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.

Do You Feel Represented? – Your Government In Action!

Detective 4I have received feedback that I write about the Department of Veterans Affairs (VA) too much.  Please allow me to explain why.  As a veteran, I am duty-bound to help my fellow brothers and sisters in arms.  As the son of veterans, mother (USN), and father (USN, USARNG), I know the hardships of being dependents of active duty, reserve, and National Guard members of the military.  The enlistment contract doesn’t end when the contract says so for the military member; the families and spouses contract is forever.

The final two reasons I write about the VA are most critical; NO body should be treated like the VA treats the veterans; the actions of the bureaucrats in the VA are not representing me and what I stand for in a representative government.  As I can easily have the Department of Veterans Affairs – Office of Inspector General Reports (VA-OIG) delivered to my inbox, it makes writing about the VA much easier, benchmarking how the government has insulated themselves and forgotten who holds the reigns of power in a representative government.  While not a reason to write about the VA, this final explanation should help you judge whether your representative government appropriately represents you and what you stand for.Why

The VA-OIG reports today begin with behavior that is intolerable and worthy of public shaming.  While the defendant remains innocent until proven guilty, the criminal complaint represents behavior inexcusable!  “Daniel Devaty of Elyria, Ohio, was charged with influencing a federal official by threatening a family member. Devaty allegedly sent a text message to the cell phone of a VA social worker threatening to kill his daughters.”

Angry Grizzly BearAnytime anyone threatens the family members, their behavior is beyond the pale and deserves public shaming and the harshest of criminal penalties.  I do not care if the perpetrator is a politician, a judge, the media, or a private citizen.  Leave the families out of any business dealings!  Hollywood, take note, I am sick to death of you threatening family members in movies, TV shows, or simply as private citizens/influencers.  For too long, you have shirked your public responsibility, and families are OFF LIMITS!  Learn this lesson well!

On the topic of conduct reprehensible, the following VA-OIG report leaves me running out of adjectives to describe the behavior of this VA Employee.  “Robert Sampson of Gulf Breeze, Florida, pleaded guilty to charges of video voyeurism and disorderly conduct. Sampson secretly recorded eight fellow VA employees using a hidden camera, disguised to look like a cell phone charger power adapter, that he placed in a restroom at the VA Joint Ambulatory Care Center in Pensacola on multiple occasions from August 2019 to June 2020.”  May the judge throw the book at him and his punishment be creative and sentence well earned!

VA 3In another VA-OIG report, we have more leadership missing problems, where a fraud scheme existed for 11 years without discovery.  “Erik Santos of Georgia was sentenced to over 11 years in federal prison for defrauding Tricare of approximately $12 million through a compounding pharmacy fraud scheme. In January 2021, Santos pleaded guilty to one count of conspiring to commit healthcare fraud and wire fraud.”  While the US Attorney beats his chest and proclaims they will catch everyone involved in the fraud, how many managers and supervisors inside Federal Government employ will lose their jobs, pensions, and freedom over allowing this fraud to occur?  What processes and procedures will be changed to protect against another fraud scheme?  Who is personally accountable for contracting that permitted this scheme to bloom for more than a decade?

VA 3The following VA-OIG report details how clowns and asylum patients run the IT program for the VA and not professionals!  The VA was tasked explicitly by legislation to meet several IT deadlines on a program for family caregivers as part of the VA MISSION Act of 2018. Unfortunately, not only did the VA fail to get the IT program up and running on time, missed mandatory reporting deadlines, and delivered a software solution 2-years past due, but the “VA did not establish the appropriate security risk category and fully assessed the system’s privacy vulnerabilities.”  Amazing, with all the IT problems the VA suffers from, with all the IS problems the VA suffers from, one would think that, where new technology was concerned, the VA would be practicing better security and using the lessons learned previously.

VA 3Would someone please tell me why private industries would be sued to the Nth degree criminally and civilly for these IT failures, but the government can evade accountability and responsibility; why?  In a representative government, the citizens can, and should, hold the elected representatives and their minions accountable for failing to uphold basic security protocols. So how did the government vote themselves a “Get out of Jail Free” card?

