Rubio pushes VA for needed oversight of community care providers

The Veterans Affairs Community Care Program (VCCP) provides health care to veterans in need outside of VA facilities. A recent report exposed flaws in the Veterans Health Administration’s (VHA) ability to identify and exclude VCCP providers who have failed to provide safe and adequate care.

U.S. Sen. Marco Rubio (R-FL) sent a letter to U.S. Secretary of Veterans Affairs Denis McDonough about the report and its impact on Florida veterans.

• Veterans across the country deserve to know that when they are referred to a community care provider, the VA has made sure that the provider is one that will provide the safe, appropriate, reliable and necessary care that the veteran needs. deserves

The full text of the letter is below.

Dear Secretary McDonough:

I am writing out of concern following a recent report by the U.S. Department of Veterans Affairs (VA) Office of Inspector General (OIG) that reveals that the Veterans Health Administration (VHA) failed to identify all health care providers who have been removed from VA employment for violating policies related to providing safe and appropriate care. The report further details that the VHA did not exclude these providers from the VA Community Care Program (VCCP). Whether veterans receive care at a VA facility or in the community through the VCCP, they rely on the VA to refer them to qualified and reliable providers. I expect the VA to immediately implement the OIG’s recommendations and take further action to rectify the VA processes that allowed this oversight to occur in the first place.

The report stated that OIG remains concerned about VHA’s inability to exclude and prevent ineligible health care providers from providing care to veterans through the VCCP. OIG discovered claims for community care from health care providers that VHA had identified as ineligible to provide such care. In addition, the OIG found that the VHA failed to capture 81 percent of clinical occupations when it identified health care providers for exclusion due to violation of a policy related to the provision of ‘a safe and adequate health care, according to the VA MISSION Law (PL 115-182). ). With the inability to identify providers who have previously violated care policies and therefore should have no role in providing care to veterans, the VA does not have the ability to exclude these providers from participation in the VCCP in the future.

While this is an issue that needs to be addressed nationwide, one specific instance that the VA OIG has considered in recent months resulted from a case involving a surgeon who had a revoked medical license in Florida but would later participate as a VCCP provider. The OIG found that the surgeon voluntarily surrendered a Florida medical license after being investigated by the Florida Department of Health and notified of possible termination for cause. The OIG stated that Optum was unclear whether this instance should be considered as part of the VCCP accreditation process, and the OIG stated that the VA contracts do not address or define this terminology.

Unfortunately, the recent OIG reports are not new assessments of VAs’ lack of ability to track provider reliability in VCCP. In 2021, the Government Accountability Office found gaps in VHAs’ ability to identify providers ineligible to participate in the VCCP. At that time, VHA evaluated 800,000 providers and identified 1,600 VCCP providers who were dead, ineligible to work with the federal government, or had revoked or suspended medical licenses. As an example, one of the providers was convicted of patient abuse and neglect in July 2019, but entered the VCCP in November 2019, where the VHA stated that the provider was mistakenly hung. This is unacceptable.

Veterans across the country deserve to know that when they are referred to a community care provider, the VA has made sure that the provider is one that will provide the safe, appropriate, reliable and necessary care that the veteran needs. deserves I would like to receive regular updates on VA’s plans to implement the OIG’s recommendations and would also like answers to the following questions:

1. What steps are being taken to ensure that the reasons for exclusion of health care providers are accurately documented and considered in the exclusion process?
2. What process improvements or updates does the VA plan to implement to ensure that no eligible provider is improperly excluded from the VCCP?
3. How does the VA ensure compliance with section 108(a)(1) of the MISSION Act, which required the VA to exclude eligibility for VCCP if the health care provider was removed from the employee’s employment Department, in its current operating procedures?
4. How often does the VA periodically review the effectiveness of its opt-out processes?
5. What specific measures are being implemented to include all clinical occupations in the automated query used to identify opt-out providers?
6. How is the VA addressing the issue of incomplete coverage of staff actions in the data leading to the failure to identify providers that should be excluded?
7. How does the VA plan to inform patients when a provider has been excluded?

I appreciate your attention to this important matter.

Sincerely,