NO MORE BS: Presidential Appointees

I-CareEvery new president hired has a list of appointees to fill in various leadership positions for the government’s executive branch.  The US Senate must approve some of these appointments, and other special conditions apply to their roles and functions.  The following is a discussion specific to the Department of Veterans Affairs (VA) but is benchmarkable to all the Federal Government’s alphabet executive and legislative appointee departments.  Important to note, “Presidential appointees come and go, but entrenched bureaucracies are allowed to live forever.”

How big is the US Government?

There are over 9,000 potential civil service leadership and support positions in the Legislative and Executive branches of the Federal Government that may be subject to political appointments.  There are four distinct types of presidential appointments, as outlined below, copied from ACSLAW.org.

    • Presidential Appointments Requiring Senate Confirmation (PAS)
        • These are top-level, senior positions that include the heads of most major agencies. Including cabinet secretaries, agency leadership at the Deputy Secretary, Under Secretary, and Assistant Secretary levels, the leaders of most independent agencies, ambassadors, and US Attorneys. Some positions within the Executive Office of the President, including the Office of Management and Budget director, also fall in this category. These positions require a congressional hearing and a confirmation vote in the US Senate [emphasis mine].
    • Presidential Appointments Not Requiring Senate Confirmation (PA.)
        • This category includes hundreds of positions, including most jobs within the Executive Office of the President. These include most senior White House aides and advisors as well as their deputies and key assistants. These appointments do not require a Senate hearing or vote [emphasis mine].
    • Non-Career Senior Executive Service (SES)
        • Members of the SES serve in key positions just below the top Presidential appointees; the posts were designed to be a corps of executives charged with running the federal government. These positions include senior management positions within most federal agencies and serve as the significant link between top political appointees and the rest of the federal workforce. While the SES mostly consists of career officials, up to 10%, or (as of 2016) 680 positions, can be political appointees. Unlike the presidential appointments, the non-career SES appointments tend to be made within each agency and then approved by the Office of Personnel Management (OPM) and the Presidential Personnel Office (PPO).
    • Confidential or Policy-making Positions (Schedule C (SC.))
        • These positions consist of political appointees in policy-making positions or positions that require a close working relationship with the incumbent officeholder or key political officials. Schedule C positions may be designated by the Office of Personnel Management (OPM) or the President’s Executive Office at an agency’s request.

I repeat, only for emphasis, presidential appointees come and go, but entrenched bureaucracies live forever!  Presenting the first problem of American Governance, the Federal Government is too bloody big!  Worse, State Governments mirror the Federal Government, and how many of those are too bloody big, 50!  Add in the city/town, county governments, and the most incredulous and pernicious problem facing action and change in America is the bloody government’s size!

ProblemsUnfortunately, the government’s size masks another problem, the incredible size of Non-Government Offices (NGOs), the United Nations, the NATO, and other agencies created through treaty, Lobbyists, Lawyers, and other non-governmental but still official people working in or on government at the Federal, State, and Local government capacities.  Since the Great Depression recovery began, the government of all levels has exploded in the growth of people, costs, resources absorbed, and more.

Bringing us back to the Senate Approved Presidential Appointees.  The US Senate confirmed VA Secretary nominee Denis McDonough Monday, Feb. 8, and he was sworn in as the eleventh VA secretary.  A brief biography of Secretary McDonough.  A native of Stillwater, Minnesota, Mr. McDonough graduated from Saint John’s University in 1992 and Georgetown University’s Edmund A. Walsh School of Foreign Service with an MSFS degree in 1996. McDonough has extensive experience on Capitol Hill, having served as White House chief of staff under President Barack Obama, deputy national security advisor, and chief of the National Security Council staff.  A proverbial insider to left-leaning politics has been made Secretary of the VA, who, like the fraudulent president, is calling for unity while working to ruin political opponents and destroy the US Constitution.

