I promised a follow-up article after Chapter 5; it took me the better part of 48 hours to cool down sufficiently to write coherently to effect an update. On 18 March 2002, I wrote about an appointment with my Primary Care Provider (PCP) being tardy, unprepared, and bureaucratese in supposedly holding a phone appointment with me. 01 April 2022, not an “April Fools Joke,” at 0731 hours, lasting 9 minutes, my PCP called me to get my approval to have me changed from her PACT team to another provider’s team. Apparently, in the highly red taped world of PCPs at the El Paso VAHCS, there must be an hour-long handoff call when a provider initiates a change of PACT team. I have my doubts and smell designed incompetence!
Let me pause here for a moment. I generally need two hours to write an article after conducting research. 18 March 2002, it took a bit longer to draft that one due to the need to blow off steam with some choice words and choke down the urge to beat a few brick walls with my fists. I am generally a very controlled person, and the fact that this PCP was so stunningly incompetent, rude, and HIPAA clueless, I admit I lost my cherub-like demeanor! That the patient advocate was able to get my secure message, upload the comments into the electronic medical record, and contact the provider before the provider had even logged the patient notes, speaks volumes about the ineptitude of the PCP. Worse, in the call on 01 April, the PCP was still on speakerphone, still disregarding HIPAA security, and quoted lines out of context from my message to the patient advocate. Speaking volumes about the processes and procedures of the patient advocate’s office to investigate patient claims without breaching confidentiality. Another topic for another day entirely!
28 March 2022, I received the following from the patient advocates office, quoted completely:
“We have received your secure message addressing your concerns. I will be sending a Patient Advocate Tracking notification with your concerns to our Primacy Care Service for review. They will be contacting you via telephone to discuss your concerns.”
I never heard anything from this mysterious “Primary Care Service” group/team. 01 April 2022 was the first response, and that was from the PCP. Sourcing the Department of Veterans Affairs (VA) and the Office of Inspector General (VA-OIG), the PCP is the second most important member of the Patient-Aligned Care Teams (PACT) at the VA; the patient is the essential member and an actively engaged and knowledgeable patient is preferred. I promise the VA-OIG has not even scratched the surface of the problems with recalcitrant, snowflake, and bureaucratic PCPs endangering patient health with the VA. Not my first run-in with an inept PCP; I sincerely hope it is my last!
In returning to the 01 April call, we find another interesting piece of data. The PCP affirmed that abdominal pain could radiate from, say a hernia, to other parts of the abdomen, but this is for a specialist to diagnose, not a Family Practitioner. Get that; the PCP is directly reversing all the published documentation by the VA and the VA-OIG by declaring that a specialist is the only person who can adequately decipher and detail why pain is occurring—putting all the PCPs in the VA Health Administration under the bus as merely button pushers and drug dealers. Then the PCP has the temerity, nay the chutzpah, to suggest a trust deficiency existing between myself and the PCP. Is it any wonder that people are detested, forlorn, melancholy, madder than a wet chicken with a raging case of hemorrhoids with the care they receive from VA healthcare providers?
Again, I repeat, only for emphasis, when any updates arrive on this issue, I will publish them in their entirety to allow the VA the opportunity to rebut, refute, or explain. Like the ongoing saga with VISN 22, the Phoenix VAMC, and being arrested and injured three times by the VA Police, I am not holding my breath and awaiting a logical response. If this were the only problem in the two weeks since the PCP shenanigans, the VA would be in pretty good shape. Alas, we know, dear readers, that the VA is in dire condition, and the elected leaders need to be scrutinizing the VA a LOT more closely than they are.
