“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.

Continued Inanity from the US Government – Where are the Elected Officials?

Angry Wet ChickenI made the mistake of ranking the various government agencies on how intractable, unintelligent, and irresponsible they are.  I ranked the IRS based upon previous experience more competent than the VA.  That is a mistake I will not repeat any time soon, as the VA and the IRS are in a neck and neck race to the bottom!  Consider how the IRS sends you paper mail notifications; if you have questions, you are referred to a website for answers and provided several customer service numbers.  Except, when the website fails, you call the notifications’ numbers and are told that you need to visit the website for faster service.  The website refers you back to customer service, whose phone queues are always so full you are automatically disconnected after being reminded to use the website for faster service.

As my mind experiences a total meltdown, I begin twitching, and my head eventually explodes; check out this cat picture:Funny Cat Backgrounds, Pictures, ImagesDignified Stray Cat Photos Celebrate Their Unique Beauty

Some will declare this is a one-off incident; surely, the IRS is not this dysfunctional.  Try it for yourself sometime.  I never ask anyone ever to, believe me, experience this for yourself.  Check out the IRS website https://irs.gov.  Try to get solid and reliable information, and see how fast your head wants to explode.  I have been trying to appeal a decision the IRS made arbitrarily since 21 March 2022 and gotten nowhere fast.  Best of all, I have a deadline of 20 May 2022 to register an appeal, yet the website cannot answer my questions and points me back to the phone number on my notification.  The phone number auto-answer assistant refers me back to the website shortly before disconnecting my call.

As a small business owner, I had trouble getting my Tax ID number; the website said to call customer support, the phone number referred me back to the website and then disconnected my call because the queues were too full.  Ad Nauseum Ad Infinitum, but the joke is undoubtedly on me; the IRS proclaims they respect my time and are anxious to resolve the concern.  Can’t you just feel the concern and anxiety emanating from the IRS?  Where are the elected officials who need to be scrutinizing the Executive Branch and demanding better returns on the taxpayer’s investment?

As my mind experiences another total meltdown, I begin twitching, and my head eventually explodes; check out this cat picture:Cats wallpaper - Cats Wallpaper (5194935) - FanpopJust say nope | Grumpy Cat | Know Your Meme

If you’re keeping count, this is the third recent article on the culture of corruption at the Department of Veterans Affairs (VA) in as many weeks.  No, I am not behind; the rate of the frequency of VA – Office of Inspector General (VA-OIG) reports has legitimately been this overwhelming.  Never forget, an indictment is not a conviction, and perpetrators remain innocent until proven guilty in a court of law and the trial and sentencing have been completed.

Hunter Matthew Burroughs and Stephen Keith Andrews were indicted by a federal grand jury in Fort Smith, Arkansas, for their roles in three separate conspiracies to defraud the US government and private workers’ compensation insurers.  Their alleged crimes include a billing and kickback fraud scheme with multiple physicians and medical clinics and separate fraud schemes involving the shipment of medications from Arkansas to two Louisiana physicians, who then distributed those medications from their clinics in violation of Louisiana laws.  Additionally, Burroughs was charged with wire fraud for allegedly falsifying emails he provided in a civil lawsuit involving his sale of the company.”

Not to be outdone:

Robin Calef of Brockton, Massachusetts, was sentenced to one month in prison followed by three years of supervised release after pleading guilty to one count of theft of public funds in November 2021.  She was also ordered to pay restitution of $102,289 to the VA.  In December 2006, Calef’s sister was receiving VA monthly benefits, passed away.  She failed to inform the VA of her sister’s death, and the VA continued to deposit monthly benefits into a joint bank account held by Calef and her sister until September 2017.  Bank records revealed that Calef made monthly withdrawals of approximately the exact amount of VA benefit funds deposited into the joint account.”

And:

Derrick Brewer of Enfield, Connecticut, pleaded guilty to one count of theft of government funds.  In March 2018, Brewer submitted paperwork to the VA offices in Hartford as part of an application for service-connected disability benefits.  Specifically, he submitted form DD-214, which indicated that his discharge from his former service in the US Coast Guard was characterized as “Honorable.” However, the form had been altered before its submission.  According to official Coast Guard records, Brewer’s discharge was characterized as “Other Than Honorable Conditions” following his convictions under the Uniform Code of Military Justice.  There is no record of the discharge characterization ever being upgraded.  As a result of this submission, Brewer collected nearly $70,000 in VA benefits from March 2018 through September 2020.  Sentencing is scheduled for 27 May 2022.”

And:

Sarah Jane Cavanaugh of Warwick, Rhode Island, was arrested on charges of using forged or counterfeited military discharge certificates, wire fraud, and fraudulently holding herself out to be a medal recipient to obtain money and property or another tangible benefit, and aggravated identity theft.  It is alleged that Cavanaugh claimed to be a wounded US Marine Corps veteran and recipient of a Purple Heart and Bronze Star and schemed to collect hundreds of thousands of dollars in veteran benefits and charitable contributions from organizations that provide monetary aid; to veterans in need.”

And:

From 2002 to 2019, Terrie Lynn Christian of Newaygo, Michigan, engaged in a fraudulent scheme that targeted children’s benefits programs administered by VA and the Social Security Administration (SSA).  This scheme, which involved obtaining benefits for two fictitious children, resulted in government losses of over $660,000, including approximately $110,000 for VA.  Christian was sentenced in US District Court to 30 months in prison, three years of supervised release, and restitution of over $660,000.  The VA OIG and SSA OIG investigated this case.”

Do you notice anything odd in these stories of fraud; the documents did not stand up to scrutiny, but fraud was still perpetrated.  I have authentic documents proving service; I have had to present original documents several times and sign affidavits testifying these documents are my documents.  I am a veteran, and under the threat of severe penalties, I swore that I was not attempting to defraud the US Government.  Would someone please explain how these people, and so many others, can commit fraud so frequently?  Would someone please explain how the VHA and the VBA accepted clearly doctored documents and fraud executed?  Finally, where are the VBA and VA employees being held accountable for failing to do their jobs and allowing this fraud to be perpetrated with complicity?Mediocrity Joke

Time after time, I have been denied help, been given the bureaucratic runaround, and refused assistance until my documentation can be certified.  Then after my documents are approved, they are still rejected by bureaucrats who refuse to do their jobs.  Yet, crimes and fraud are perpetrated with the same bureaucratic inertia and complicit behavior.  Elected officials, do you understand why taxpayers are frustrated?

What reignites the explosion of my head is that these are only two of the multiplicity of government agencies.  Nobody knows how much fraud is perpetrated by employees and customers, and worse, even fewer care.  Elected officials, will you please explain why you are not more concerned and avidly involved in ending the fraud?