While writing this article, three additional VA-OIG reports have been delivered to my inbox.  The newest VA-OIG report discusses a topic that the VA continues to struggle with, namely transparency.  Apparently, the goblins in Goblin Town still cannot stomach sunlight and prefer to keep their nefarious deeds hidden.  Unfortunately, the lack of transparency in hiring practices leads to more VA-OIG investigations into employee wrongdoing, cost the taxpayers phenomenal fees to rid the government of poor hiring decisions, and all this before the union becomes involved.  From the report, we find the following:

“… VHA delegated much of its data reconciliation to its local facilities, which introduced variability in the process and did not allow for consistent creation, maintenance, and verification of information. VHA also had inadequate business processes to ensure quality data were available to support effective medical facility staffing oversight. Without consistent methods and reliable source documents for managing information, VHA cannot be sure HR Smart data accurately reflect VA’s budget and workload requirements.”VA 3

Did you catch that local facilities were given authority, which increased risks in hiring, all while management cannot perform their functions properly?  I remain convinced that the VA built designed incompetence into every action to protect themselves from ever being forced to take action. But, unfortunately, like always, the news only gets worse!Plato 2

A little background is needed to appreciate the problem in the following VA-OIG report fully.  Coronavirus Aid, Relief and Economic Security (CARES) Act required the VA to report to the OMB how they spent money appropriated for America’s Veterans and the VA during the pandemic.  The following is what the VA-OIG found:

VA met monthly reporting requirements to OMB and Congress on supplemental fund obligations and expenditures. VA also submitted required weekly obligations and expenditures from supplemental funding to OMB by program activity. Of approximately $17.3 billion in medical care supplemental funds, VA reported it had obligated about $7.11 billion and had spent about $5.67 billion by December 29, 2020. The VA-OIG team noted three concerns where VA’s reporting was not complete and accurate: • Obligations were at risk of not being included in VA’s reports. • VA initially delayed the reporting of reimbursable obligated amounts for two months. • VA’s reports contained negative dollar amounts in data fields that should have only positive amounts, which misstated VA’s overall reported obligations. Those concerns indicate weaknesses in how VA and VHA internal controls are structured to meet reporting requirements. Despite the risks identified, VA performed only a limited review at the summary fund level of its COVID-19 obligations and expenditures before reporting. A review of summary funds is not detailed enough to identify potential anomalies and ensure the reliability of externally reported information” [emphasis mine].VA 3

I did not find this in the VA-OIG report. Did anyone ask why the VA failed to meet the reporting for the first two months?  After the FISMA Congressional hearings, everyone knows the VA sucks at information technology and information security (IT/IS). So why was the VA given more money and told to budget it using existing failed software, processes, and procedures?  My work in the finance field is limited; however, when a company cannot handle its finances properly and meet legal obligations, a third-party accounting firm can be hired to handle this for the organization.  OMB, why are we not using this solution at the VA?  OMB, why is a third-party auditing company not conducting in-depth analysis and audits of the VA?  With all the missing taxpayer dollars at the VA and Department of Defense, it seems that you are just as negligent as the agencies you are supposed to monitor.

Theres moreAs they say on the Home Shopping Network, “But wait!  There’s more!”  Unfortunately, the same holds of the VA, just without the enthusiasm!  Each VA Medical Center in the Department of Veterans Affairs – Veterans Health Administration (VHA) is expected to have supplies, also referred to as caches, on hand at all times to handle local emergencies and national health care incidents.  For example, a pandemic!  The VA-OIG investigated these prepared caches and found that only 9 of 144 supply stockpiles were ever mobilized.  The excuses, oh these excuses, are like butt holes, everyone has one, and they stink!

      1. “Medical facility directors reporting supplies were not needed or caches lacked sufficient quantity for meeting pandemic demands.”
      2. “The Veterans Health Administration (VHA) changed the process for mobilizing caches during the pandemic, but without clearly communicating it to medical facility directors” [emphasis mine]. – We have the blind leading the blind, in a darkened room, in a London fog!
      3. The VA-OIG, not the VHA, not the local VAMC, but the inspectors “identified problems with cache maintenance and monitoring.” – Never forget, this is a job of several people, overseen by a director, who reports to facility leaders, and inspectors had to find the maintenance and monitoring problems. Just let that sink in for a minute!
      4. Most caches contained some expired or missing personal protective equipment, diminishing their ability to support pandemic preparedness.” – This is an example of how the VHA is “Defining Excellence in Healthcare!”
      5. The “VHA had incomplete documentation on cache activations, making it difficult to know which caches would need to be restocked.” – See item number 3 above.
      6. Medical facility leaders were not always able to accurately report if their facility’s cache was activated during the pandemic.” – Is the proof sufficient that the VA leadership IS the problem with the VA; yet?VA 3