We begin the latest chapter of VA-OIG reports with yet another physician bilking the government:
“Robert Clay Smith, a Louisiana physician, pleaded guilty to conspiracy to commit healthcare fraud, wire fraud, and illegal remunerations (taking kickbacks). According to court documents, the scheme, which ran from 2013 until 2017, involved individuals associated with a medical supply and billing company recruiting Smith to dispense pain creams and patches to his workers’ compensation patients by offering him a split of the profits. The company acted as the billing agent for Smith, handling all the paperwork and submitting the allegedly fraudulent claims to the US Department of Labor, Office of Workers’ Compensation Programs, and private insurers. In exchange, the company paid Smith 50 to 55 percent of the profits collected from successfully billing insurers, at markups of 15 to 20 times what the medications cost.”
Plus the following:
“Robert Schneiderman of Langhorne, Pennsylvania, admitted to participating in a massive compounded-medication kickback scheme that he and others ran out of a pharmacy in Clifton, New Jersey. Schneiderman pleaded guilty in federal court to one count of conspiracy to commit healthcare fraud and one count of conspiracy to violate the Anti-Kickback Statute. From 2014 through 2016, Schneiderman and his coconspirators used Main Avenue Pharmacy, a mail-order pharmacy with a storefront in New Jersey, to run a fraud and kickback scheme involving compounded drugs like scar creams, pain creams, migraine mediation, and vitamins. Schneiderman was the president of Main Avenue Pharmacy and was a founder and CEO of its corporate parent. Main Avenue Pharmacy received over $34 million in reimbursements from healthcare benefit programs on compounded medications alone. Approximately $8 million of that total was paid by federal payers. Schneiderman himself earned over $400,000 through the course of the scheme. This case was investigated by the VA OIG, FBI, Department of Defense OIG, Defense Criminal Investigative Service, and Department of Health and Human Services OIG.”
Don’t forget this one:
“Dr. Harry Doyle, a psychiatrist from Philadelphia, Pennsylvania, and his wife, Sonya Doyle, have agreed to pay $3 million to resolve alleged violations of the False Claims Act. The alleged violations include submitting false billing to the US Department of Labor Office of Workers’ Compensation Programs (OWCP) for psychiatric services that were not provided and upcoding and double-billing patient claims. The Doyles have also agreed to be voluntarily excluded from federal healthcare programs for 25 years as part of the settlement. This is the largest recovery against a single psychiatrist in the history of the OWCP. A multiagency investigation of Dr. Doyle’s practice revealed that from January 2013 through April 2021, the Doyles allegedly billed for services not rendered, some of which occurred when they were not physically present in the United States. This case was investigated by the VA OIG, the Department of Labor OIG, and the United States Postal Service OIG.”
More is coming on this one:
“Ten Texas doctors and a healthcare executive have agreed to pay more than $1.68 million to resolve False Claims Act allegations involving illegal remuneration in violation of the Anti-Kickback Statute and Stark Law. According to a multiagency investigation, from 2015 to 2018, the doctors allegedly received thousands of dollars in illegal remuneration from eight management service organizations (MSOs) in exchange for ordering laboratory tests from Rockdale Hospital doing business as Little River Healthcare, True Health Diagnostics LLC, and Boston Heart Diagnostics Corporation. Little River funded the illegal remuneration to the doctors in the form of volume-based commissions paid to independent contractor recruiters, who used the MSOs to pay numerous doctors for their referrals. The MSO payments to the doctors were disguised as investment returns but were based on and offered in exchange for the doctors’ referrals. As part of their settlements, the defendants have agreed to cooperate with the Department of Justice’s investigations of other parties involved in the alleged law violations. To date, 17 doctors and two healthcare executives involved in this scheme have agreed on settlements totaling more than $2.7 million. The civil settlements resulted from a coordinated effort between the VA OIG, Department of Health and Human Services OIG, Defense Criminal Investigative Service, and the US Attorney’s Office for the Eastern District of Texas [emphasis mine].”
Elected officials, the next time you are asked about the incredible amounts of fraud in government-provided healthcare and insurance, do not buy the media talking points that the fraud is minimal, contained, or anything but designed incompetence on the part of the bureaucrats to act as a jobs program for investigators! The same investigators who are refused sufficient tools to investigate shenanigans by employees in the Federal Government adequately.
