“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 2022Sen. 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.

NO MORE BS: Have You Heard?

DutyThe following is a recap of several stories that should have been big news, but since the corporate media is practicing “Biden Behind Covering” (BBC), I doubt this news was heard anywhere.  However, this information is critical, and I have included the links if you want more than my paltry summation of the story.  I encourage you to always hit the links included in the articles I publish, so you know where I get my source materials.

Judge for yourself the importance of the following, but I encourage you to judge wisely, for America is in deep trouble!

Inflation Definition: Formula & How to CalculateFrom the NCSL regarding the future of finance, we find a curious article, “Do State and Local Governments Need to Worry About Inflation?”  The simple answer is absolutely, as the continuing pension crisis will be multiplied as inflations grows.  How much is inflation up, a year ago inflation was 4.2% less than it is today.  But that is a statistic that doesn’t carry the real weight of the problem.  If you owed $100 last year, without interest calculations, you now owe $4.20 more.  That $10.00 steak is now $10.42, before taxes.  That tank of fuel, before all the taxes, is $0.42 more expensive than a year ago, and inflation was already hurting America.  The way inflation works is comparable to running on a freshly waxed floor in your socks, you have to exert more effort to maintain your same spot, forget slowing down, or stopping for that will include falling.  Let me reintroduce you to a term used in the early 1970s, stagflation.  Stagflation occurs when the inflation rate is so out of control, no new jobs are created, employers are looking to cut employees left and right to maintain shareholder profits, and the entire economy grinds to a messy halt.

Inflation may erode PTI's political capital - Newspaper - DAWN.COMRisk managers across the financial system are looking at the government on the Federal, State, and Local levels and are not liking what they see as inflation continues to grow beyond the Federally approved 2% annual allowed rate.  As taxes adjust for increased inflation, it will require more money to pay taxes to maintain current levels, as inflation depletes the value of dollars saved.  Thus, every government is looking at their “Rainy Day” funds, and are watching it depreciate as inflation increases, and this is happening before a penny is even spent.

VaccineFrom SHRM, we find the next astounding piece of news, the “EEOC Gives the Greenlight for Limited Incentives for COVID-19 Vaccinations.”  Mandatory vaccinations are illegal in the United States, currently.  However, incentivizing vaccinations by an employer has now been made acceptable.  Do you see a problem with this EEOC ruling?  Did you notice how slippery the slope is between employers incentivizing vaccinations and mandatory vaccinations?  During periods of higher inflation, how much value is $500, from an employer to vaccinate?  Other employers are allowing employees to sticker their badges showing they vaccinated and can stop wearing a mask in public.  No sticker, you have to keep your mask on.  Slippery slope?  Colleges, K-12 Schools, and other organizations all have a hodgepodge of rules for mingling in a post-COVID government mandated lockdown, as the “New” normal.

Do you see the problems with employers picking winners and losers based upon vaccination status?  How long before those who cannot, or will not, be a guinea pig for a useless vaccine, that is shrouded in mystery, and which has zero long-term studies completed, for a viral disease with a 99.02% chance of survival, are shown the door because of risk averse insurance policies?  I have some concerns with this decision and remain convinced that the EEOC has been bought and paid for by parties unknown.  Their last several decisions have left me seriously concerned.  Watch the bureaucrats, they are sneaky!Plato 2

Virginia Allen, writing for The Daily Signal, provides the next piece of news that should be wall-to-wall with parents marching.  “California Public School Gives Third Graders Assignment About ‘Place on Gender Spectrum.’  Let that sink in for a moment.  9-year-old students are being asked to choose where they place themselves on the “gender spectrum.”  What the heck is a “Gender Spectrum?”  At 9-years old, I was more interested in getting better at little league than I was about anything else, except my paper route.  A quote from the article sums the problem nicely:

The school board is completely indoctrinated. Many teachers are completely indoctrinated. … You cannot change their mind. The only thing you can do is vote them off [the school board] and let them know there are consequences to teaching children inappropriate things for their ages.”