In the US Navy, a significant part of my job was to maintain and monitor emergency supplies. Additionally, to use and cycle through reserves during drills and replenish those supplies quickly and efficiently not to impair the ship’s ability to protect itself 24/7.  I did my job well enough to earn three people Navy Accommodation Medals.  I took over the emergency stores, and all consumable supplies were expired or consumed.  Within 3-months, I was winning accolades and awards.  Yet, 144 caches of emergency supplies for the VHA need more procedures, more documentation, and more oversight to fulfill the mission correctly.

Knowledge Check!I beg to differ!!!  We need leadership, active, engaged, enthused, leadership!  We need the medical facility leader to stop designing incompetence and do the job they have been hired to perform.  We, the taxpayers, need the oversight instruments of the Federal Government to become a lot more effective at demanding results.  We desperately need the elected officials we have hired to scrutinize the government!  Just imagine if you hired someone to perform a mission-critical job, and in the middle of needing emergency support, the person hired reveals, “Oops, I might not have done my job properly.”  How fast would that person be fired?  Now, why can we not do the same to the government employees?

So, ask yourself, do you feel represented by your government?

© 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.

NO MORE BS: Speaking of Administration (Bureaucrats) in Government

I want to send congratulations to the US District Attorney’s Office – District of New Jersey; they have uncovered a fraud scheme worth $93 Million in kickback frauds, bribery, and theft of taxpayer monies; this is good news for the United States.  From me, you have my deepest thanks!

Some significant details are missing from this report, and I would expect these details to have been made public:

      1. How many of those charged were employees of Medicare, TRICARE, and CHAMPVA?
      2. How long was this scheme in place before discovery?
      3. How was this scheme discovered?
      4. Who was offered immunity from prosecution to turn traitor and open the doors to the scheme? Why?

One partial question was answered, “From March 2018 to October 2019, several conspirators withdrew money from the scheme approximately $1.6 Million.”  I guess this is as good a time as any to remind everyone that under the law, you are presumed innocent until proven guilty in a court of law.  Five people are charged in this case, where two others have admitted guilt, bringing the total of people involved to seven.

Some things might be slightly different from my time in government procurement, US Army, and US Navy.  I know that when you use the same provider more than two or three times in a single quarter of a fiscal year, someone should be asking a bunch of why questions and checking the contract.  Yet, to the best of my understanding of the case details as provided, this was not occurring.  Thus, more questions need to be raised:

      1. Who are the contracting officers in this case for the government agencies most affected by the fraud?
      2. Who are the supervisors of the contracting officers who allowed these abnormalities to exist without question?
      3. Who is reviewing the contracts to improve protection against fraud in the future?

Remember, no employment details were provided for those charged to see who was/is a government employee and who was/is not.  But, with Medicare, TRICARE, and CHAMPVA all involved, there should be a lot more details coming forth, and as of today (28 April 2021), there is nothing more available.  Bringing more questions to the front:

      1. Where is the media covering another government fraud case? Surely this should be of interest to every media outlet since the scheme covered at least some of President Trump’s tenure.  You would presume the media’s Trump Derangement Syndrome would have kicked-in to plaster this news nationwide.
      2. Where are the investigative reporters tasked with finding the details, rooting out the causes, and spurring politicians to action to “fix the government?”
      3. Where are the politicians, those who had to be notified about this case, in praising the DA’s office, clambering for justice for the taxpayer, and promising that these people involved will face stern justice? Or are these politicians silent because it doesn’t allow them to play a race/sex/gender card?

Healthcare fraud remains the number one issue for Medicare and the VA to tackle, as well as TRICARE, Tri-West, CHAMPVA, and every other government healthcare agency.  The problem lies in how the administrators do their jobs, affect policy, and scrutinize their employees.  Yet, every government healthcare fraud case leaves out the details of what the agencies will change to avoid future problems and prevent similar schemes.