Frankly, all of these cases need the government workers to be held accountable, and the myriad of red tape loopholes CLOSED! I remember an election; I forget who and the exact when, but a significant election plank in the platform was healthcare reform, promising to clean up the swamp and bring accountability to Washington and the government. The public is still waiting, and I know enough of you have run on this topic from both parties to repaper the walls (inside and outside) of the White House.
Yet, even if only outside providers and executives were scheming, the VA might not be in too bad a condition. Except for the employees of the VA, VHA, and VBA, which continue to be caught up in ethics violations at a minimum:
“The VA-OIG conducted an administrative investigation that included a congressional request to look into allegations that Charmain Bogue, former executive director of the Veterans Benefits Administration’s Education Service, committed ethical violations arising from her spouse’s consulting work for Veterans Education Success (VES). VES is a nonprofit advocacy group that regularly had business before the Education Service. The allegations also pointed to possible incomplete financial disclosures by Ms. Bogue concerning her spouse’s consulting business. In their work, investigators uncovered evidence of other potential conflicts of interest and related misconduct by Ms. Bogue [emphasis mine].”
VA-OIG finding:
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- Bogue participated in Education Service matters involving VES without considering whether it raised an apparent conflict of interest and acted contrary to the ethics guidance she received from her supervisors.
- Bogue sought résumé feedback from the president of VES to aid in her search for career advancement without considering whether this raised apparent conflict of interest concerns in subsequent VES matters. VES also endorsed Ms. Bogue for presidential nominee positions.
- Bogue provided insufficient detail about her spouse’s business in 2019 and 2020 public financial disclosures; VA ethics attorneys had found them compliant. She remedied the subsequently identified deficiency in her 2021 disclosure.
- The OIG found that Ms. Bogue refused to cooperate fully in the OIG’s investigation by refusing to complete her follow-up interview. Her husband and VES president also refused to participate in OIG interviews, and the OIG lacks testimonial subpoena authority over individuals who are not VA employees. Bogue resigned from VA in January 2022.
UPDATE: 14 April 2022 – Sen. Grassley was hoodwinked by the VA on this issue and The Daily Signal (linked) has more of this report. I covered this before, I repeat only for emphasis, when you are discharged from the VA, you lose your ability to be a “whistle-blower.” As a point of fact, this is how the VA is able to hide a lot of their shenanigans, get rid of the person rocking the boat, invent the paperwork, cover the whole incident over as a “bad-apple” and keep you collective heads down and mouths shut until the VA-OIG investigation concludes. The VA’s ability to abuse whistle-blowers is further compounded by Federal Attorneys who cherry-pick the cases they know they can win. Which further protects the VA’s shenanigans and disheartens and mystifies those who have been wrongly terminated. The Daily Signal reflects this pattern of corruption perfectly citing the records obtained by Empower Oversight.
Some commentators have claimed that blaming elected officials for not scrutinizing or not providing tools to investigate entirely is unduly unfair to the congressional representatives. Really?!?!?! The VA-OIG conducts an investigation, the people being investigated refuse to comply, and the VA-OIG is toothless to enforce a full and complete investigation to initiate Attorney General and FBI investigations and actions to recompense the defrauded taxpayer. Ms. Bogue and the VES have invalidated any trust the taxpayer should have in their respective activities, but this, like so many other investigations into VA employees, will die of apathy before anyone is held accountable. Even though a congressional representative demanded an investigation, nobody is being held liable. Nobody is forced to compensate the defrauded taxpayer, yet the taxpayer is still expected to elect the same old representatives to their jobs. Blaming the congressional representatives (legislative branch) for not scrutinizing the executive branch, one of only two jobs these people have, is somehow unfair? NO!
Remarkably, between the 18 March disaster with the PCP and 01 April’s compounding idiocy, the VA-OIG published an ironically titled investigation report.
“Improved Governance Would Help Patient Advocates Better Manage Veterans’ Healthcare Complaints.”
