From the U.S. Government Accountability Office, www.gao.gov Transcript for: Potentially Ineligible Providers in the Veterans Community Care Program Description: Veterans can receive health care services through community providers when they face challenges accessing care at VA facilities. The Veteran's Health Administration is responsible for ensuring community-based health care providers are qualified and competent. However, our work has identified some gaps in this oversight that could allow unqualified providers to deliver care to veterans. Today, we'll find out more from Seto Bagdoyan, a director in our Forensic Audit and Investigative Service team. Welcome, Set. Related GAO Work: GAO-22-103850, Veterans Community Care Program: VA Should Strengthen Its Ability to Identify Ineligible Health Care Providers Released: January 2022 [Music:] [Seto Bagdoyan:] One ineligible provider is really one too many. [Holly Hobbs:] Hi, and welcome to GAO's Watchdog Report, your source for news and information from the U.S. Government Accountability Office. I'm Holly Hobbs. Veterans can receive health care services through community providers when they face challenges accessing care at VA facilities. For example, if they live too far away from a VA facility. The Veteran's Health Administration is responsible for ensuring that these community-based health care providers are qualified and competent. However, our work has identified some gaps in this oversight that could allow unqualified providers to deliver care to veterans. Today, we'll find out more from Seto Bagdoyan, a director in our Forensic Audit and Investigative Service team. Welcome, Seto. [Seto Bagdoyan:] Hi, Holly. Happy to be here today. [Holly Hobbs:] So Seto, how many providers were found to be ineligible? [Seto Bagdoyan:] Yes, we flagged about 1,600 providers as being potentially ineligible. This is important to note because we are not in the business of determining eligibility. That's the VA's job. And we'll be referring these providers to the VA Office of Inspector General and the relevant VA program office for their review, determination of eligibility and any subsequent appropriate action. VA is eager to receive the referrals and review the providers we flagged, so that's a really good thing. [Holly Hobbs:] Why might a health care provider be ineligible to provide care under the VA's Community Care Program? [Seto Bagdoyan:] Well, there is a number of key factors that make a provider potentially ineligible, including their licensure status, whether that license has expired, has been revoked or suspended for some reason; a criminal record to whether it's an arrest or a conviction; or an exclusion from participating in a federal health care program, for example, for having committed fraud in a prior program. [Holly Hobbs:] How is the VA currently checking provider's eligibility? [Seto Bagdoyan:] So, among other things, VA purportedly checks a provider state level licensure status. Whether a provider has been excluded from participating in a federal health care program. Whether a provider is deceased, or whether a provider has been convicted of a felony or other serious federal or state offense. [Holly Hobbs:] And for our report, we looked at VA approved community care providers. What did we find? [Seto Bagdoyan:] Well, we found that basically VA was cutting corners in the vetting of providers. The eligibility of reviews we found are uneven and inconsistent. And essentially the agency was simply not following its own established standard operating procedures in certain key areas, such as regular data checks and matches, and the timely removal of those providers it had flagged as ineligible from the system. [Holly Hobbs:] Can you give us some examples of potential ineligibility that we found? [Seto Bagdoyan:] We had a total of about 1600 potentially ineligible providers that we flagged, and there are a couple of noteworthy ones. In one instance, a provider had a string of disqualifying issues. He had an expired license, had been arrested for assault, had been excluded from participating in federal health care programs, and had been convicted for patient abuse and neglect. Yet, through a failure of vetting controls, this provider was allowed to join the Community Care Program. In another instance, a provider had a revoked medical license, with his license documentation clearly warning that this person posed a clear and immediate danger to public health and safety. But through another failure of vetting controls, this individual was somehow deemed eligible for referrals in the program, and both of these examples help illustrate that having ineligible providers poses a risk to veteran's health. [Holly Hobbs:] So, Seto, what's the disconnect here? If VA has a reviewing process to prove that providers are eligible, how are so many not meeting these requirements? [Seto Bagdoyan:] Well, as I mentioned earlier, it is essentially a failure to apply the vetting process in a consistent and thorough manner. Our work, which was a deep dive, basically found that they were really cutting corners. They were not performing monthly checks, for example. And even when they did flag someone as ineligible, that individual, like the two that I mentioned, were not removed in a timely manner. And so they kept in the program. And had they been called upon, they might have pose a risk to whoever they treated. {MUSIC} [Holly Hobbs:] So Seto just told us that while the VA has processes in place to identify and remove ineligible providers, we found instances where potentially ineligible providers were still in the community care program. And this could be because of gaps in how the VA implements its processes. So Seto, what can the VA do to improve its oversight of the community care providers? [Seto Bagdoyan:] Right, we made ten recommendations which the VA agreed with. So based on these, it can do two things overall. First, follow its own standard operating procedures and apply relevant controls without cutting corners. This is fundamental. And then second, expand its analytics activities to include additional data matches and cross tabs, and even more importantly, ensure that those providers it does flag as ineligible are removed in a timely manner. [Holly Hobbs:] And last question, what's the bottom line of this report? [Seto Bagdoyan:] The bottom line here is that VA should take the issue of provider eligibility seriously and act decisively on a number of fronts, as we've recommended, because potentially ineligible providers pose risks to veteran's health and in this regard, one ineligible provider is really one too many. [Holly Hobbs:] That was Seto Bagdoyan talking about GAO's recent review of the Veterans Community Care Program. Thanks for your time, Seto. [Seto Bagdoyan:] My pleasure. [Holly Hobbs:] And thank you for listening to the Watchdog Report. To hear more podcasts, subscribe to us on Apple Podcasts, Spotify or wherever you listen and make sure to leave a rating and review to let others know about the work we're doing. For more from the congressional watchdog, the U.S. Government Accountability Office, visit us at GAO.gov.