      1. When will the heads of these government healthcare agencies be hauled in front of Congress to testify about healthcare fraud, and why they continue to refuse to follow the law laid down by Congress?
      2. When will Congress develop a spine and hold these bureaucrat administrators accountable for the failure of their agencies to protect the taxpayer from fraud, bribery, theft, and other healthcare scams that only make problems worse and cost billions in dollars annually?
      3. Where are the politicians who are sick to death of seeing fraud occur and not seeing action by those placed to head these organizations?

As an employee, two other employees and I signed a letter claiming that the processes being followed by the Emergency Department of the VA Hospital in Albuquerque, NM., were violating the Fraud, Waste, and Abuse of the government.  We proposed changes that would improve patient care, increase employee productivity, and increase the security of patient HIPAA information.  The HAS Administrator refused even to consider the letter, even with favorable approval from the supervisor.  I sent the letter to the hotline, the specific place every poster in government buildings tells people to contact when you witness fraud, waste, and abuse in government.  My answer was crickets!  Then, I was terminated from employment; that is how the VA administrators treat employees who try to raise the bar in performance and reduce fraud, waste, and abuse.  See, if you are not an employee, you cannot be a whistle-blower.  Nice loophole for administrators to employ to threaten, cajole, Quid Pro Quo, and protect themselves from accountability!

      1. When will the administrators be held accountable for the fraud, waste, and abuse experienced in their agencies?
      2. When will the taxpayer be vindicated and receive just consideration of rights and accountability for taxpayer dollars wasted, stolen, and debt increased without cause?

Please do not allow the tone of this article to produce a fraudulent thought; I have no problems with the government helping its citizens.  But I demand better accountability and responsibility from those few selected to lead the agencies involved.  I demand higher accountability from the politicians, who chose to run for office, and whose job it is to scrutinize the government!  I demand a complete and accurate accounting for my tax dollar, and this should not be a complex action for any government to make.  When fraud is your number one issue and has been since your agency was launched, I would expect some progress to have been made in processes, procedures, and standards by now, and I do not see any of this occurring!

© 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.

More VA Insanity – COVID Mask Policy – Denial of Service

I-Care02 March 2021 – Today, I got a secure message from the pulmonologist at the VAMC in Phoenix; he needs me to go to the hospital for a series of tests to understand why I cannot breathe.  Except, when he tried to get me into the hospital, he was told the VA Mask Policy would not be allowed to be “adjusted,” and the administration is the problem.  Worse, the local administration refuses to engage in discussion, refuses to write a cohesive and legal policy, and absolutely continues to deny service to veterans illegally.

I desperately need answers as to why the VA Hospital is allowed to act in this manner.  The denials of service are more than just a mask policy issue where COVID is concerned.  The actions of the Phoenix VAMC since June 2020 extend beyond simple bureaucratese where COVID masking is concerned.  Where are the elected representatives in scrutinizing the Phoenix VAMC?  Where is the media in demanding answers to the abuses being witnessed?  Where are the police in protecting the innocent?

InertiaTo actively work to refuse service, shut down dissenters, and muzzle those who honestly want to help and change the Phoenix VAMC into something worthy of respect and improve the care of the patients who try and obtain healthcare at the facility is atrocious behavior worthy of the harshest condemnation.  My medical chart clearly states I cannot wear a mask, the pulmonologist needing me to receive tests to understand why, is unable to obtain community care due to administrative fiat, and unable to get the VA to stop needlessly harassing, injuring, and arresting me because I cannot safely wear a mask.  All because the administrators would prefer to refuse service, deny care, and then complain that nobody is making their appointments.

2004, I started this journey with the Department of Veterans Affairs (VA); I had spinal problems, I was short of breath, I had neurological issues, and a host of other issues.  Yet, for more than 10-years, the VA refused care after I left the service with injuries because of the Veterans Benefits Administration (VBA) treatment.  As soon as I finally get the VBA to act, the Veterans Health Administration (VHA) begins to act like I am scum that was drug in off the streets.

