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.
Words 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.
Take 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!
While 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!
The 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!
When 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 
The 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.
The Department of Veterans Affairs – Office of Inspector General (VA-OIG)-released six investigation reports in the last two days. Each one is mentally breathtaking at the egregious behavior of bureaucrats! Stupidity that is so repugnant it breaches the laws of morality and leaves the reader stupefied. Every year, for the last decade-plus, the behavior of the Department of Veterans Affairs (VA) has become more obscene, more outlandish, more detestable, and more openly hostile towards veterans; it sickens me to read the investigation reports, write, and catalog these abuses!
Next, we travel to 
Having been an employee of the Department of Veterans Affairs, working in the 
I worked the shift where a regular, homeless veteran, wheelchair-bound, had fallen and broken his leg. He waited with his broken leg swelling, stuck at an odd angle, and in obvious distress for more than 6-hours because the head nurse that day had a personal grudge against the veteran! I saw how the charts were “adjusted” for timeliness of care, and I reported the problems up the chain to no avail! I had witnessed nurses harangue patients, gossip about them, chart surf in violation of HIPAA, and never was anything done by leadership when it was reported. A patient sat in an expedited treatment room for four hours, listening to the nurse’s gossip and joke, awaiting stitches for a bleeding wound, and never was treated. All because the day shift was getting off and didn’t want to be bothered to treat the patient. The patient’s family reported this behavior to me as they were leaving for a better hospital. I reported the whole incident, included the family’s description, added my observations. The leadership shook the whole incident off as a disgruntled employee (blaming me) making a less than desirable situation worse.
The first week of June is often a period of recovery. I have no idea why, but the first week of June is usually a recovery time. Maybe it was all those years in school; I honestly do not know. However, the world does not stop, and while the media goes 24/7 over the Memorial Day Gun Violence, stories are evolving that need your attention more. I do not say this lightly, as I understand those wounded and killed in gun violence are tragedies and cause for grief, but the corporate media has always used these “major stories” to allow other things to slip past.
Have you heard 
Have you heard the Federal Government remains hell bound and down on destroying the family but is explicitly 
I implore you to please join your voice to mine, and let’s remember Memorial Day 2022 as the day marking how in 2021 we changed the VA, we limited the government, and seized our liberties and freedoms, as the founding fathers intended! We can make a difference in the government, provided we band together without the petty names and distinctions currently being used to separate and divide. We, the American Citizens, deserve better from the government we pay for, even if we must use every legal tool in our arsenal to cull the politicians and take the freedoms they have stolen.
If you read any of the comprehensive inspection reports, you will see this is a common and recurring theme at the VA. Some of the medication policies are being followed, but the same problem with drug testing, informed consent, patient follow-up, and quality measuring monitoring always remain a problem. It is almost as if the SAIL learning matrices do not even exist as a quality improvement tool.
One of the first rules in overseeing junior people working is to make available someone to answer questions, immediately, and render support if needed. I have had the pleasure of training junior people in a myriad of tasks over the years. When I read this Department of Veterans Affairs – Office of Inspector General (VA-OIG) report, a plethora of questions arise, and I deeply question the professionalism and competence of the doctor overseeing the work of residents in a VA Hospital who are performing procedures.
Finally, we come to what I was hoping to be a great report, where the politician’s heads were going to explode at the inefficiencies, the detestable behavior, and the horrendous responses to legally mandated IT infrastructure changes, and why those changes are not happening at the VA. I was not disappointed; I was thoroughly disgusted that his report fell on plastic ears speaking plastic words from wax lips! Statement of Michael Bowman, Office of Inspector General, Department of Veterans Affairs, 
Let me remind you, 
The gall of this director to continue to blame legacy systems that were legislated to have been scrapped between 2000 and 2010 continues to highlight the incompetence of the director in conducting business and holding people accountable for failed projects and overspending of taxpayer monies! The director went further and stated the following, at which time, every single Congressional Representative should have stood and demanded his head. The “VA does not properly manage and secure their IT investments.” Tell me director, why should you remain employed if the VA does not properly manage and secure their IT investments? Is the failure to manage and secure IT investments the root cause for veterans to continue to suffer identity theft from the VA losing their identity?
America, with these bureaucrats in charge, why shouldn’t we be weeping and wailing, and gnashing our teeth in frustration? When will we, the owners of this atrocious government, finally scream ENOUGH and demand a full change of heads at the ballot box? For until the elected representatives are forced out, the bureaucrats abusing us, will only continue! The VA is sick, but the problem lies in the bureaucrats, administrators, and directors leading the VA at the Federal and VISN levels. So many other government agencies are just as sick, or worse, and the same problem arises, the leadership refuses to act, but still expects a big titanium parachute when they leave office! I say it is time to tell them NO!
VA Secretary Denis McDonough
DNC-Consulting 