Let me cast your mind backward to 2005.  United States v. Alvarez, 567 US 709, is a case in which the United States Supreme Court ruled that the Stolen Valor Act of 2005 was unconstitutional.  The Stolen Valor Act of 2005 was a federal law that criminalized false statements about having a military medal.  Elected officials, when the judges legislated from the bench, overstepping their authority, why didn’t you immediately go back to work and redraft legislation to end the theft of valor and penalize people committing fraud?  Instead, you rolled over like a dead, bloated, floating body, and valor theft has worsened!Plato 3

Elected officials, why have you not drafted new legislation to curb government theft?  Why have you consistently refused to act to curb the bureaucrats from abusing taxpayers?  Why do you remain silent on the shrinking morals in America that open the doors for more abuse of the law?  We elected you to the office to take action; what are you doing?  Yes, mayors, city councilors, judges, dog catchers, school board members, county commissioners, and every other single officer elected, you are included in this plea for action!

Dont Tread On MeAgain, I implore you, the voters, to scrutinize your elected officials for their continued employment.  Yes, start today.  I know the elections are months away, but it requires time to evaluate performance, become knowledgeable, and prepare to act on election day.  You deserve a better government, and those in office deserve to be unemployed!

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

The history:

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

The findings:

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

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

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

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

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

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

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

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

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

Jacob and Esau – The Perils of Government; An Analogy

Bobblehead DollSeveral books of scripture, in multiple religions, record the story of Jacob and Esau.  Jacob and Esau are twins male children of Isaac and Rebekah.  The boys were competitors for their entire lives.  Esau acts outside his parent’s wishes in marriage, sells his birthright to Jacob for a bowl of pottage (stew or beans; something cooked in a pot), and late in life is reconciled to Jacob even though his people continue to have animosity towards Jacob’s people to this day.  While the story of these twin brothers remains useful to those in religion and teaches several morals of importance, Jacob and Esau represent a classic tale of why government should be limited in size and scope.

Genesis 27, Old Testament, contains the story of how Jacob obtains the birthright blessing, which had been sold to him by Esau for the aforementioned bowl of pottage.  Consider with me what would have happened if the same bloated government we have right now had meddled in the affairs of Isaac, Jacob, and Esau.  The cost of meddling in the internal family affairs, the government would have taken 40% inheritance tax.  Esau would have always had the government as a millstone and ready excuse for not reconciling with Jacob, and lawyers and government officials would have further sundered the family.

Remember this, for it has importance in the following discussion, the government does not grant freedom, EVER!  As described and stated in the US Constitution and US Bill of Rights, freedom comes from a power higher than government, and government was only, ever, instituted for the benefit of man.  Ask yourself, is your government benefitting you?Plato 2

I guarantee the answer is no; regardless of the political spectrum, you prefer.  Why, because the government should not be exerting powers in areas that control or curtail the freedoms of the people.  Esau never valued his birthright, so selling it was easy, and a bowl of pottage was a rich reward for something he did not value.

How expensive is government-funded medical treatment?  Some will claim, but those receiving treatment never see a bill; really?  Costs are more than merely a statement representing the need to pay money.  What about the loss of privacy?  What about the loss of freedom to choose what treatments and providers are best for you?  What about the loss of innovation to the thumb of oppression from the government?  What about the loss of self-reliance and the health benefits of independence?  What about the destruction of your community and the connections people felt with and pride for community hospitals?  What was lost when the medical community forced, through the abuse of government intervention, the knowledge of herbs for the sterility of Big Pharmaceutical drugs?

For the hope of a prosperous retirement, what was sold; freedom and money in the now.  Yet, one should ask, where does the government get the power to take money, then give it back at some future point?  Except, how many of those government retirement Ponzi Schemes are fully funded, even with all the money flowing in?  The answer is as empty as Esau’s bowl.  Still, the government continues to steal money through forced taxation and purchase the hopes and liberties of citizens for that hoped-for bowl of pottage, prosperity in retirement.Plato 3

For the hope of reducing poverty, the government purchased a class of people whom they could abuse and ignite for political gain anytime they want or desire.  To create this aggrieved class of people, the government took over welfare programs, bought people with bread and circuses, asked them to stay in government houses, live on government food, enjoy government-provided entertainment, etc.  What was sold for this bowl of pottage; liberty, potential, freedom, upward mobility financially, safety and security, and hope.  What has been the consequences of this purchase; a permanently aggrieved class of people who look longingly at another’s possessions and desire them through theft because hard work is racist, demoralizing, and stops the government handouts.  Worse, the government had to grow in power and size to “manage” this class of people, creating those with six-digit salaries to rub the purchased people’s faces in the irony of what was lost in the purchase.

The United States has been waging a “War on Drugs,” almost since its founding.  The government considers one drug “good,” mainly due to the ease of controlling it for taxation purposes, and another drug “bad.”  Yet, how successful has it been in this “war?”  Not at all, and its failures are increasing year-over-year, even while new methods of taxation are being invented to manage “legal drugs.”

Alcohol in the United States has had a history of acceptance, tolerance, legal banning, and returned to tolerance and acceptance, all through human desires, abuse of government powers, and the need for tax revenue.  Sin taxes, the class of tax used to allow a citizen government approval to get drunk, stoned, or inject poison into their bodies, are among the highest taxes in America.  Yet, the more the taxes increase, the more people want these products, and the more the government wants people to use these products, for we see the purchase of something transitory using something highly precious to barter.  What is more precious than time and physical health, and what is purchased but something that can only temporarily ease pain or provide relief at best.Apathy

Tobacco has been a favorite drug of the government for its population to enjoy, pushing the popularity of the drug even while condemning and restricting how, when, where the drug can be enjoyed.  Tobacco farmers have played vital roles in American history, and the product has been a significant cash crop for government revenue.  Have you ever wondered where the money and research facilities originate to improve cigarette addiction?  Have you ever considered where the marketing materials originated to pitch the health benefits of smoking?  Do you realize that government is the biggest provider of money for research and marketing purposes?  Never forget the government has become flush with cash, pushing tobacco, regulating tobacco, and licensing tobacco.  Now ask yourself, why would the government give on the one hand and take on the other, because it is making money with both hands as people sell something precious for something valueless and transitory.

Do people get injured and need assistance; yes, but the government is never the answer to provide help.  Are there those who are trying to thrive and escape poverty; yes, but the government is never the answer to providing help.  A truth from time immemorial, governments do not produce anything; thus, the government must first take through legalized theft, taxation, and legal abuse to give to someone else.  Every representative government must walk a balancing act between what a government is and what responsibilities a government must shoulder.  Except, how many continue to make Esau’s mistake and sell something incredibly precious for something transitory and essentially valueless?

Worse, evaluate the consequences of allowing the purchase to occur.  First, the seller experiences buyer’s remorse, anger, jealousy, regret, and the government making the purchase laughs, making the bitterness of the sell more poignant.  Second, the seller needs an outlet for this buyer’s remorse.  In an effort to continue to purchase while appeasing, the government allows the seller to go destroy the property and goods of another less politically connected person and calls this social justice.  Third, the abused class of people who are not politically affiliated or are political rivals, whose property is being destroyed, looks on, and envy, malice, and contempt are bred, which furthers the goals and desires of the government.The Duty of Americans

Esau took a long time to be reconciled to Jacob, but it first required admitting that he had sold his birthright (something of great value) for something transitory and valueless (food).  Jacob and Esau’s story remains of great importance and a cautionary tale, especially for understanding why government needs to be smaller, less involved, and less able to abuse the citizenry.  For too long, the governments worldwide have either abused their powers to purchase or been established as a tyrannical and oppressive government.  Either way, the government is the problem, and the answer continues to be the same, curb the government!