VA SealHere’s the real problem, political appointees, set the culture for the entire VA.  Over the last four years, Secretary Wilkie has had his hands overfilled with the abhorrent culture set by his predecessor, which allowed for tremendous amounts of skullduggery, crime, illegal action, and much more to thrive in the VA Now, without any further ado, let’s discuss some of the problems Sec. Wilkie found after the Obama Presidency.

Veterans experienced blatant HIPAA and EMTALA abuses at every VA medical center (VAMC) across the country, as witnessed by employee whistleblowers who were then fired or abused by the VA bureaucracy for telling the truth.  Over the last four months, the VA-Office of the Inspector General (VA-OIG) has prosecuted multiple cases of theft of funds, theft of government resources for resell, and other criminal elements in the employees of the VA.  A culture allowed to grow and breed under all three of President Obama’s VA Secretaries, Shinseki, acting Secretary Gibson, and McDonald.

Survived the VAThese three President Obama VA Secretaries should still spark a memory.  They led the VA through two cases of where the Phoenix VAMC was killing veterans.  Where the employees responsible skated, the media required a scapegoat, and the VA Secretary’s left government service with full pensions, retirement benefits, and other goodies at taxpayer expense!  Talk about “Golden Parachutes!”

Within just the last two weeks, or since the start of February 2021, the VA-OIG has reported seven cases of misconduct by VA employees and other related individuals.  Including a woman who faked her death to avoid being held accountable for defrauding the VA.  She and her husband will be held responsible, but the entire sordid affair had help from VA employees not being held accountable for not doing due diligence or their jobs.

From the VA-OIG report, we find the following:

Robert S. Stewart Jr., 35, pleaded guilty to making false statements in order to obtain multimillion-dollar government contracts, COVID-19 emergency relief loans, and undeserved military service benefits. Stewart, the owner, and president of Federal Government Experts LLC, also defrauded the VA by falsely claiming to be entitled to veteran’s benefits for serving in the Marine Corps when, in fact, he never served in the Marines. He is scheduled to be sentenced on June 16, 2021.”

ScalesAgain, we have a perpetrator who needed help from VA employees to defraud the government, which are not held liable as co-conspirators to a crime.  I want to know why?  To register as a veteran, you need documentation, and that documentation has to be approved by several people.  A 201 File is required.  Other supporting documentation is required to show duty in dangerous situations, orders for transfer, a monumental paper trail that is generated, securely kept, and digitized for ease of data checking.  All of which require VA employees to do their jobs correctly.  How can falsely claiming veterans’ benefits still be occurring?  Where are the employees conducting quality assurance checks and performing their roles?

From the VA-OIG report, the following is obtained.

Thomas E. Duncan, a VA procurement supervisor at the Jesse Brown VA Medical Center in Chicago, Illinois, was charged with five counts of wire fraud, one count of witness tampering, and one count of falsifying records. Duncan allegedly received approximately $36,250 in kickbacks from Daniel Dingle, the president of a medical supply company, in exchange for steering at least $1.7 million in product orders to Dingle’s company, many of which were never fulfilled. Dingle was charged with four counts of wire fraud.”

Detective 4I find it interesting how long these fraud schemes are surviving, and I am always left asking, “What else occurred that was “beyond the scope” of the VA-OIG investigation” that will not be charged.  This procurement supervisor felt comfortable defrauding the VA, which tells me that he learned how to commit fraud from someone and taught fraud to others, so what else is occurring that is illegal, unethical, or immoral in this department?

From the VA-OIG report, we find two cases of interest, including another prime example of a third party, able to defraud two different government bureaucracies and no employee accountability.

Kelly Wolfe, 49, pleaded guilty to conspiracy to commit health care fraud and filing a false tax return. In addition, Wolfe and her company, Regency, Inc., have agreed to pay up to $20,332,516 to resolve allegations that Wolfe and Regency violated the False Claims Act, including falsifying documentation in order to fraudulently establish durable medical equipment corporations to bill Medicare and CHAMPVA for medically unnecessary equipment.”

