle, and you have pissed that honor away for trinkets not worth a mess of pottage!Plato 2

The second principle of being the Commander in Chief is demanding honesty, first from yourself, then from others.  Is the job too big for you? It’s no shame to admit you are in over your head.  It is no shame to realize you need help.  It is a crime to act like you have the brains and talent, lying to yourself, while the world burns like Rome and Nero fiddles!  Your counselors, administration, and vice president are all crooks, scoundrels, and fools, but you have the responsibility!  This is why honesty is so desperately needed and fundamentally critical.

President Jefferson provides the following principle for the Commander in Chief, and while President General George Washington embodied this principle, President Jefferson said it best:

“If we are to guard against ignorance and remain free, it is the responsibility of every American to be informed.”

Knowledge Check!Are you informed about the consequences of your decisions?  If so, why are you continuing to adhere to wrongheaded decisions that are destroying America, ruining Afghanistan, and allowing China to threaten her neighbors, bully her neighbors, and be the aggressor party in a prelude to war?  Do you not understand that your responsibility for the consequences of your decisions is eternal, and you owe the God of this land, even Jesus Christ, accounting for how you have led during your time in office?  The blood of innocent people is on your hands because you and your advisors have refused to listen, refused to act, and chosen the worst possible action when working to the detriment of everyone on this planet.  You are actively failing as a president; does this not matter to you?

Inherent in the law is the following axiom:

“Ignorance of the law is not an excuse for breaking the law.”

You need to understand this principle, for failure to be learned is not an excuse, ignorance of the law is not an excuse, and ignorance of the consequences is not an excuse.  You cannot blame your staff when standing before a judge and jury, nor can you evade responsibility and accountability. Honestly, the responsibility ultimately stops at your desk, the music ends, and you are left holding the bag full of whatever crap landed on your desk.The Duty of Americans

President Jefferson also provides the following axiom for a Commander in Chief, one which you have avoided your entire life, and it is time you were made to should this burden as an adult!

“A nation, as a society, forms a moral person, and every member of it is personally responsible for his society.”

What does this mean; allow me to explain using your example.  Your first, Second, and Third attempts at running for president were fraught with verbal gaffes where outright lies, bald-faced untruths, and plagiarized speech were put forth for the public as your ideas and ideals.  Thus making you a liar, a thief, and the worst sort of scoundrel possible, yet, through gerrymandering and a lot of money and your Jello-like spine, you have managed to stay in office long past your maximum level of incompetence.  What sort of moral society have you been promoting and living in?  Do you realize you are responsible for that moral decay you have been broadcasting from your senate office?  Do you know that your morals are now being stamped upon the military, and the military is going to find that your morals do not fit the honor, courage, and commitment needed to fulfill the mission?  The Uniform Code of Military Justice, which you now fall under as Commander in Chief, would find you guilty and in need of severe punishment.  How can a soldier, airmen, Marine, sailor, etc., go before the mast for UCMJ punishment with you as Commander in Chief and be found guilty of morals you exemplify daily?  By the way, this is the same problem your buddy Obama suffered from for eight damnable years when he occupied your chair!Patriotism

Speaking of eternal consequences, and being the Commander in Chief, President Lincoln has some choice words for you to learn.

      1. “In times like the present, men should utter nothing for which they would not willingly be responsible through time and eternity.”
      2. “You cannot escape the responsibility of tomorrow by evading it today.”
      3. “With this honor devolves upon you also a corresponding responsibility. As the country herein trusts you, so under GOD, it will sustain you, [or utterly reject you].”

Knowledge Check!As you have been weighed, measured, and found wanting, I will take a moment and explain to you what these three quotes mean for the Commander in Chief of the U.S. Armed Forces.  Firstly, watch your language.  You have not done very well with this in the past.  Your lies, half-truths, falsehoods, and plagiarized speech is beyond contempt, but the useless speeches you keep giving threatening to put legal and law-abiding citizens in prison for the sole crime of making a living is beyond detestable and shows a definitive lack of character.

Secondly, your words last for eternity.  I remember watching you as a child and thinking, “Putz!” Then cheering when the news broke that you had chucked your campaign for president.  How wonderful the Internet is for bringing back your words for your shame and discomfort, and how I enjoy watching your comments fall from your lips and condemn you for the liar and cheat you are.

Thirdly, those crimes are coming back in spades by trying to evade responsibility yesterday for being a liar and cheat, a thief, and a robber.  But, you have been placed into a position of honor for which you are not comfortable, for which you have not the strength, stamina, and mental fortitude to perform the necessary duties the role commands.  Who is making the decisions in the White House?  Why?

