Federal Reports

The VA Office of Inspector General (OIG) assessed aspects of community care and VA direct care programs at the Montana VA Healthcare System (system) for fiscal year 2022.

Among patients who received VA primary care and VA mental health care, 98.8 and 77.5 percent, respectively, did so exclusively through VA direct care. The utilization of specialty care services through only VA direct care or only community care depended on the type of specialty care sought. Most community care referrals were requested due to patients’ associated drive times to access needed care.

The OIG found that:
   •    VA staff acted on most direct and community care referrals within two days.
   •    Approximately 65 percent of VA direct care referrals reviewed (not canceled or discontinued) had an associated appointment set within seven days, and approximately 56 percent of community care referrals reviewed had an associated appointment set within 21 days.
   •    VA staff completed approximately 95 and 48 percent of direct and community care referrals, respectively, within 90 days of the requested date.
   •    Approximately 39 percent of patients with community care referrals for primary care obtained an appointment within 20 days of the requested date, and about 64 percent of patients received an appointment for mental health care within 20 days of the requested date.
   •    Approximately 97 percent of all community referrals were for specialty care; 54 percent of patients received an appointment within 28 days of the requested date.
Finally, the OIG identified two potentially disqualified former VA providers associated with community care claims paid by the system.

The OIG made five recommendations to the Montana VA Healthcare System Director related to timely appointment setting, timely completion of community care appointments, consult management, appointment wait times, and utilization of eligible community care providers.

Veterans are eligible to receive community care under certain circumstances, such as when their local VA medical facility does not provide the requested service or when a provider determines community care is in their best medical interest. In October 2020, the Veterans Health Administration’s (VHA) Office of Integrated Veteran Care (IVC) began implementing the Veteran Self-Scheduling (VSS) process at VA medical facilities. The process allows eligible veterans to schedule their appointments directly with community providers after these providers receive an approved request for services and an authorization for a veteran to receive care from them. Although many facilities implemented the process in 2020, staff were not required to offer the option until September 2023. The VA Office of Inspector General (OIG) conducted a review to determine whether IVC had adequate controls in place and whether IVC provided effective oversight of the process.

The OIG found IVC needs to improve its oversight of the VSS process to strengthen support and mitigate the risk of misuse of the scheduling option. IVC did not adequately help facilities use and monitor VSS before requiring them to use it. Additionally, neither IVC nor facility leaders implemented controls to identify potential misuse of VSS, such as opting veterans into the system without their permission or knowledge. If oversight is not improved, inappropriate use of the VSS option may go undetected, and veterans may experience delays in care.

The acting under secretary for health concurred with OIG’s eight recommendations for the under secretary to make sure IVC, in coordination with VHA’s chief operating officer and the Veterans Integrated Service Networks, take appropriate steps to better assist medical facilities with implementing VSS, improve controls over VSS so that the scheduling process is used appropriately, and improve oversight to make sure the process works as intended.

Why We Did This Report

The U.S. Environmental Protection Agency Office of Inspector General conducted this evaluation to determine whether the upgrade to the Superfund Enterprise Management System is likely to facilitate improved documentation of institutional controls in the “Institutional Controls” module.

Summary of Findings

Because of system limitations and insufficient guidance, the information in the classic SEMS “Institutional Controls” module is not complete and available for reporting, monitoring, and other oversight activities. The upgrade to SEMS 2.0 is unlikely to improve this condition. Specifically, classic SEMS and SEMS 2.0 do not track institutional controls as independent elements of a site remedy, and they do not allow users to track planned institutional controls. In addition to these system design limitations, at the time of our fieldwork, the Office of Land and Emergency Management had not mandated that the regions use the “Institutional Controls” module, nor had it issued guidance regarding the purpose and use of the module. Consequently, the regions do not use the “Institutional Controls” module consistently, so the data do not completely or accurately reflect actual site conditions.

We assessed NPS’ process for estimating and adjusting project cost estimates for construction contracts awarded using GAOA funds.