Knowledge Check!If COVID has taught the populations of the earth anything, let us learn this valuable lesson, the government is the problem, not the solution!  The size of government is oppression, the cost of government is theft, and the loss of precious freedom and liberty for transitory and valueless gifts or benefits which come at too high a price in treasure and other precious resources.  We, the owners and the abused of government, must change how we think and feel about the role of government before all is lost to the ever-hungry maw of government and self-interests!

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

That’s Crazy!!! – More Chronicles from the VA (CH 5)

I-CareThe end of the year inundation continues unabated.  Unfortunately, so to does the failure of the Department of Veterans Affairs (VA) – Office of Inspector General (VA-OIG) to inspire and motivate change.  Thus, my continual efforts in opening the transparency and demanding accountability for the VA leadership, and insistence that the American Congress do its job in scrutinizing the executive branch!  I repeat, only for emphasis, the US Congress (the US Senate and US House of Representatives collectively) only have two jobs.  1) write laws that are constitutional and for the benefit of all, themselves included, American citizens.  2) scrutinize the executive branch to protect the American Citizen from abuse and runaway actions.  Feel free to read the links to each story for more information, the failure of elected officials to act and prevent this behavior is abysmal, and these are just summaries, the full story is detestable!

In yet another fraudulent scheme, the fraudsters are penalized but the VA employees are left without penalty.

Thomas Farese, 79, of Delray Beach, Florida, and Domenic J. Gatto Jr., 47, of Palm Beach Gardens, Florida, are charged in an 11-count indictment with conspiracy to commit wire fraud, conspiracy to commit health care fraud, health care fraud, conspiracy to transact in criminal proceeds, transacting in criminal proceeds, and conspiracy to violate the federal Anti-Kickback Statute.VA 3

Two VA employees, over the course of four years, caused the VA to lose $1.38 million in kickbacks.

Two Chicago-based VA employees were charged in connection with a fraud scheme that involved pocketing cash payments from vendors in exchange for steering orders for medical equipment to those vendors. Andrew Lee is charged with one count of wire fraud, while Kimberly Dyson is charged with one count of conspiracy to commit bribery and four counts of bribery. Lee and Dyson worked as prosthetic clerks in the VHA Prosthetics Service in Chicago, where part of their duties was to select vendors to order medical equipment for VA patients using government purchase cards. The charges allege that Lee and Dyson schemed with coconspirators who owned or operated medical supply and distribution companies, in some cases placing orders for unnecessary and more costly monthly rentals of medical equipment, rather than purchasing the equipment as VA physicians had ordered. The scheme fraudulently caused the VA to overpay one company by more than $1.38 million from 2016 to 2020. Lee and Dyson pocketed kickbacks of at least $220,000 and $39,850, respectively.VA 3

From fraud to theft, we find another VA employee improperly taking advantage of their position for personal gain.

Former VA-certified registered nurse anesthetist, Elizabeth Prophitt of Saline, Michigan, was sentenced to three years’ probation for stealing controlled substances, including several opioids, from hospital-dispensing machines. Prophitt pleaded guilty to five counts of obtaining controlled substances by fraud, misrepresentation, or deceit. She used her position as a surgical nurse to steal more than 2,000 vials of Schedule II and Schedule IV controlled substances, which included fentanyl, hydromorphone, morphine, and midazolam. Prophitt would use protected patient information and falsify medical documents to obtain the controlled substances. Instead of using the medication on patients, she diverted the drugs for her own personal use.VA 3

For all those people who shudder when they think of how porous the government is in protecting personal identifiable information (PII), the following should alert and provide more fodder to end the political ambitions of representatives who continue to refuse to do their jobs!

Five out of seven conspirators were convicted for their roles in a scheme to defraud the VA and the Social Security Administration of more than $1.8 million. A Florida jury found Omar Shaquille Bailey and Ronaldo Garfield Green guilty following an eight-day trial, while a third codefendant, Jamare Mason, pleaded guilty on the second day of trial. Two other codefendants, Kadeem Gordon and Mario Ricketts, had pleaded guilty prior to trial, while two remaining codefendants have yet to be apprehended. The members of this conspiracy obtained the personally identifiable information of disabled veterans and Social Security beneficiaries and used this information to fraudulently open bank accounts and prepaid debit cards. They also forged documents in the victims’ names that directed the VA and the Social Security Administration to deposit benefit payments into those fraudulent accounts. The defendants and their coconspirators withdrew these funds from ATMs and banks throughout South Florida and Georgia for their own personal use. Much of the funds were ultimately funneled to the architects of the scheme in Jamaica. The five guilty defendants are awaiting sentencing.VA 3

Please remember, an indictment is not a conviction, and every person is allowed their day in court, in front of a jury of their peers, before sentencing and judgment is passed.  With that said, the following indictment is pretty compelling.  If found guilty, may the defendant be forced to do community service in distinctive clothing, in a public place, and carrying a sandwich board detailing their crimes.  Inexcusable and unforgiveable are terms not used enough for some crimes!

Rosemary Ogbenna of Washington, DC, was named in a 35-count indictment for allegedly carrying out a scheme to steal more than $400,000 in government benefit funds provided by the Social Security Administration (SSA) and VA. According to the indictment, Ogbenna operated a rooming house business and perpetrated the scheme to target some of her tenants. She obtained and maintained control over SSA and VA benefit funds intended for the care of elderly, mentally ill, disabled, and veteran beneficiaries, and used the funds for her own personal use and benefit.VA 3

The Raymond G. Murphy VA Medical Center (VAMC) in Albuquerque, NM is in the news again.  No surprise if you, like me, are familiar with the conditions and leadership at this VAMC.  Unfortunately, another veteran has died due to the malpractice and malfeasance, abuse, and lack of leadership in the VA.

The VA-OIG determined that poor oversight of resident physicians (residents) likely contributed to the patient’s delayed lung cancer diagnosis. A resident ordered an abdomen and pelvis computed tomography (CT) scan. Although a follow-up chest CT scan was recommended within 90 days, it took 175 days to complete. The chest CT scan results included resolution of a spiculated lung nodule and worsening of opacities in the lung representing a cavitary infection or cancer, and a positron emission tomography/CT (PET/CT) scan was recommended. The follow-up PET/CT scan showed a lesion in the right lung, but a biopsy was not done. The patient was examined and diagnosed with cancer at a non-VA hospital.

The VA-OIG concluded that deficiencies in care coordination between Primary Care, Pulmonary, and Emergency Departments’ staff also contributed to delays. In addition, contract teleradiologists did not use available prior images for comparison.  The facility failed to use quality management and patient safety processes to evaluate the care of the patient.VA 3

Here’s the kicker, and it should infuriate every taxpayer in America.  The Raymond G. Murphy VAMC was recently found to be meeting all SAIL metrics in a comprehensive healthcare inspection completed by the VA-OIG.  SAIL metrics are how the VA leadership are measured in being knowledgeable and competent in these positions.  Check out the link on SAIL metrics for more information.  Leaving only one question, “How can the VA leadership be found competent, and still be killing veterans?”