Dont Tread On MeFinally, we come to the absolute crux of the matter.  As Commander in Chief, the honor of commanding men and women in the military comes with a corresponding responsibility. The country loves her military and trusts you to treat them appropriately.  You did not do so in January and got a minor backlash.  You are not doing so in Afghanistan and will catch a much higher backlash as the media watches a repeat of Saigon in Kabul as the Embassy is evacuated.  Your buddy Obama has a dead Ambassador he has never answered for, which (historically) has always been a declaration of war.  What do you have?  An entire country laid to waste, the waste of millions of dollars in materials, millions of lives destroyed, and the wasted efforts of millions of people and multiple presidents.  You have betrayed the American people’s trust, and you will be held accountable, just like your good friend Mayor Lightfoot (with stickyfingers) is being held accountable in Chicago, only many, many magnitudes worse!

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

Paul Harvey – Detestable VA Chronicles for Week Ending 07 Aug 2021

Bobblehead DollPaul Harvey is a hero of mine.  I miss his voice on the radio.  He exuded a calm demeanor, regardless of the terror, the trials, and the terribleness of the news reported and discussed.  I do not have Paul Harvey’s sense of calm.  When I heard about the beheading of a woman in America, in broad daylight, by an illegal immigrant who has been on a one-man crime spree from El Paso to Minneapolis since 2007, my cherub-like demeanor took a tremendous hit.

The Department of Veterans Affairs (VA) – Office of Inspector General (VA-OIG) reports on a couple from Kansas who are flat out despicable, faking blindness to increase disability payments from the VA and Social Security.  Frankly, I hate liars and thieves and agree to the restitution ordered, but I do not agree that the couple deserved probation.  Stealing benefits should come with more than simple probation and restitution.  Where is the community service in distinctive clothing and sandwich boards declaring they are thieves?VA 3

However, this couple represents a symptom, not the disease of the VA and Social Security specifically, and the Federal Government generally.  When leaders act reprehensibly, criminals will test the system to find weaknesses and attempt to benefit from leadership failures.  The disease of poor leadership has far-reaching consequences, and criminal activity is not unexpected.  Who is addressing the disease?  When will the citizens of America receive justice to see the healing of the illness that has captured the government?

Military Sexual Trauma

I-CareImperative to understanding, Military sexual trauma (MST) experienced while serving in the military affects both women and men with potentially severe and long-term consequences. Psychological trauma, such as MST, also increases the risk of physical health conditions such as cardiovascular disease, stroke, and diabetes.  The Veterans Health Administration (VHA) requires that each facility has a designated MST Coordinator with at least 20 percent of their time dedicated to protected administrative time.  For the record, “protected administrative time” is the time required to be spent on administrative duties, writing clinical notes, ordering supplies, scheduling appointments, administrative responsibilities, and so forth.

In 2018, the VA-OIG discovered just how detestable and deplorable the VBA’s processes and procedures were for military sexual trauma (MST).  Having been a victim of MST, this issue is of particular interest to me, and I continue to follow this issue closely.  I wish I had some encouraging news on this issue, but the VA-OIG found:

“… Processors did not always follow the updated policies and procedures. VBA leaders did not effectively implement the VA-OIG’s recommendations and did not ensure adequate governance over military sexual trauma claims processing. The VA-OIG concluded that VBA was not properly implementing the recommended changes.”VA 3

In 2016, when claims were being improperly and prematurely denied, the problems were considered a lack of training, a lack of policy, a lack of procedures, and comprehensive guidance was needed.  In 2018, additional training and guidance were needed, time, and leadership were recommended, even though claims were still improperly and prematurely denied.  In 2021, it is now blatantly obvious we have a systemic failure of leadership at the VBA to process claims in a manner that is conducive to good order and discipline!

On the same day, this investigation was released, the VHA investigation results for MST coordinators were released to the public.  I bet you can guess what was found, but let’s allow the VA-OIG the opportunity to detail the failures:

“The VA-OIG conducted a national survey and interviews to evaluate MST Coordinators’ duties and perceived challenges.