Imagine that, more designed incompetence negatively impacting the veterans seeking care at a VA medical facility, stating the obvious by the investigators. Who on earth would be responsible for seeing that regulatory agencies had the tools needed to scrutinize and demand corrective action? Calling all elected officials, did you notice that one of the prima facia tools a veteran has to report problems, conveniently called “patient advocates,” does not have the sufficient authority, adequate oversight, and tools to execute their jobs? The VA-OIG reports the following:
“The Patient Advocacy Program helps advance the Veterans Health Administration’s (VHA) efforts to improve customer service, support veterans’ access to quality care, and provide a mechanism to resolve healthcare issues. Patient advocates document veterans’ concerns, communicate the resolution, provide follow-up and feedback, and identify trends for potential opportunities to improve medical facilities. In FY 2020, VHA tracked about 162,000 serious complaints in its patient advocate tracking systems.”
On a side topic, VA-OIG, how do you define a “significant complaint” and separate it from other types of complaints? Honest question, the information was, to quote my PCP, “remarkably” missing from your investigation report! Would the VA-OIG like to know why so many veterans’ complaints have risen to a “serious” level? You reported the exact problem:
“A complaint is considered resolved when the complainant communicates the outcome, and the record is closed in the tracking system.”
Maybe, the VA-OIG merely overlooked the logic problem, but complaints increase when the solution pushed down the throats of the veterans does not fix the actual situation. Honest question, no sarcasm involved. Is a “serious” complaint one where significant harm or death to the patient has occurred? Is a serious complaint one that breaks federal laws, EMTALA, comes readily to mind?
Having had “solutions” forced down my throat, speaking only for myself, I am thoroughly sick of having the patient advocates bureaucratize my complaint, then fail to act, and then compound the problem by quoting policy to me as a reason to close the complaint, when the VHA never have written policies and procedures! Maybe, you might want to look into the root causes of some of those “closed” complaints and ask root causation questions!
What did the VA-OIG find when they investigated the patient advocates?
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- VHA lacked adequate governance of the Patient Advocacy Program.
- VHA did not effectively issue and implement adequate policy, monitor complaint practices, and provide guidance to medical facility directors responsible for local program management.
- Patient advocates did not always enter complaints into the system.
- Even though complaint records generally appeared to be closed on time, patient advocates did not always document the communication of the outcomes to the complainants.
- The VA-OIG substantiated an inadequate program policy to identify clear expectations and responsibilities.
- The VA-OIG found that they (patient advocates) did not always adhere to the documentation requirements to show full complaint resolution.
- At the local and VISN levels, responsible personnel did not consistently analyze patient advocate tracking system complaints about trends.
Feel free to read the complete abomination of designed incompetence for yourself. Essentially the VA-OIG concluded that the VHA has been burning taxpayer money in a patient advocacy program, and the designed incompetence is so apparent it can be tracked from L2, where the James Webb telescope is located! Worse, you won’t need the James Webb telescope to see the designed incompetence!
Unfortunately, I could have guessed the first three findings without looking. Every VA program is designed so ineptly, reprehensibly led, criminally incompetent, and with such dastardly deceptive doings that fiction writers’ storylines have to be written better to sell books. You cannot make this stupidity up and make a profit. Hollywood would run screaming into the night if they made a true story about the ineptitude found at the VA!
Elected officials, where are you? The VA-OIG presents copies of their findings to you, and I have yet to witness a single one of you holding the VA Leadership criminally responsible for the failures at the VA. Even when the VA is killing hundreds of veterans, the US Congress refuses even to act upset, let alone scrutinize for a change! Remember how many veterans were intentionally killed in Phoenix waiting for treatment? How many VA employees lost their jobs and pensions or were forced in front of a judge for murder? It is a fair question, where are the elected officials in the legislative branch working to end the criminal “fraud, waste, abuse,” and designed incompetence in the executive branch?
© Copyright 2022 – M. Dave Salisbury
The author holds no claims for the art used herein, the pictures were obtained in the public domain, and the intellectual property belongs to those who created the images. Quoted materials remain the property of the original author.