Angry Wet ChickenWhen discussing the abuse of veterans and the failure of VA leadership, it never ceases to surprise me the utter half-truths, bloviations, and oratorial yoga, and logical pretzel twisting that is accepted by the US Congress.  The following link takes you to a list of witness testimony given by VA-OIG representatives to the US Congress.  If these “witness” statements leave you sick and mentally struggling, don’t say you were not warned.  The VA-OIG, like the VA, is replete with verbal contortion performers and nowhere is this most noticeable than in “witness” testimony!

Regarding verbal chicanery, oratorial yoga, and despicable verbal gymnastics to provide job security while taking zero action, here is the link to the Semiannual Report to Congress by the VA-OIG.  Don’t say I didn’t warn you, the bureaucrats are out in full force and are playing every card in the deck to protect themselves from Congressional Scrutiny, while attempting to pass themselves off as honest, fair, and doing a good job for the American People.  The problem is in Congress not properly scrutinizing these shenanigans and demanding compliance with the law!

VA SealThe remaining 15 notifications from the VA-OIG are the standard reports on comprehensive healthcare inspections (CHIp) where leaders are measured, never found wanting, even though too often the leaders are failing and useless.  Other notifications included the audit for data security and IT measures completed by a third-party auditor, and which the VA continues to fail but Congress refuses to hold people accountable.  The third and final series of notifications in this batch were several dealing with individual VISN level of local VAHCS/VAMC level inspections on specific topics, such as COVID response, supply chain failures, and other issues.

Unfortunately, the answer is always the same the leaders are inept, inadequate, and incapable of initiating change before a veteran dies, before fraud and abuse occur, or before the VA-OIG makes an attempt to inspire change.  Not that the VA-OIG is very capable or properly equipped to inspire change, simply that the VA-OIG made an attempt.  The root cause remains clear, Congress refusing to do their job has led to the US Military Veterans being actively abused by the Department of Veterans Affairs.  Lackadaisical scrutiny, politicization, and two recent presidents who allowed Congress to label the US Military Veterans as “domestic terrorists,” have had detestable consequences for the American Taxpayer and the US Military Veterans and their families.?u=http3.bp.blogspot.com-CIl2VSm-mmgTZ0wMvH5UGIAAAAAAAAB20QA9_IiyVhYss1600showme_board3.jpg&f=1&nofb=1

Are you sufficiently inspired to change how you vote, demand elected leaders to act, and improve how the government in America from the city/county to the US President operates?

© 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.

Response From the Texas Medical Board (TMB) – Insanity From Bureaucrats

?u=http3.bp.blogspot.com-CIl2VSm-mmgTZ0wMvH5UGIAAAAAAAAB20QA9_IiyVhYss1600showme_board3.jpg&f=1&nofb=127 October 2021, I complained to the Texas Medical Board (TMB) about an incident with a Texas Medical Doctor and his unethical treatment of me, the patient.  The full complaint can be reviewed here.  The file number for this action: #22-1620, and the response I received is a textbook case of bureaucratism from beginning to end, in a letter dated 02 November 2021.

  1. The author of the letter, writing on behalf of the TMB, cannot even use my appropriate title, name, and the letter dismissing my concerns is a form letter of the worst design, surpassed only by the VA whose form letters cut off almost an extra inch in the right-hand margin.
  2. An investigation into the issues with the Dr. AAMR Arif Herekar MD was not launched as the actions by the provider “do not fall below the acceptable standard of care.” The letter references “Sec. 154.058” as the legal standard.

Texas Occupations Code – OCC § 154.058. Determination of Medical Competency is a truly interesting document, designed, I can only surmise, to protect the asininity of the bureaucrats.  A point-by-point breakdown is discussed.

  • Each complaint against a physician that requires a determination of medical competency shall be reviewed initially by a board member, consultant, or employee with a medical background considered sufficient by the board.”

Nowhere in the letter does it reference an individual who reviewed my complaint.  If I read this section of the code correctly, all that has to happen is a living person check to ensure Dr. Herekar has a license to practice medicine in Texas.  Essentially, Dr. Herekar has met the basic competency for this section.  Dr. Herekar is living, paying his dues, and a living bureaucrat has assured us he is licensed properly by the State of Texas.  As a side note, do you feel better that a bureaucrat assures the general population a doctor is appropriately licensed and dues-paying; I do not!

  • If the initial review under Subsection (a) indicates that an act by a physician falls below an acceptable standard of care, the complaint shall be reviewed by an expert physician panel authorized under Section 154.056(e) consisting of physicians who practice in the same specialty as the physician who is the subject of the complaint or in another specialty that is similar to the physician’s specialty.”
  • The expert physician panel shall report in writing the panel’s determinations based on the review of the complaint under Subsection (b).  The report must specify the standard of care that applies to the facts that are the basis of the complaint and the clinical basis for the panel’s determinations, including any reliance on peer-reviewed journals, studies, or reports.”

Yet, my complaint was somehow satisfied under section (a), so sections (b) and (c) do not apply.  Leading me to wonder, but not to question enough to “file an appeal.”  What I wonder about is the professional and ethical standards allowing for a provider to lie about a patient’s actions and then dismiss that patient from receiving further care, based upon the lies generated, and dismiss the patient using Facebook instant messenger.  As the bureaucrat cannot, and will not, respect me sufficiently to explain, expound, and address me correctly, one must wonder about the rest of the State of Texas and the bureaucrats who call their actions competent.

  1. Consider with me the problems of a medical provider lying about a patient’s actions, and ask yourself, would you trust that medical provider?

The Department of Veterans Affairs (VA) and the American Taxpayer is paying for me to visit a non-VA or “Community Based” provider.  That provider does not want me as a patient and makes this clear from the moment he introduces himself.  Why; possibly because I cannot wear a mask. Perhaps because the VA chooses how much that provider will be paid. Maybe because the provider simply does not want more military veterans as patients.  Fundamental core reason never provided, but the provider is at best passively hostile and willing to invest the barest of minimums in care to receive the maximum amount from the VA possible.

Because the provider must provide the VA with patient notes, the easiest way to rid himself of a military patient is to lie about that person’s conduct.  Thus, the doctor can play the victim, receive payment, and continue the veteran abuse perpetuated by the VA.  The lies of this provider are reported to the VA, and providers at the VA consider the veteran a “behavioral problem,” further reducing the quality of care.

Yet, the TMB considers the actions of this provider above the “acceptable standard of care.”  It must be a good gig to be a liar and thief in medical practice in Texas, for the bureaucrats at the TMB will protect you and assure the community that care was above the “acceptable standard.”  Tell me, TMB, what is below the acceptable standard of care?  If a medical provider can lie, cheat, and dismiss patients using unsecured methods of communication, and this is above “the acceptable standard of care,” what are actions below the “acceptable standard of care?”