            • 80% of the respondents reported having been assigned at least 20 percent or more of protected time.
            • 39% reported inadequate resources to fulfill MST Coordinator administrative responsibilities.
            • The VA-OIG found that insufficient protected administrative time, role demands, insufficient support staff, and inadequate funding and outreach materials challenged MST Coordinators’ ability to fulfill role responsibilities.
            • The VA-OIG found that MST Coordinators who reported more dedicated time than other MST Coordinators did not necessarily serve at facilities with higher numbers of patients in MST related care.”VA 3

Did you catch that final point?  Resources are not being adequately provided based upon patient load to locations where veterans need care.  Another symptom of leadership failure, being designed into the organization as a policy and working procedure, meaning this is designed incompetence!

Knowledge Check!Here’s the biggest rub, a veteran can be receiving care from the VA for MST at the VHA and still be denied MST on a VBA claim.  I have not heard it working in reverse where a claim is being paid, but the VHA refuses care, but given the failures of the VA as an organization, I would not be surprised to learn this was occurring.  How do I know that care can be provided for MST and not be allowed on a claim?  I am among a number of MST victims, all-male, who have been regularly denied VBA claims but are receiving care for the psychological harm.  Veterans talk to each other.  I have heard the stories of fellow veterans being attacked, assaulted, molested, drugged, raped by male and female attackers, and heard how the VBA had revictimized them.

What’s worse, MST leads to PTSD, and people are suffering PTSD from a number of traumatic events not receiving care or benefits because the VA refuses to acknowledge these problems.  Admitting a problem is the first step in addiction programs; well, it is also the first step in healing leadership failure, and the VA is suffering from dynamic leadership failure at every level!  Know a veteran whose story needs to be told, refer them to me; let’s get this information out.  I am sick to death of the VA getting away with murder.

Programs and Inspections

VA SealThis week, the final three emails from the VA-OIG reflected a VISN wide comprehensive healthcare inspection (CHIp) conducted virtually, a VAMC/VAHCS CHIp conducted in Spokane, Washington, and a program report on the failures in the Veteran-Directed Care Program.  The most interesting finding in the CHIps was how short the leadership teams had worked together, a month, and how many open positions for leaders there were, more than half.  Talk about glaring symptoms of leadership failure, were the leadership teams broken up from employee turnover?  If so, did the employees retire, or were they retired to avoid criminal convictions?  With all the investigations for fraud, as discussed on these pages frequently, I can only guess how leaders churn in a VAMC/VAHCS/VISN.

Believe it or not, the Veteran-Directed Care Program is full of faults, problems and is suffering from a lack of leadership as the program balloons.  Color me shocked!  Surely, somewhere in the VA, if only to screw with the gods of perversity and Murphy their prophet, there must be a functioning and well-led program, department, office, etc.Angry Wet Chicken

It is so absurdly depressing to catalog these failures of leadership week after week and never see any improvement.  We see increasing failures, we observe heightened criminal activity, there is undoubtedly raised awareness of needs and moral distress in abusing veterans, but where is the improvement towards achieving excellence?  Where is Congress in scrutinizing the legislative branches, officers, and leaders?

If a congressional representative can order the VA-OIG to investigate the MST Coordinators, which they did, where is Congressional action on the results?  Surely this is not too difficult a question to ask.  Better still, where is Congress?  I have now reached out to all the elected Federal officials in Arizona, Texas, and New Mexico.  Texas, because that is where I have been forced to receive care from.  New Mexico because I now live here.  Arizona because I was physically injured by VA employees there.  The amount of interest received has been less than zero!Angry Grizzly Bear

How can interest be less than zero, you ask.  Well, while I have not received any response to my original complaints, I have received a TON of marketing materials about how those congressional representatives “Care about veterans, the community, pets, animals, and America.”  Maybe, not always in that order, but absolutely with less sentiment than I have for the weeds growing on my sidewalk!  Thus, I ask again, with all sincerity, where is Congress in scrutinizing the government?  I demand to know the “Rest of the Story!”

© 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

© 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.

It IS ALL About Leadership – More Shameful VA Chronicles

I-CareRecently, guardianships have been in the news, and I doubt this story will make the lawyers very happy.  The department of Veterans Affairs – Office of Inspector General (VA-OIG) reports that an Albuquerque couple has been sentenced for defrauding guardians, which included veterans.  The criminal report claims:

“Susan Harris acted as president and was the 95-percent owner of Ayudando, while Moore acted as chief financial officer and was a five-percent owner. They engaged in a pattern of criminal conduct from November 2006 to July 2017 that included unlawfully transferring money from client accounts to a comingled account without any client-based justification.  They wrote and endorsed numerous checks, often of more than $10,000, from these comingled accounts to themselves, family members, cash, and other parties where payment would benefit their families.”