Darren Cady, owner of Southeastern Physical Therapy in Ashville, North Carolina, agreed to resolve allegations that he received illegal kickbacks and violated the False Claims Act by submitting claims to the VA for reimbursement for medically unnecessary durable medical equipment.”

Will someone please explain how the employees can shirk responsibility for allowing this crime to occur?  Will anyone investigate the cultures of corruption that enable and empower these nefarious beings access to taxpayer dollars?  What about the victims who are refused care because crime sucked resources out of a government program?

The providers’ fundamental roles in VAMC’s across the country are the communication of test results in a timely, honest, and forthright manner.  Yet, one of the first things you learn as a patient of the VAMC is that test results are never discussed forthrightly, honestly, or timely!  I suffer from this problem daily.  Apparently, the problem is so expansive that the VA-OIG investigated the Beckley VAMC in West Virginia and found abused patients, but the VA-OIG claimed the patients were not adversely affected, no harm, no foul, and recommendations were made to improve patient communications.  I could scream in frustration at how often this scenario repeats at the VAMC’s across the US.  Even when the VA employees have caused adverse patient results by not communicating test results, the VA Employees skate on being held accountable.

LookGo to a non-VA hospital or medical doctor if they do not contact you about your test results; regardless of the test results, do you become frustrated, less trusting of that provider, and concerned about your health?  Yet, the VA can routinely, as in every patient, withhold, delay, or obfuscate patient communications and never is held accountable!  That is what is meant by a culture of corruption!

The last entry in our two-week window of the VA-OIG reports is the declarations of insufficient oversight for issuing prosthetic supplies and devices.

VA’s Prosthetic and Sensory Aids Service (PSAS) is the world’s largest provider of prosthetic devices and sensory aids. Prosthetics include artificial limbs and any device that supports or replaces a body part or function, such as wheelchairs and pacemakers. Sensory aids include hearing aids, optical prescriptions, low vision, mobility aids, speech, and communication aids. The cost of PSAS services increased from over $2.9 billion in fiscal year (FY) 2016 to nearly $3.5 billion in FY 2019. … Consequently, VHA improperly issued an estimated $15.8 million in prosthetic supplies in 2017. However, 94 percent of transactions related to deceased veterans were proper. The remaining 6 percent were improper, but the OIG did not identify evidence of fraud with respect to these errors. VHA also maintained adequate oversight of duplicate supply issuance [emphasis mine].”

Let’s review;  100% of the cases reviewed, 94% went to deceased individuals, 6% were improper, but the oversight was adequate.  Are you kidding me?!?!  What does a deceased person need with prosthetic devices?  When we discuss employee accountability, proper role fulfillment, and proper oversight through process regulation, this includes protecting the taxpayer from abuse by sending deceased patients expensive medical equipment.

Presidential appointees are in a difficult position; they must serve at the president’s pleasure and lead an organization with an entrenched bureaucracy.  However, the manner of the presidential appointee’s leadership is the living factor that becomes the employees’ behavior, attitudes, and ethics.  Having written about the VA-OIG reports for over 10-years, I have seen good leaders come, and bad leaders go, but always the front-line patient-facing employees will mimic the attitudes, behaviors, and ethics of the presidential appointee, who was hired after Senate confirmation.

PatriotismTo change this paradigm and improve the employees’ behavior, there must be significant and fundamental changes in government size and the government leaders being held personally accountable for the harm and the failure of those being led to do their jobs!  When you do not know the problem, abuse of your rights, privileges, and freedoms occurs.  If you ever need to see why the government size matters, read a few offices of inspector general reports.  These reports are delivered first to the elected representatives, who are supposed to enforce the law upon the executive branch as a money-saving measure.  When was the last time you saw this occur in those televised committee meetings; not, in my lifetime!

© 2021 M. Dave Salisbury
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