Explain to the community, dear bureaucrat, how HIPAA was protected and the patient’s rights protected as part of “acceptable standards of care.”  Relate how trust in medical providers is enhanced when a medical provider can lie about a patient’s behavior, slander and ridicule that patient, causing more issues in receiving healthcare for that patient.  The Texas Medical Board is supposed to be the arbitrator and settler of problems; yet, this problem is not resolved, simply pushed on to other bureaucrats.  That is the epitome of job security for bureaucrats, not properly fulfilling your duties.cropped-bird-of-prey.jpg

I repeat, only for emphasis, “Houston, we have a problem!”  That problem is internal malfeasance and misfeasance on the part of bureaucrats.  To the Governor of Texas, to the Texas State Legislator, what are you willing to do to fix these despicable actions of useless bureaucrats?

© Copyright 2021 – M. Dave Salisbury
The author holds no claims for the photos or images 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.

If Everyone Cared – More Detestable VA Stories (Chapter 2)

?u=http3.bp.blogspot.com-CIl2VSm-mmgTZ0wMvH5UGIAAAAAAAAB20QA9_IiyVhYss1600showme_board3.jpg&f=1&nofb=1For the last two weeks, I have been a little remiss in writing.  My cousin passed from diabetes, two of my grandkids got sick with COVID (they are recovering), and I was diagnosed with asthma.  The last two weeks have been a roller-coaster of ups and downs, so imagine my surprise as I went to catalog more of the Department of Veterans Affairs (VA) – Office of Inspector General (VA-OIG) reports, Nickelback’s song, “If Everyone Cared,” was playing.  Pandora certainly appears to have a sense of humor and an innate sense of déjà vu.  I cannot think of a better title to proclaim the need for raising awareness and what is needed to fix the VA.  Until everyone is aware and the scab hiding the infection of the VA are ripped away to be exposed to the sunlight disinfectant, nothing will change, and taxpayers will continue to pay for the abuse of veterans who deserve so much more.  Thus, as we celebrate US Constitution Day, let us remember the veterans who have helped protect and defend the US Constitution and improve the government response!

The VA-OIG reports begin in Kansas City, Missouri, with a $335 Million Fraud Conspiracy, which included $615,000 in tax violations.

By pleading guilty today, Patrick Michael Dingle, 50, admitted that he conspired with Matthew C. McPherson, 45, of Olathe, Kansas, to fraudulently obtain contracts set aside by the federal government for award to small businesses owned and controlled by veterans, service-disabled veterans, and certified minorities.”VA 3

A sentencing hearing will determine if any prison time and what if any, restitution is required in this plea deal.  Frankly, the fact that the fraud existed from 2009-2018 is nothing short of a blatant and utter slap in the face for the taxpayer.  How many federal employees had to have seen the documents, failed to perform due diligence, refused to do their jobs, and were not named as co-conspirators or, at a minimum, facilitators of the crimes?  Is aiding and abetting a criminal operation not a charge that can be brought against the federal employees who empowered this fraud?  Thus, I demand all these people explain why and how an investigation can occur and not include the facilitators, those federal employees, who did not do their jobs!

Assistant US Attorney Paul S. Becker is prosecuting the case. The following agencies assisted in the investigation: the Department of Veterans Affairs, Office of Inspector General; the Department of Defense Criminal Investigative Service; the US General Services Administration, Office of Inspector General; the U.S. Small Business Administration, Office of Inspector General; the Army Criminal Investigation Command, Major Procurement Fraud Unit; the Department of Agriculture, Office of Inspector General; IRS-Criminal Investigation; the US Secret Service; the Air Force Office of Special Investigations, Procurement Fraud; the Naval Criminal Investigative Service; the Defense Contract Audit Agency – Operations Investigative Support (OIS); the US Department of Labor, Office of Inspector General; and the Department of Labor, Employee Benefits Security Administration (EBSA).VA 3

File the following under false imprisonment, and will someone please tell me why those employees involved are not in prison now!  A patient in the inpatient mental health unit and community living center at the Tuscaloosa VAMC in Alabama was falsely imprisoned and kept against their will for more than 2-years.  Was denied access to a patient advocate, which should be a red flag that something is disastrously wrong right there.  Plus, official mail to an elected official was improperly handled by staff to prevent elected officials from knowing about the veteran’s plight.

Here is what the VA-OIG investigation substantiated in their investigation:

    • Staff did not adequately assess the patient’s admission status as voluntary or involuntary and did not follow commitment requirements during the first two of the patient’s three Inpatient Mental Health Unit admissions.
    • Staff did not properly manage a letter from the patient that was intended for a public official.
    • Staff did not correctly identify a surrogate decision-maker and did not address ethical concerns regarding the appropriateness of the patient’s surrogate decision-maker.
    • Staff did not comply with requirements when the patient requested an against medical advice discharge.
    • staff at the facility denied a patient’s discharge requests and did not ensure the patient’s access to a patient advocate.
    • Staff failed to follow informed consent procedures.
    • Staff denied the patient’s discharge requests.
    • Staff did not conduct a sufficient or timely decision-making capacity evaluation and documented unsupported, conflicting decision-making capacity information in the patient’s electronic health record.VA 3

These are serious crimes, not bad administrative practices, felonious crimes.  Yet, the employees skate, the patient was held against their will, and nobody will be responsible for this disaster.  Where are the elected officials?  Where are those hired to scrutinize the government?  In this situation, any other medical organization would be facing lawyers armed with righteous indignation and seeing dollars signs in their dreams.  Yet, because this is the VA, the patient can be harmed, and no one will ever care, and that is a crime the elected officials are guilty of and need to be held to task for!

Moving to Biloxi, Mississippi, we found another VA employee who had sticky fingers and a long time to steal from the government (2009-2020).

Chad Paul Jacob of Saucier, Mississippi, pleaded guilty to stealing personal protective equipment, electronics, and medical equipment while working as the assistant chief of supply chain management for the Gulf Coast Veterans Health Care System in Biloxi. From 2009 through December 2020, Jacob stole and resold VA property at local pawn stores and on his personal eBay account.”VA 3

For eleven years, they were working as the assistant chief of supply.  The employee had how many reporting employees and superiors have had to sit through how many records audits.  In all these eleven years, I cannot believe that nobody ever suspected problems.  Who did the thief learn how to steal from the government from?  How many employees churned, and did any of these employees churn because they tried to report irregularities, and the boss ensured they were disposed of to silence them?  The VA has been taken to several congressional hearings to eliminate the whistle-blower rather than fixing the problems at the VA.  Thus, it is not in any way, shape or form, out of line to be suspicious about employee churn and fraudulent actions taken by a supervisor to eradicate and protect their schemes!  Why are these questions never asked in the VA-OIG investigations where schemes are uncovered by ranking and supervisory personnel?

Remaining in the south and moving next door to Slidell, Lousiana, a doctor, has been indicted for illegally dispensing opioids in a health care fraud scheme.

Adrian Dexter Talbot of Slidell, Louisiana, was charged for his role in distributing Schedule II controlled substances, including oxycodone and morphine, outside the scope of professional practice and for maintaining his clinic to distribute controlled substances illegally. He was also charged with defrauding health care benefit programs of more than $5.1 million, given that the opioid prescriptions were filled using health insurance benefits.”VA 3

Remember, an indictment is not a finding of guilt, and the defendant remains innocent until proven guilty in a court of law by a jury of his peers.  There is a very compelling point made by our founding fathers that need to be repeated here and declared more often in American Society.