To some of you, I am preaching to the choir; but sometimes the choir sings better when they have more knowledge. Please help sing louder. To others, what I am about to say is so far out of your current understanding that your brains might hurt; I am sorry. You will never understand snowflakes and trolls, but I am willing to take that chance!
Now, let’s talk about the 10-year plan, a $2.3 Trillion plan that is a “more-than-infrastructure proposal” but is nothing but the Green New Deal in disguise. So far, the best record for the details that have been released comes from 
Remember, our pattern for this insanity is from President Obama, who had a comfortable first two years due to a friendly House and Senate. They could not do these enviro-legislation issues due to US Constitutional problems, so President Obama used executive orders. Again and again, climate science has proven to be a money-sucking black hole for taxpayers while the limited few buy new jets, new luxury yachts and force restrictions upon everyone else.
How many people will die from the cold or the heat due to the cost of electricity, electricity failure, and not having a backup or tertiary source for heat or cooling? Every year America sees people die from the cold and excessive heat. Want a pattern for how higher electricity costs and liberal-brain dead solutions work; let’s look at California. Last year, loss of power killed people on medical equipment, where electrical lines were not properly maintained, sparked fires, and rolling brownouts are common. Now that you see the middle and lower class sacrifices, ask yourself, did Speaker Pelosi (D) or any of here Hollywood and political buddies suffer any inconveniences from brownouts and loss of electrical power?
Hey Speaker Pelosi, how big are your freezers and refrigerators again? How many do you have in your walled mansion? How much electricity do you consume? Climate scare is a method for an unconstitutional power grab, plain and simple, and every single American needs to be actively engaged in fighting these restrictions! The fight for liberty is cloaked in “Climate Science,” and every nation on earth has been infected with this power-grabbing sickness where politicians win and the citizens lose!
As a veteran who struggles with post-traumatic stress disorder (PTSD), stemming from military sexual trauma (MST), where a first-class petty officer jumped on my back and tried to rape me. When I see the Department of Veterans Affairs – Office of Inspector General (VA-OIG) reports on PTSD from MST, I pay close attention. Since the Department of Veterans Affairs (VA) continues to deny my MST claim because MST does not happen to men, I get agitated when I see these VA-OIG reports repeating year-over-year with the same excuses and designed incompetence. Designed incompetence is all about creating ready-made excuses for failing to perform correctly the role one has been hired or promoted to perform. Consider the following:
Why are the causes of the problems considered designed incompetence, because they never change! At the VBA, the processors all need constant training to remain current in their positions; but never receive the training. The VBA never holds value-added training sufficient to train the employees on their jobs, but this remains the number one excuse to justify poor performance in VA-OIG inspections. Failure to perform the job is also not a new excuse, where the VA-OIG reports are concerned. Not understanding how to ask for help is also not new, and frankly astounds and mystifies observers that those hired remain employed when their performance clearly remains insufficient to the job expectations. While it is unique to the VA to see a procedure manual, it is only natural and expected that the manual is poorly organized, poorly executed, hard to follow, difficult to find, and generally useless. The VA is famous for this designed incompetence trick.
Congress mandates VBA claim error rates; there is supposed to be a quality assurance check to reduce the error rates. Yet, with all the checks, the balances, and the quality assurance programs, the VBA continues to surpass the error rates and physically harms veterans due to their inefficiencies. Yes; a failure rate of 16% is a “Big Deal!”
For the first time in more than a decade of chronicling the VA-OIG reports, I am mentioning a 
Worst of all, this condensed version did not even scratch the surface of the issues reported in just three VA-OIG reports. Shame! Shame! Shame! Shame on the elected officials, Republican, Independent, and Democrat, who have allowed this problem to grow and done nothing! Shame on the myriad of presidents who have done nothing but throw good money after bad, without demanding progress and holding real people responsible for real results! Shame on every single VA employee who shirks their job for easiness to the pain and suffering of a veteran, dependent, or spouse!