For the better part of 11 years, this couple has spent money not their own, abused their charges, and defrauded vulnerable clientele.  While the federal attorneys and investigators crow about catching this couple and ending this situation; what about all the rest of the guardianships where abuse is occurring?  I have read horrific stories about victims of guardianship abuse and hope more will be done on this topic very shortly!VA 3

For 11 years, where were the VA and the Social Security Administration?  Where were the local hospital leadership, social workers, and other federal employees who had to have known something fishy was going on?  Where are these Federal Employees now?  Where are the politicians scrutinizing this incident to ensure that protection for vulnerable citizens never happens again through legal guardianships?

Now traveling to Eastern Oklahoma VAHCS in Muskogee where an audiologist provided poor care and billed for unrendered services.  Pay close attention to the VA-OIG report; the leadership failures on this report alone are voluminous and unforgivable!

“A facility fact-finding review revealed the audiologist provided poor care to eight of 43 patients reviewed, including misinforming patients who needed hearing aids that hearing aids were not needed. Although the audiology leaders reported the fact-finding results to the OIG, they failed to evaluate whether patients needed clinical follow-up; determine whether additional patients were affected by the audiologist’s poor care; evaluate whether clinical disclosures were required for the affected patients; and communicate the fact-finding results to the Facility Director, who was, therefore, unable to initiate the process to determine the necessity of a large scale disclosure. The instances of poor care were also not reported to the Patient Safety Manager, who was, as a result, unable to assess the adverse events to determine if patient safety interventions were indicated. The VA-OIG also found that performance monitoring of facility audiologists was not conducted as required. Annual competency assessments and annual performance appraisals were not consistently completed and did not contain adequate performance standards. Audiology leaders failed to consider whether the audiologist’s actions warranted a report to the state licensing board due to a lack of understanding of the requirements for reporting and, therefore, the Facility Director was not informed of the need to initiate a state licensing board review” [emphasis mine].

Will, someone please tell me, were the audiology leaders who failed to perform their jobs removed from Federal Employment?  What about the audiologists causing the problems?  Are they removed from Federal Employment?  Were their licensing practices curbed to protect other populations of patients?  The leadership failures here read like a Steven King horror story but do not have the satisfaction of finishing the story.VA 3

Yet, the Department of Veteran Affairs (VA) will continue to market that they are “defining quality in healthcare.”  The jokes write themselves but cannot be fired from Federal Employment!  Politicians, why can these jokers not be fired from Federal employment for such egregious abuse of their positions and failures to do their jobs?

I-CareTraveling further to North Carolina, we find that the perpetrator of this fraud has pled guilty, but again responsibility, accountability, and correction of the VA is being skirted.

“John Paul Cook, 57, of Alexander, North Carolina, pleaded guilty to defrauding the VA. After enlisting in the Army in 1985, Cook sustained an accidental injury and complained the injury worsened a preexisting eye condition. In 1987, Cook was discharged, and he began receiving benefits that would increase over the next 30 years due to Cook’s repeated false claims of increased visual impairment and unemployability. In 2005, the VA declared Cook legally blind, and he began receiving disability-based compensation at the maximum rate despite repeatedly passing vision screening tests to obtain or renew his driver’s license and purchasing vehicles that he routinely drove.”

1987 to 2020, we will be generous in counting the years here; regardless, we are looking at 30+ years this fraud continued.  Where were the verification protocols?  I have had to produce a valid driver’s license at the VA to obtain and keep current my VA identification card.  How did this fraud go on for so long?  What is the VA doing to stop, or at least hinder, those who would defraud the government before the problem becomes 10 years old, let alone 30?!?!  I cannot fathom how this fraud went on for so long without a routine checkup, a routine exam, a follow-up exam, etc.VA 3

Going north from South Carolina, we find more fraud, this time in New Jersey, where a man did not report his mother had deceased and continued to claim her benefits for a total of over $200K.

“Melvin Greenspan, 72, of Perrineville, New Jersey, pleaded guilty to defrauding VA of over $200,000 in survivor’s pension benefits. After the death of his mother in 2006, who had received survivor’s pension due to his father’s prior military service, Greenspan failed to notify the VA about his mother’s death and made withdrawals of the benefits through 2018.”