“… Should the People of America, once become capable of that deep simulation towards one another and towards foreign nations, which assumes the language of justice and moderation while practicing iniquity and extravagance, and displays the charming pictures in the most captivating manner of candour, frankness, and sincerity.  At the same time, it is rioting in rapine and insolence; this country will be the most miserable habitation in the world.  Because we have no government armed with power capable of contending with human passion unbridled by morality and religionOur Constitution (the US Constitution) was made only for a moral and religious people.  It is wholly inadequate to the government of any other.” – President John Adams

The drug war and the opioid crisis stem from the same problem, a lack of morality and religion.  The duplicity of showing candor, frankness, and sincerity, while at heart there is nothing but ravening appetites and the minds of wolves, is the problem.  Sure, drugs create a social and medical issue out of the unbridled appetites and passions.  The core is the lack of self-restraint from being disconnected to religion and morality and from social duty, responsibility, and accountability.  Thus, making people miserable and looking for a cure.Knowledge Check!

The case above expresses this point clearly; the doctors involved were filling an appetite.  As long as there is an appetite, there will be people willing to risk everything to fill the appetites of others; moral and social disconnection, and the US Constitution cannot govern these people except to their destruction!

Moving to Fort Lauderdale, Florida, we find another series of indictments for more fraud, reflecting the same social disconnection.

Kingsley R. Chin of Fort Lauderdale, Florida, the chief executive officer of SpineFrontier Inc., and Aditya Humad of Cambridge, Massachusetts, the company’s chief financial officer, was indicted on one count of conspiracy to violate the Anti-Kickback Statute, six counts of violations of the Anti-Kickback Statute, and one count of conspiracy to commit money laundering. Chin and Humad allegedly bribed surgeons to use SpineFrontier’s products, and in turn, the company received millions of dollars in revenue from surgeries the surgeons performed.”VA 3

Traveling north to Bedford, Massachusetts, we find another dead veteran and culpability so thick it should be used as a board to apply corrective discipline for all parties involved!  From the report, we see the scope of the investigation for the VA-OIG:

Mr. Timothy White was a resident of the Bedford Veterans Quarters (BVQ), an independent living facility operated by Caritas Communities, Inc. (Caritas), in space leased to it through VA’s enhanced-use lease program. A month after Mr. White was reported missing, his body was found in the emergency exit stairwell of the building that houses the BVQ. This stairwell down the hall from his room was VA property and not leased to Caritas.”VA 3

The VA-OIG found the following as facts in the investigation:

    1. The VA police department’s failure to locate Mr. White resulted in part from the police and others at VA not considering the veteran an at-risk missing patient, which would have required a stairwell search.
    2. The Veterans Health Administration and the Office of Security and Law Enforcement lacked clear guidance regarding the obligations of VA police to search for nonpatients reported missing on VA property.
    3. VA police also did not discover Mr. White in the stairwell because of an improper order by the then-police chief to cease patrols of the building in which Mr. White was found.
    4. The OIG found that the VA police chief exceeded his authority as VA policy, and the lease required VA police to patrol VA property.
    5. Medical center staff mistakenly believed the emergency exit stairwells were not VA space; they did not clean them.
    6. The confusion among medical center leaders and staff regarding the lease scope and VA’s obligations stemmed from a lack of clear guidance from the Office of Asset and Enterprise Management.
    7. Routine police patrols and stairwell cleanings likely would have led to Mr. White being found earlier.

Angry Grizzly BearNow, as logical thinking adults, do you buy the load of excuses being sold here to pass off the blame for a dead veteran?  I know I am certainly NOT buying this load of bull!  Having worked and spoken in-depth to leaders of VA Police Departments, the excuses to not do stairwell checks and camera checks for missing patients are beyond inexcusable!  I know of a situation where a patient was lost on VA property.  Every police officer and staff member, even those on off-shifts, were called in, issued out in teams, and every square inch of the property was investigated until the patient was found.  Yet, somehow this patient was able to DIE unnoticed in a stairwell!  Are you kidding me?!?!?!

Regardless of whether this veteran died of malnourishment, dehydration, exposure, or lack of medication, he died horribly!  The veteran died at the hands of responsible parties, and those parties need to be held accountable for his untimely and atrocious death!  There is NO EXCUSE for this veteran to have died.  SHAME on the administration!  SHAME on the VA Police!  SHAME on the third-party contractor.  SHAME on the leaders of government who have allowed this abuse and refused to act!

Moving west to Chalfont, Pennsylvania, we find more stolen valor and theft of government benefits.

Richard Meleski of Chalfont, Pennsylvania, was sentenced to three years and four months in prison, three years of supervised release, and ordered to pay $302,121 in restitution for stealing VA benefits by pretending to be a veteran who the enemy had captured during combat. In July 2020, Meleski pleaded guilty to one count of healthcare fraud, two counts of mail fraud, one count of stolen valor, two counts of fraudulent military papers, as well as two counts of aiding and abetting straw purchases, and one count of making false statements in connection with receiving Social Security Administration disability benefits.”VA 3

While there are many more VA-OIG reports needing sunshine disinfectant, let us remember Mr. White, who has passed, and the feloniously falsely imprisoned unnamed veteran from today’s VA-OIG recap.  These two veterans especially deserve respect, dignity, and remembrance.  Their families and friends deserve praise and prayers.  America deserves answers, and federal employees need to be held accountable for failing to do the job they are paid tax dollars to perform!

I-Care© 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.

If Everyone Cared – More Detestable VA Stories

I-CareAs I went to catalog more of the Department of Veterans Affairs (VA) – Office of Inspector General (VA-OIG) reports, Nickelback’s song, “If Everyone Cared,” was playing.  I cannot think of a better title to proclaim the need for raising awareness and what is needed to fix the VA.  Until everyone is aware and the scab hiding the infection inside the walls of the VA are ripped away to be exposed to the sunlight disinfectant, nothing will change, and taxpayers will continue to pay for the abuse of veterans who deserve so much more.

We begin with an indictment and a reminder.  An indictment does not indicate guilt or innocence, and the parties mentioned are presumed innocent until proven guilty in a court of law by a jury of their peers.

Scott Mitchell Brown, John Henry Swiencki, and David Jeffery Hughes, Jr., were all charged with one count of conspiring to distribute hydrocodone, oxycodone, and amphetamines. Brown was also indicted for stealing prescription medications, possessing stolen mail, and obtaining unauthorized health information from the Kerrville VA Medical Center in Texas.”VA 3

I am a big fan of punishing liars and thieves of all stripes and support justice served in this case.

David Naylor, 59, of Spring Hill, Florida, was sentenced to two years and three months in federal prison, followed by three years of supervised release, for theft of government funds. Naylor made false representations regarding his physical limitations in connection with his application for VA disability compensation.”VA 3

While the following perpetrator has been caught and sentenced, she represents but the tip of the iceberg.