LookWhat drives me crazy, I have been across the United States and seen the inhumanity of the VA Administration up close and personal too many times to think the problems are limited to only one VISN or another.  I have witnessed veteran patients and dependents worthy of the highest care denied service and then further abused by the VAMC refusing these people’s future care.  I have witnessed VA employees create rules to inconvenience a veteran patient, slow care, and deny service to a patient who had to travel 4-6 hours to the VA.  The VA-Office of Inspector General (VA-OIG) relates more and more abuses by VBA and VHA staff monthly, where accountability is lost, responsibility rarely accepted, and the cycles of abuse continue because nobody in VA leadership will act!

Does anyone understand what this entails?  A patient, not me, with chronic pain and incredible service-connected injuries, is denied the ability to drop off a letter for his primary care provider, and the VA employee who would handle the letter anyway refused to accept the letter unless the letter was mailed.  The veteran drives four-hours to the VA Hospital every time he needs care and he works to maximize his time while at the VA taking care of as much business as possible.  The employee claimed that if the patient left the letter on that employee’s desk, the employee would throw it away.  The VA employee refusing to help a veteran was shortly promoted, moved to a less visible clinic, and the veteran who needed the help still has not received the support he needs.  Even after writing to the hospital administrator, the VISN administrator, and his congressional representative.  Why do I know so much about this case, I witnessed the scene and have been kept abreast of the trouble this veteran is having.

Survived the VAI met a veteran on social media who is in my same boat and cannot physically and safely wear a mask.  He has been actively denied service, even while bleeding, at the ER.  If President Trump had not signed the Community Care Act, which forces the VA to allow patients the VA refuses to see to access community-provided care, both of us would have been much worse than we are today.  Monday (01 March 2021), a nurse from my primary care provider called to relay information. The nurse refused to provide service, refused to answer questions, and then chose to become offended and disconnected the call.  Worse, I still have no idea why the nurse called, the purpose for the call, or what outcome will be derived from the call.  Why; because you cannot directly call your clinic and receive answers.  The phone chain games mean I call the clinic and get routed to a call center, they leave a message for the provider, and possibly within a week, I might obtain an answer from the provider.

Want to reach your clinic directly; send a secure message through the MyHealtheVet portal.  Then wait for an answer that can take as little as 24-hours, or as long as 3-months, if you get a response at all.  I have asked simple questions through both phone and secure messages and received atrocious answers, answers not fit to print, and answers that are a logical pretzel-making no sense but are regarded as “the policy of this hospital.”  A non-veteran I was casually talking to asked, “Why do you use the VA at all?”  The short answer is because if you do not use the VA, the billing nightmare to get the VA to pay for healthcare from military-connected injuries is a bloody nightmare!

VA SealCase in point, 30 June 2020, I checked into an ER for care.  January 2021, I receive a collections notice for the visit.  I called and asked why; apparently, the hospital submitted the statement to TriCare instead of TriWest, causing confusion and denial of service.  But, the VA “due to HIPAA” policies could not speak directly to the hospital, only to me.  I had to call the hospital and inform them of what the VA said.  The hospital’s billing department, the collections agency, and I are stuck between two bureaucracies at the VA, and I have an active collections problem hammering my credit.  These shenanigans are, but a small part of the regular issues all veterans are handed because the VA refuses to do their jobs creates rules and policies at whim to inconvenience, and flat out refuses to do their jobs!

Patients seeking care at the majority of VA Hospitals face no customer care, worse customer service, refusal to honor the job, disrespect of the patients, dependents, and veterans, and worse service for active personnel.  I have seen the VA’s actions, and I refuse to stay quiet about the illegal behavior, unethical actions, and the immoral treatment of veterans, active service members, and the qualified dependents seeking care and finding crass bureaucratic red tape.  There is no reason for this abuse of the patient, except as previously mentioned, the VA Hospitals can “get away” with bad behavior where non-government hospitals cannot.

Where do we go from here?

DetectiveWith the government being less than enthused with ending the COVID-Farce, with the media refusing to recognize a problem and assist in advocating for a reprieve, and with the elected officials failing to scrutinize the workings of the executive branch’s operations properly, I am not sure of the proper answer to this question.  Insanity, according to Einstein, is doing the same things over and over, expecting different results.  The paradigm of government-provided healthcare is a pernicious fraud and desperately needs to be corrected.  But the answer is more than simple bureaucratic inertia found in many other government agencies.  The VA has built a special case for itself, and the solution will necessarily require new approaches and new thinking.