Where was the leadership?  Where are the leaders now?  Another fraud case, older than a decade, and still the VA cannot be held accountable for facilitating the fraud.  I am stunned!  How did this one continue for so long?  Doesn’t the VA check local newspapers, the Social Security Administration, other Federal Agencies?  Since the culprit was not held on defrauding SSA, one can only presume the mother’s death was reported there.  Why did the VA not get notified to ask the family questions?VA 3

On the topic of guardians and leadership, the following story makes me angry!  However, I will withhold further elaboration since those accused remain innocent until proven guilty by a trial of their peers.

“Johnny Ray Gasca, 51, was arrested for allegedly abducting a 68-year-old woman with dementia from the West Los Angeles VA Medical Center in California. A witness recognized Gasca and reported he might have previously taken money from the woman’s bank and retirement accounts. Following his arrest, Gasca described the victim as his girlfriend and told agents that they stopped at a bank where the victim made a $15,000 withdrawal after leaving the medical center.”

In the first report from the VA-OIG discussed, we found guardianship rules being violated to the Nth degree.  In this story, we have no information of an assigned guardian, and we have a dementia patient being abused.  The dementia patient was traveling with a friend; who is the legal guardian for a dementia patient?  Where are the family or friends legally bonded to render aid for this patient and monitor finances to protect them from abuse?  How can the VA operate one way in one locale and 180-degrees differently in another locale and the leadership not held accountable?VA 3

Speaking of missing leadership, the following VA-OIG report is a beauty!  The Department of Veterans Affairs – Veterans Health Administration (VHA) has a program to help homeless veterans, where contractors are used, and the VHA uses case management documentation to verify the veteran is receiving the assistance being paid for, the program is called the contracted residential services (CRS) program.

“The VA-OIG found facility staff did not consistently document case management and monitor the progress of veterans in the program.  Further, four of the 14 CRS contracts reviewed had performance deficiencies, with one resulting in improper payments of $592,000. These deficiencies may affect the health and safety of veterans living in transitional settings. Moreover, VA lacks assurance that veterans received required services. There were also contract administration problems in 13 of 14 reviewed contracts. Contracting officers did not always properly delegate responsibilities to staff functioning as contracting officer’s representatives. Further, one facility’s representative did not ensure contractors provided meals or the means to purchase them, as required, and another lacked invoice supporting documentation for approval. The VA-OIG audit team estimated that 107 of 119 contracts had monitoring and administration deficiencies. Furthermore, the team estimated that VHA made $35.3 million in improper payments, of which approximately $21.6 million was technically improper because the individuals authorizing payment were not delegated authority to serve as contracting officer’s representatives.”

If your accomplishment rate in your employment was 48%, would you retain your job for very long?  If 90% of your documentation claiming how well you do your job was missing or fabricated, how long would you maintain employment?  If you delegated people to complete your work who were unauthorized and you were contractually culpable, how long do you think you would stay out of prison?  How long would your boss stay out of jail?  How long would your company exist?  Now, answer me this riddler, why does the government get a pass on these questions?VA 3

Finally, we have Deputy Inspector General David Case’s testimony regarding the failure of VA leadership where the implementation of a new electronic health record (EHR) is being stalled.  If you care, the VA leadership and the VHA leadership are failing the EHR initiative.  Not that this was not expected, and not that this is not surprising, the IT and IS departments of the VA and VHA are so hopelessly lost it amazes me the VA is even using computers and not written records!  But, do not take my word for it, Case himself claims,

“Detailed in this statement, we have repeatedly found unreliable and incomplete estimates for upgrades and costs, inadequate reporting affecting transparency to Congress, and stove-piped governance with decision making that does not appropriately engage Veterans Health Administration (VHA) personnel who are the end-users of the new EHR system.”VA 3

Knowledge Check!Get that; the leadership failures are obstructing Congress and hindering the EHR progress!  What can we conclude from this batch of VA-OIG reports:

        1. The VA, VHA, VBA, and National Cemetery leadership are actively missing, like the Democrats from the Texas Legislature.
        2. If the leaders are present, the leaders are the problems in progressing.
        3. The leaders have created a system where fraud and abuse of the veterans and taxpayers can be achieved with ease.
        4. Nobody in the US House of Representatives or US Senate scrutinizes the legislative branch sufficiently to effect changes.
        5. When in doubt about where your leaders fall, check to see if they are in their offices. Oh, wait, that won’t help, their offices have locks on the doors!

If this is how the VA defines quality healthcare. In that case, the veterans are screwed, the taxpayer is sunk, and the leaders will enjoy their magnanimous federally approved retirement packages, ad nauseam ad infinitum!

© 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.