Rita Copeland, 59, of Portsmouth, Virginia, was sentenced today to nine and half years in prison for wire fraud and aggravated identity theft in connection with schemes to defraud veterans. She operated Veteran Services of the Commonwealth, which claimed to provide veterans with caregiving, contracting, and rental assistance services. In total, from at least 2017 through 2020, Copeland’s schemes impacted at least 29 victims and resulted in a combined loss of approximately $430,000.”VA 3

Again and again, the following questions are asked and never answered; yet, the questions remain pertinent.   Who at the VA had to have known this abuse of veterans was occurring and did nothing to stop the abuse?  There are too many checks and balances, too many hands, and too many inspectors for fraud of any magnitude to exist for very long without raising flags needing investigating.  Where were the VA employees?  Who knew?  What did they not do?  Are they still Federal Employees?

Another veteran died, needlessly at the hands of VA providers, due to ineptitude, failed management, poor training, and a series of unfortunate events that cascaded.  I weep for the family of this veteran and mourn for their loss.  I am sorry you have had to experience this tragedy and wish there was something more I could do than simply spread the story of this deleterious behavior and hope for sunshine disinfectant.  The patient died from “presumed anoxic brain injury (his brain failed to receive enough oxygen).”

The VA-OIG found that physicians’ failure to provide adequate benzodiazepine dosing to address the patient’s delirium tremens, review the patient’s abnormal electrocardiogram before haloperidol administration, and transfer the patient earlier likely contributed to the patient’s deterioration and ultimate death.  The VA-OIG substantiated that a non-VA paramedic documented that the oxygen flow was not active.  Facility leaders and staff reported a lack of knowledge about the failed oxygen delivery. The nursing staff did not complete all required alcohol withdrawal assessments.  A physician improperly ordered restraints, nurses failed to obtain full vital signs while the patient was in restraints, and nurses did not receive restraint training as expected.  The VA-OIG substantiated that facility leaders and staff did not communicate initiation of emergency detention with the patient’s family; however, notification is not required.  Leaders did not conduct an institutional disclosure with the patient’s family timely or in person and did not provide a relevant update.”VA 3

Did you catch that last sentence; while the patient was dying, the facility leaders and providers, including the nursing staff, were more concerned with CYA (covering their own acts) than notifying the family they had screwed up, and their family member had died.  If the nursing and staff did not have the training, why and how could they use restraints on a patient? This is blatantly illegal!VA Seal

Let’s cover one more egregious item from this summary of unfortunate events; I visited a doctor who is transitioning out of medicine who made the following comment, “Medicine has changed, practicing medicine has changed, and the practice of medicine is no longer about treating people, but checking boxes, the patient be damned!”  The patient was a “walking chemistry experiment, and no single nurse or provider took a minute to stop providing care, assess the patient, and stop administering drugs!  Instead, they just kept pumping more drugs in until the patient died and then covered their tracks with designed incompetence to protect their failed inadequacies.  This is not “practicing medicine,” you would not treat an animal in this manner; at least not and keep your license!

A death row convict is not allowed to die from anoxic brain death, as it is considered incredibly painful and a cruel and unusual method of death, which is why the gas chamber has been banned as a legal means of causing death for death row inmates.  Yet, under a medical team’s care, a patient in a VA hospital is allowed to die in this horrific manner, and nobody is held accountable.  Is it any wonder why this article is suitably titled “If Everyone Cared?”LinkedIn VA Image

Not many outside of the veterans affected and their families know that the VA has been pushing opioids for decades down the throats of veterans.  At the height of the opioid crisis, the VA shut off all opioid drugs and told the veterans to seek help for addictions to pain medications.  The VHA did not evaluate the individual patients for need, did not seek alternatives, did not try to reduce dependency over time, simply cut off all opioids, and told the veterans to deal with the problems.  Unfortunately, opioids were not the only drug series that the VHA cut off suddenly on veterans without notice, cause, or individual patient consideration, and deficiencies in coordination for the care of patients and drug mandates from VHA has lead to suicides, murders, and other violent problems as addictions cause social problems.VA 3

When discussing failures to coordinate care for patients, abuse of patients, and the need for patients to be housed in the proper treatment centers for their needs to receive the right care, the following should boil your blood and comes from Fayetteville VAMC in North Carolina.

The VA-OIG identified that the psychiatrist used the involuntary commitment process in a manner that was inconsistent with the state’s established parameters and failed to adequately assess and document the patient’s capacity to make informed decisions and determine whether the patient had a healthcare agent. In addition, the patient’s primary care providers and psychiatrist missed an opportunity to coordinate specialty care needs for the patient.”VA 3

Essentially, a bureaucrat incarcerated a veteran against their wishes, without a trial, an appeal process, and proper medical care.  Now, imagine you are the family of this veteran or a friend, and you see this occur and feel powerless to help, impotent to intercede.  Every avenue you approach is blocked because of the authorities, the bureaucrat in charge who wields their power illegally.  How do you feel?  What do you do?  Where do you turn?  Is it any wonder why this article is suitably titled “If Everyone Cared?”

I-CareAmerica, we need to care about what is happening in our representative government, in our name, with our tax dollars, and to our neighbors, family, and friends.  There are no excuses for the abuses witnessed!  There are no excuses for medical providers to get away with this outrageous behavior in private hospitals or government-paid-for-care.  Let us all heed Nickelback’s song and the intent; let us be the “everyone” who cares!

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

Chronicling the VA – May We Remember the “Pobrecito!”

I-CareA Spanish-speaking Mexican colleague taught me this term, “pobrecito,” meaning “poor little one.”  As I chronicle the VA ineptitudes, failures, criminal behaviors, and abusive actions, I am always conscious of the pobrecito, the poor little one, the poor victim who got harmed.  Too often, the victims never receive any compensation, acknowledgment, or retribution, nothing for having become a victim of the VA.  Too often, the Department of Veterans Affairs (VA) – Office of Inspector General (VA-OIG) investigates long after the abuse has occurred, and the victims are not covered in the scope of the investigation, or worse, the victim was killed, and the family is left to mourn, and nobody can help.

Angry Grizzly BearWhy chronicle the VA abuses; because the needs to be held accountable, speak the language, and have tougher skin and broader shoulders than the VA’s normal victims.  The VA is slowly learning they can harm me, but they cannot shut me up!  I will not stop fighting the VA for humane treatment, honorable service, and dedicated systems.  The VA is sick because apathy and inertia were allowed to replace common sense and decency, leadership was replaced with cost accounting and bureaucratic red tape, and human kindness was eradicated and replaced with drones and robots.  I know how to make the VA better; I do not have all the answers, but I know how to launch the revolution and begin cleaning the VA, and I will not stop calling upon those responsible for fixing the mess they created!

Starting this week’s VA-OIG headlines of crimes and inspections, we find a couple in South Florida who used the system to bilk more than $20 Million in purchase order scams.