The belief that government is good for anything but injuring others remains an idea that needs to spread far and wide in an effort to reduce the harm caused by the government.  The American people require a higher return on their investment in the government through forced taxation.  Yet, the administers of government and the elected representatives hired to scrutinize the government fail to act, believe the bureaucrats over the citizen, and are part of the problem.

Fishbone DiagramRoot cause analysis points to inertia as being a prime candidate in the failures experienced and witnessed.  Inertia is a comfortable blanket to wrap yourself in when change is supposed to occur, but change scares you.  The hospital administrators refused to act because that would require a spine and written records scare the hospital administrators; especially those in Phoenix after two dead veterans’ scandals where responsibility pointed to people who possessed written records.  Hence, besides inertia is the fear of being held accountable because the written records exist.  Yet, because policies, directives, and processes are not being written down, behavior can worsen where the veteran patient is abused, and there is nothing that can be pointed to claiming the actions taken were inappropriate.

Detective 3Logic claims that if the VA denies service to a class of veteran patients, then another option for receiving care should automatically open.  However, the lack of written policies and the inertia of the employees causes the veteran patient a nightmarish cycle of needing care but not being able to access care.  Because the employees are following spineless leaders and inertia is better than sticking one’s neck out and acting differently from the pack.  Thus, plotting a path forward requires leadership and a willingness to document, change, and adapt, all of which appear anathema to the VA generally and the Phoenix VAMC particularly.

The VA-OIG just recently finished an audit of community care claims being handled by 3rd party contractors.  The results are fairly typical of the VHA and VBA using designed incompetence.

The OIG audit found that inadequate contract terms and VA’s lack of effective oversight contributed to claims processing inconsistencies and errors. The VA’s contract did not include standardized criteria for contractor employees to use when distributing and processing claims. Furthermore, the contract did not require contractor employees to follow VA’s Office of Community Care (OCC) claims-processing guidance. Although the contractor cannot be faulted for acting inconsistently with OCC guidance not required in its contract, the resulting inconsistencies mean VA lacks assurances that proper processes were used. VA also did not have an official quality reporting mechanism in place before February 2019.”

The VA-OIG report quoted above discussed how 13% of the claims were handled inappropriately, causing veterans’ problems and delays in processing for providers.  In Albuquerque, NM., I saw this firsthand.  The VA sent me to a community provider; the community provider filed all the proper paperwork and kept gathering more paperwork for the next three years.  Finally, when all the red tape was satisfied, ¾’s of the bills were too old to receive payment.  That provider went bankrupt trying to provide services to veterans because he could not get paid in a timely manner.  I was there for the full and abysmal treatment of this provider by the VA.

Detective 4The designed incompetence is galling and getting worse.  The VBA is the portion of the VA that makes claims decisions.  Recently the VA-OIG investigated the VBA specifically to check consistency to comply with skills certification for compensation and pension claims processors.  The results are a horror story of designed incompetence, failure to do the job, and trainers’ failure to train properly.  Of the 10,800 claims processors required to certify their jobs, 4700 were never tested from 2016-2019.  Of the 2,500 who failed the certification test, 1,900 did not have any repercussions, training plans, identified corrective action, or employer counseling.  Worse, the VBA failed to take any personnel actions on 98% of the population surveyed (10,800).  2018, as in the entire fiscal year of 2018, the certification tests were unavailable due to technical issues on the VBA’s intranet.  Meaning that effectiveness in 2019 to measure and certify was virtually useless!  Does anyone wonder why veterans are refusing to trust the VBA and the VHA?  Is the problem clearer that congressionally elected officials’ failures to scrutinize the government influence the employees’ behaviors for the worst?  How many claims have been improperly decided, wasting taxpayer time and money and the veteran’s time and money since 2016 by failing to certify to fill the roles and duties the American Taxpayer is paying them to fulfill?

Wasting TimeIt is imperative for profound and fundamental organizational change at the Department of Veterans Affairs to begin as soon as practical.  Worse, scratch the surface of any other government agency on the Federal or State level, and the same problems arise.  The same abuse of taxpayers, the same refusal to do the jobs hired to perform, and extensive cultures of inert slugs just punching time and wasting money until they can retire!

© 2021 M. Dave Salisbury
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