Prosecuting Department of Veterans Affairs officials who broke the law and firing those who deliberately manipulated reported wait times to hide long backlogs is the surest way of ending fraudulent practices, the agency's interim inspector general told a House committee Monday.
“It comes down to accountability of the senior leadership out at these facilities,” Richard Griffin said when asked how the scandal-ridden system of delivering care to veterans can be fixed. “Once someone loses his job or gets criminally charged for doing this, it will not longer be a game and that will be the shot heard round the system.”
Griffin's statement came during a late-night hearing of the House Committee on Veterans' Affairs to probe the ever-widening crisis at VA, where multiple investigations have documented deliberate manipulation of patient wait time data to hide long delays in care.
The inspector general has already documented “systemic” falsification of data at VA, a finding confirmed by the agency's own internal investigators.
VA officials also admitted delays in care are linked to the deaths of 23 patients due to gastrointestinal cancers.
Rep. Jeff Miller, R-Fla., chairman of the committee, asked Griffin whether criminal conduct has been identified by the IG in its ongoing review.
“We have found indications of some supervisors directing some of the methodologies to change the times,” Griffin said, adding his office has been in discussions with the Department of Justice which could lead to prosecutions.
“Whether or not in the opinion of the Department of Justice they rise to the level of criminal prosecution is still to be determined in most instances,” Griffin said.
Miller said the committee has sent DOJ a letter seeking a criminal investigation, but has heard no response.
Some members of Congress have called for the FBI to be brought into the review. Griffin said during a Senate hearing last month that the IG has criminal investigators on staff who are involved in its review.
Several committee members questioned how any information coming out of the VA can be trusted given the widespread manipulation of records that falsely made it appear veterans were getting the care they needed when they needed it.
The IG investigation began in Phoenix in June, but has now spread to at least 69 facilities where there are reports or indications that patient wait times were falsified.
Philip Matkovsky, assistant deputy under secretary for health at VA, acknowledged the charges that have long been leveled by whistleblowers and confirmed by independent investigations are true.
He said the current meltdown of the agency’s credibility creates an opportunity to “reset” flawed policies that rewarded failure and encouraged improper practices.
“We now know that within some of our health care facilities there are systemic and totally unacceptable lack of integrity,” Matkovsky said. “This is a breach of trust. It is irresponsible. It is indefensible and it is unacceptable."
After apologizing to veterans, Congress and the American people, Matkovsky said reforms will be implemented and unscrupulous practices will not be tolerated.
The recent scandal is viewed by VA as “the opportunity for us to set a reset, to sweep away and establish a clear-eyed assessment of our actual performance, not our reported performance.”
Matkovsky's comments came after Griffin and Debra Draper of the Government Accountability Office told the committee of nearly a decade of warnings from their independent investigators showing a pattern of data manipulation and long wait times at VA health facilities.
Rep. Doug Lamborn, R-Colo., said he is concerned about VA’s treatment of whistleblowers, saying he has been contacted by VA employees in his state who raised concerns that were denied by agency officials.
“There is intimidation taking place,” Lamborn said. “How do we change the culture from intimidation to where people are free to step forward?”
Matkovsky said retaliation against whistleblowers is not tolerated at VA.
“Nothing saddened me more than an employee who says ‘I was trying to do it right. I know it is right and I received instructions to do it wrong,’” Matkovsky said. “That is simply not tolerable.”
The Washington Examiner reported last month that VA whistleblowers routinely faced retaliation ranging from hostile treatment by supervisors to firings after they tried to report wrongdoing to the inspector general, Congress or some other outside entity.
The Examiner reported Monday that the independent watchdog group Project on Government Oversight was hit with a subpoena from Griffin's office after it set up a confidential hotline for VA whistleblowers. POGO is fighting the subpoena.
In his written statement to the committee, Griffin said ongoing reviews of VA facilities nationwide “have identified instances of manipulation of VA data that distorts the legitimacy of reported wait times.”
An interim IG report issued last month found “systemic” problems with reported wait times. The IG identified 1,700 veterans in the Phoenix VA health care system who were waiting for primary care appointments, but did not show up on official waiting lists.
“Until that happens, the reported wait times of these veterans has not started,” Griffin said. “Most importantly, these veterans were and continue to be at risk of being forgotten or lost in Phoenix HCS’ convoluted scheduling process. As a result, these veterans may never obtain a requested or required clinical appointment.”
The inspector general has issued 18 reports since 2005 documenting long waits, falsification of appointment data and negative impacts on patient care.
The most recent investigation was triggered at an April 9 hearing of the House veterans' committee, at which Miller revealed allegations of a secret waiting list being used to hide long delays in care in Phoenix.
Earlier Monday, VA released the latest results of an ongoing internal audit that found widespread falsification of patient wait times, often under the orders of supervisors.
Overall, 13 percent of the scheduling staff interviewed by VA auditors said they entered the wrong date related to a patient’s appointment after receiving instructions to do so from a supervisor or someone else in the agency.
At least one instance of the falsification was found in 76 percent of the facilities examined by VA’s internal investigators.
Some schedulers said they were disciplined for failing to falsify records.
Performance bonuses for top administrators are linked to meeting agency goals on patient wait times.
“Findings indicate that in some cases, pressures were placed on schedulers to utilize inappropriate practices in order to make wait times appear more favorable,” the audit report released Monday states.
“Such practices are sufficiently pervasive to require VA re-examine its entire performance management system.”
The audit is separate from the inspector general’s investigation launched in June amid allegations that a secret waiting list was being kept in Phoenix to hide long delays in patient care.
The findings in the internal audit triggered renewed demands that a criminal investigation be turned over to the Justice Department and responsible administrators be fired.
“Today’s report is more disturbing proof that corruption is ingrained in many parts of the VA health care system,” Miller said in a statement issued Monday. “The only way to rid the department of this widespread dishonesty and duplicity is to pull it out by the roots.”
Sen. Bernie Sanders, I-Vt., chairman of the Senate Veterans Affairs Committee, said the internal audit proves “incompetent administrators and those who have manipulated wait-time data should be dismissed at once.”
Miller and Sanders have competing bills that would allow the secretary of veterans' affairs to fire or demote incompetent or dishonest managers. The Miller bill passed the House 390-33 last month.
The accountability portion of the Sanders/McCain proposal would allow for expedited firing of incompetent VA managers, but would retain some civil service protections and appeal rights that are not in Miller’s bill.
Those appeals would be fast-tracked, under the Senate version, which was supposed to be filed in bill form on Monday.
Draper of the GAO repeated earlier testimony that the VA could not assure patients who had backlogged appointments canceled received the care they needed.
Draper said in her written statement that VA “could not accurately determine whether patients actually received the care they needed, or if they received the care in a timely fashion.”
A review by GAO published in January 2013 found poor documentation and the lack of independent verification made it impossible to know whether the cases were properly closed.