Earron Starks was sentenced to 30 months’ imprisonment, followed by three years of supervised release, and ordered to pay over $2.4 million in restitution. Carlicha Starks was sentenced to three years of supervised release, including one year of home confinement, and ordered to pay $501,000 in restitution. They paid kickbacks to VA employees as part of a large-scale bribery scheme, which enabled the Starks couple and other corrupt vendors to receive over $20 million in purchase orders from VA medical centers in West Palm Beach and Miami. Fourteen additional defendants were charged for their roles in this scheme.”VA 3

Who’s the pobrecito in this case; the taxpayers, the veterans, and the United States.  Federal Employees had to not only know the crimes occurring but be complicit in the crimes.  Will they lose their retirement benefits, have to repay their wages, and face criminal charges and jail time for their culpability?  Fourteen additional defendants, how many were supervisors in the know and on the payroll who were promoted during this scheme whose supervisors failed to do their jobs and scrutinize the work of their underlings?  The shadiest part of this entire scheme is encapsulated in the following sentence:

All VA Employees were either terminated or resigned.”

Name me one private-sector employer who could get away with a massive scheme and enjoy similar benefits!Survived the VA

We find another VA employee embroiled in theft of equipment which sold the stolen goods in Ohio.

Kevin Rumph, Jr., of Fairburn, Georgia, pleaded guilty to stealing more than $1.9 million in medical products while employed at a VA community-based outpatient clinic in Atlanta. Between 2013 and 2021, Rumph made hundreds of unauthorized purchases of equipment used to treat obstructive sleep apnea. He then stole and sold the equipment to a vendor in Ohio. Sentencing is scheduled for November 17, 2021.”

I have worked in purchasing in both the US Military and in the private sector.  If I went to my bosses with “hundreds of purchase orders for supplies,” they would naturally be curious.  Repetition of hundreds of similar requests would raise red flags and demand audits of my records and proof of need.  Why did this not occur at the VA?VA 3

In the US Navy, I was in charge of ordering stock and saw requests for certain o-rings spike, as I knew the Chief Engineer would spot this and ask why, I asked why, went to the equipment records, dug up the maintenance reports, and asked questions of the mechanics and technicians.  In doing so, we discovered an unreported problem with machinery.  This is called due diligence; why was it not being practiced by the supervisor of Mr. Rumph?  You cannot tell me a seven-year trend line is something that was an anomaly and easily missed in budget reporting year-over-year!

Exclamation MarkLet’s admit a truth for certain; COVID has been a farrago of gargantuan size from day 1.  In acknowledging this, no blame is being proportioned to the front-line workers in any way, shape, or form.  But, the administrators, policymakers, politicians, and government bureaucrats have certainly proved they could unscrew the inscrutable!  Worse, the bureaucrats proved that their idiocy was highly contagious, infecting more people than COVID, spreading faster than COVID, and killing more people than COVID.  Our proof of this concept arrives from Houston and the Michael DeBakey VAMC.

The VA Office of Inspector General (VA-OIG) conducted a healthcare inspection regarding allegations of incompletely screening for COVID-19 and treatment of a patient with serious mental illness who presented for same-day care at the Michael E. DeBakey VA Medical Center (facility).”

Findings:

      • The VA-OIG substantiated that facility staff did not complete the patient’s COVID-19 temperature screening.
      • The VA-OIG substantiated that facility staff failed to manage the patient with COVID-19 symptoms medically.
      • Sent the patient to the drive-through testing area without medical evaluation, did not isolate the patient, complete a care plan, or follow the policy for transporting patients suspected to have COVID-19.
      • The vulnerable patient disappeared while in the facility’s care, was found off-site four days later experiencing a medical emergency, taken back to the facility, and died the following day [emphasis mine]!
      • The VA-OIG determined that the Mental Health Intensive Case Management team failed to address documentation discrepancies related to the patient’s surrogate and educate the family on COVID-19 visitor policy and screening processes.
      • The VA-OIG identified the facility’s noncompliance with the missing patient policy.
      • Facility leaders’ failure to report an adverse event and ensure a timely review of the patient’s episode of care.
      • The VA-OIG identified facility leaders did not timely or accurately disclose to the patient’s family the medical mismanagement that led to the patient’s adverse clinical outcome, e.g., death!
      • The VA-OIG concluded the failure to screen, isolate, and evaluate the patient resulted in potential COVID-19 exposure to staff, patients, and the public when the patient moved through facility grounds.VA 3

What was not covered in the scope of the VA-OIG investigation was whether the staff had proper training on the written policies or if training had been suspended due to the “pandemic health emergency.”  Failure of training has been a running and recurring theme for the VA before the pandemic, and the failures of training have led to thousands of “adverse clinical outcomes” at the VA, up to and even including death.  Yet, as evidenced in this example, small decisions lead to catastrophic events.  The infected patient was mentally unstable and missing for four days; how many people interacted with the patient as a superspreader event?  Who is at blame at this VAMC for this event, the leaders!  They failed their people, failed this patient, and failed this family!

Detective 4Before continuing, we must pause and take a moment to send heartfelt congratulations to two VA Health Care Systems (VAHCS) who passed their comprehensive healthcare inspections (CHIp), if not with flying colors with significant improvement, and are deserving of the highest praise.  Would the leaders of the Fort Harrison VAHCS in Montana and the Western Colorado VAHCS in Grand Junction please stand and take a bow.  Your improvements, conduct, and capacity to achieve reflect that success is possible with good leadership.  Keep up the good work; find ways to improve daily, and may continual success be ever yours!

Finally, we come to a regular topic, the failure of the VA as a whole entity to manage to pass a simple audit on financial matters and the continuing debacle where hiring is concerned during the pandemic.  Let me refresh your memories on the hiring debacle; first, the VA-OIG found that VISN leaders “were generally pleased with the “flexibility” provided during the pandemic for speedier hiring.”  What did the American people get for reduced hiring practices at the VA?  More criminal employees, more employees with shady pasts, more employees with sticky fingers, and more employees who could not find employment in public schools, now working for the federal government.VA 3

How did that relaxing of hiring practices work out for the American people and the veterans receiving care; not very well!  But, let’s all relax; the VISN leaders are “generally pleased.”  Frankly, I would be shocked if anything ruffled the VISN leaders’ feathers long enough for them to care; they are mostly at the top of their career ladders and failing a presidential appointment to Washington, know they are set for life.  So, why rock the boat?!?!

As for financial audits, the VISN leaders know that money continuously is appropriated to carry them and their poor decisions forward.  Just ask the Denver VAMC where the construction cost overruns are still costing the taxpayers, and no one was ever held liable for that boondoggle or any other crime and scheme for that matter.

Question 3Why?  Why are victims left to rot, the assaulters and victimizers promoted, and the VA as an organization left in the hands of disreputable, dishonest, unethical, and immoral people?  Why is the VA a culture of corruption, greed, envy, sloth, and disinterest when the US military is the exact opposite?  America is not what is found in the halls of the VA, why has the VA been allowed to become something anathema to the American people?

Knowledge Check!Great Britain, you find similar in your halls of government.  Your people are amazing; your government workers are just as despicable and deleterious as the American VA, IRS, and DMV.  Australia, great people, absurdly detestable government workers.  France, interesting people, but the government employee seems to have been drug from the bottom of the scum sucked from the Seine.  I have met incredible people in Italy, Greece, Germany, South Korea, etc., but the story rings true everywhere; the government does not represent you.  Pobrecito; what has happened?

© 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.