During much of the 1980s G. I. Joe cartoons had a commercial that ended, “Knowing is half the battle.” In the spirit of “knowing,” the following is a discussion on the US Bill of Rights. The US Bill of Rights is the first 10 amendments to the US Constitution. Many people think that the US Constitution begins with these 10 amendments, and there remains significant ignorance over what is said, and what is meant, in the US Bill of Rights. Finally, the US Bill of Rights, or the first 10 amendments, was passed by the US Congress and ratified by the states too, “… Prevent misconstruction or abuse of its (US Government) powers, that further declaratory and restrictive clauses should be added, and as extending the ground of public confidence in the Government, will best ensure the beneficent ends of its institution.”
Amendment 3 states: “No Soldier shall, in time of peace be quartered in any house, without the consent of the Owner, nor in time of war, but in a manner to be prescribed by law.” The language of this amendment, particularly, never ceases to amaze me. In order to protect the liberty of individuals, soldiers cannot be housed in a citizen’s home; thus, protecting the ability and freedoms of thought and property from unlawful government intrusion.
Consider how the Patriot Act, a horribly misnamed piece of legislation, allows for warrantless searches in the name of protecting America. Like the Affordable Care Act produced the reverse and increased the cost of health care while reducing the quality of health care, the Patriot Act has stripped patriots of safety in their property, papers, and so forth. 2018 had two cases argued before SCOTUS regarding warrantless searches and seizures; warrantless search and seizure is unconstitutional, yet they occur. The two cases of warrantless searches were both decided by SCOTUS in the petitioner’s favor (Collins v. Virginia & Byrd v. Government). SCOTUS has ruled on cellphone data, and many regarded that law as dangerous due to the argument that survives that since the government owns the technology the cell phone providers use, then the individual users have no right to privacy or constitutional protections by using cellular phones, cellular data, and where that user goes is able to be scrutinized without warrants.
Amendment 6 states: “In all criminal prosecutions, the accused shall enjoy the right to a speedy and public trial, by an impartial jury of the State and district wherein the crime shall have been committed, which district shall have been previously ascertained by law, and to be informed of the nature and cause of the accusation; to be confronted with the witnesses against him; to have compulsory process for obtaining witnesses in his favor, and to have the Assistance of Counsel for his defence.” When it comes to legalese muddying the intelligence of an issue, I have not found anything more convoluted than the definition of a “
Amendment 9 states: “The enumeration in the Constitution, of certain rights, shall not be construed to deny or disparage others retained by the people.” Rights of the people, the US Constitution, and the individual constitutions of each state and commonwealth in the American Union, cannot infringe upon other rights of the people as they individually dictate. How did we American Citizens lose sight of this amendment and what it means? How did we lose the US Constitution? Under Amendment nine FISA Courts should never have been established. The right to die without health care intervention is encapsulated in the ninth amendment, but somehow this has been lost. I remember distinctly losing the classroom debate that assisted suicide is a right under the ninth amendment; I also remember the day when states started passing laws to counter assisted suicide. Consider the case of Boston Children’s Hospital v. Justina Pelletier, and you will find the ninth amendment abused and tattered by the hospital bureaucracy, as well as horrible malpractice.
The politicians, from both major parties, are guilty of government overreach and unconstitutional power grabs at the city, county, state, and federal government levels. America must stand, to survive America must return to the roots established by the US Constitution. Yes; this means getting the government out of Social Security, Welfare, and butting its nose into the rights and liberties of the individual citizen. Consider the following, a whale and the ocean. Does the government represent the whale or the ocean? For if the government is the ocean, then the wale is reliant upon the government. But, if the whale is the government, then we the citizens of America are the ocean and the government is dependent upon us. The US Constitution claims the government is the whale and we the citizens are the ocean, and the government depends entirely upon the consent of the governed.
I speak by way of invitation; join me, revoke your consent to be governed by these totalitarians!
DNC-Consulting 