When your politicians are no longer afraid of the citizens they afflict, tyranny has begun to reign!  California is a perfect example of what happens when the populace checks out, the politicians stop fearing the ballot box, and power concentrates under a single party.  Now, ask yourself, is this the America you want for your kids and grandchildren?  I know my answer!Apathy

Cal Thomas also writing for The Daily Signal, presents the scariest topic of all, “Ministry of Truth 2.0.”  Consider for a moment, you make a comment in a grocery store, an off-hand comment to another person, the next day a person from Homeland Security is knocking on your door to discuss your passing of disinformation, who possesses the legal authority to place you under arrest, no evidence needed, and you are guilty until reluctantly allowed to be innocent.  From the article:

Secretary of Homeland Security Alejandro Mayorkas is reportedly considering the development of tools that would help America’s children discern truth from lies and know when they are being fed “disinformation.”

Millstone of Designed IncompetenceIf you have not read, or listened to, George Orwell’s book 1984, you might not recognize “the Ministry of Truth,” which is the propaganda arm of the government who rewrites history to what the government says it is, and not what actually happened.  Would someone please explain to me who appointed the Homeland Security Secretary the harbinger and decider of truth and lies?  When the media cannot even get the truth right, how will a government, senate appointed, person who serves at the pleasure of the current sitting US President know, recognize, or even understand truth?  When the media allow truth to be “subjective to circumstances, environments, and cultures,” how will bureaucrats be able to discern truth?

Tell me, how will the tools be protected from the bias of the tool designers?  One of the biggest issues in modern research is researcher bias; yet somehow the secretary of Homeland Security can magically control bias to protect the tools from the opinions, knowledge, experiences, and politics of the designers.  Exactly how will this occur?  Do you recognize how slippery this slope is, and how dangerous?Why

As a homeowner in a town that is within 50-miles of the southwest border, the continued blind-eye being turned to the southern border infuriates me.  Please, follow this link, and then consider what is being said.  Do not look at the politics of the situation, do not listen to the political leaders and political commenters.  Listen to your heart, your gut, your conscience, and tell me, if the 9-year old girl was your sister, cousin, daughter, what would be your response?  From the article we also find the following:

The cartels are making an ungodly amount of money on a daily basis, somewhere to the tune of $15 to $25 million a day in just the trafficking and smuggling of human beings. That doesn’t include the narcotics. We’re seeing, for example, fentanyl, 5,000% increase in fentanyl coming across the border.”

America Is Crying Digital Art by Deborah VicinoWant to hear the truth about the problem on the southern border, let’s talk about “got-aways.”

Got-aways” are individuals that are crossing the border illegally that don’t want to get caught. They don’t want to go through processing because they are either a gang member, someone on the terrorist watch list, a convicted sex offender, [or] a violent offender. These are people who know that once they are caught, they will get turned right back around because of their record, because they have a record in the United States.”

From January to June, the Border Patrol, through all their efforts, have lost around 200,000 “got-aways.”  These are people seen on cameras, who have eluded apprehension, and are now roaming American streets.  A convicted sex offender was given a small baby to help him cross the border.  Where the parents of this child are, no one knows.  So, even when they get caught, we still have problems getting rid of the vermin mixed into this humanitarian crisis.  How many terrorists from non-South and Central American countries have slipped through as “got-aways?”

Knowledge Check!America is being taken for a ride by the Cartels who run the Southern border!  This is the truth, and anyone trying to tell you something else is selling snake oil and trying to make a buck off the tragedy that is the US Southern Border.  Like all evil and conspiring people through history, the innocent are the shields covering the criminal actions, these children deserve better, but they will never have a future until America becomes a land of laws again, where the Rule of Law is honored.

Child Abuse - New Day Advocacy CenterCan you hear the Statue of Liberty weep at how are laws are being manipulated by the drug cartels, for the glorification of single-party rule and fiscal return on investment?

© 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.