VA health enrollment system in disarray, audit finds

Filing an application for enrollment is the first step veterans must take to gain access to health care at the more than 150 VA hospitals across the country. But a scathing new federal review finds the health enrollment system overseen by a national VA office in Atlanta is in disarray.

Poor oversight and mismanagement of the enrollment system resulted in delays to health care access for some veterans and likely denied access to others, according to a draft report that the VA’s Office of Inspector General wrote in May.

The report highlights the depth of the problems in the VA’s enrollment process that is overseen by the Veterans Health Administration and its national Health Eligibility Center in Atlanta.

“VHA does not have reasonable assurance that veterans receive consistent or timely enrollment decisions at VA medical facilities nationwide,” the report says.

An AJC investigation in April showed how a plan to fix an enrollment backlog of hundreds of thousands of health care applications was botched and undermined by the executives sent in to fix the problem.

The inspector general’s draft report written the next month sheds additional light on those and other problems. VHA officials failed in their oversight of the system and did not provide formal training to those making enrollment and eligibility decisions for veterans at local hospitals.

Only about 35 percent of the more than 100 facilities examined by auditors had required policies and procedures for making health care enrollment decisions. When a veteran applies for health care VA officials are required to enter that information in the enrollment computer systems. That can help verify the veteran’s eligibility, but some hospitals failed to follow that process.

This led to enrollment delays, the report said. The report does not say explicitly that eligible veterans were denied enrollment and access, but the enrollment process was so inconsistent that fact is implied by the report.

Some hospitals kept no record in computer systems of a veteran’s attempt to apply and there was no follow-up if the veteran needed additional proof of eligibility.

“By not entering the applicants’s information, the enrollment staff delayed or, in some instances, may have inadvertently prevented obtaining available evidence to validate the applicant’s eligibility for VA health care,” the report said.

Some hospitals kept no record of the veteran’s effort to apply if the application lacked information to complete it.

“The individual was essentially turned away if the application was incomplete,” the audit found.

VA Secretary David Shulkin oversaw the VHA for a year and a half before his confirmation to the top job in February. He vowed to fix problems in the Atlanta national enrollment center when he accepted an inspector general’s report in September 2015 that identified problems at office and within the VA’s enrollment system.

“Be assured that VHA regards the issues raised with the utmost seriousness and we are taking actionto address the concerns,” he wrote in response to the 2015 report.

Part of that fix was to carry out a plan to enroll as many as possible who were stuck in the pending application backlog. Many of the 800,000 on the list had been in the backlog for years. About 300,000 had died while on the list. Some on the list may not have been actual applications and for those who were trying to apply it was unlcear how many were still seeking VA health care enrollment.

But the VA was tasked to make efforts to contact all the living veterans on the list. If the agency couldn’t reach them or the veteran failed to respond within a year the VA could remove their names from the backlog.

Because of problems and questions surrounding that process, Sen. Johnny Isakson and other leaders in Congress in March asked Shulkin to take additional steps to ensure eligible veterans were enrolled before purging the backlog list.

Shulkin received additional pressure this week from a whistleblower in Atlanta to halt the process to delete the applications because of the ongoing problems in the enrollment system. Scott Davis, who testified before Congress in 2014 and provided the draft audit to the AJC, in an to Shulkin on Wednesday said the plan to purge the applications was moving forward.

“The audit shows that veterans in many cases are denied access to care not because of incomplete applications but because of actions taken by VA staff who were not properly trained,” Davis said.

A spokesman for Shulkin on Wednesday said VA will not close out the applications until the issues are resolved.

“VA has closed no legacy pending applications within the Veterans Health Administration enrollment system due to the ongoing Inspector General review,” said VA press secretary Curt Cashour. “Also, VA will close no legacy pending applications until we have reasonable assurance that all applications have been fully researched and resolved.”

 

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