Veterans Health Administration: Action Needed to Address Persistent Control Weaknesses and Related Risks in Employee Screening Processes
Fast Facts
The Veterans Health Administration provides health care to over 9 million veterans. It is responsible for ensuring that its providers are qualified, competent, and suitable to provide care.
The Drug Enforcement Administration requires VHA medical centers to get a waiver before employing anyone with a controlled substance-related felony conviction whose job gives them access to such substances. But VHA doesn't have a waiver policy and didn't consistently request them, so VHA's screening process may overlook individuals who may pose risks to veterans.
We recommended VHA implement a policy regarding these employment waivers to protect veterans.
Highlights
What GAO Found
The Veterans Health Administration (VHA) received adverse information regarding some employees but lacked control procedures to ensure it responded as required. For example, VHA received information about some employees' controlled substance-related felony convictions and actions taken against certain employees by the Drug Enforcement Administration (DEA). VHA was required to obtain waivers from DEA for any of these employees whose job involved access to controlled substances.
aDEA registrations are required for certain health care practitioners licensed to dispense, administer, or prescribe controlled substances.
GAO identified 12,569 VHA employees with indications of controlled substance-related criminal history. Of these, GAO obtained further information about a generalizable sample of 305 employees and found 50 of them had one or more controlled substance-related felony convictions. However, VHA has no policy regarding DEA employment waivers, including guidance for determining whether an employee has access to controlled substances. VHA confirmed that it did not request waivers for 48 of the 50 employees GAO identified and did not confirm whether it requested waivers for the remaining two. VHA officials said they are developing an employment waiver policy. They did not provide a timeline for when the policy is to be approved and implemented. Without such a policy, including guidance for determining whether an employee has access to controlled substances, VHA cannot assess whether its employees, such as those identified by GAO, need waivers. Without a waiver policy, VHA risks a continued lack of assurance that its facilities are complying with DEA regulations that help control against theft and diversion of controlled substances.
GAO also identified vulnerabilities in VHA's process for completing employee background investigations. For example, GAO found that 13 of the 305 employees in the generalizable sample did not have background investigations as required by regulation and policy. Without adequate control procedures to ensure employee background investigations are completed as required, VHA lacks assurance that its personnel are properly vetted and suitable to provide care to veterans.
Why GAO Did This Study
The Department of Veterans Affairs (VA) operates one of the largest health care systems in the nation, with over 9 million veterans enrolled in the VHA health care program. VHA is responsible for ensuring that its more than 400,000 health care providers and support staff are qualified, competent, and suitable to provide safe care.
GAO was asked to review VHA's employment and suitability procedures. This report examines the extent to which (1) VHA responded to adverse information regarding employees' criminal history or DEA registrations and (2) vulnerabilities exist in VHA's processes for completing and documenting background investigations.
GAO analyzed a generalizable sample of 305 VHA employees employed as of January and June 2020 with indications of controlled substance-related criminal history. GAO examined court records and other documentation, reviewed regulations and policies, and interviewed officials from VHA, DEA, and other agencies.
Recommendations
GAO is making 14 recommendations to VA, including that VHA establish a timeline for finalizing and implementing a policy regarding DEA employment waivers. Such a policy should include guidance for determining whether employees have access to controlled substances. GAO also recommends that VHA establish control procedures to ensure background investigations are completed and documented. VA agreed with GAO's recommendations.
Recommendations for Executive Action
| Agency Affected | Recommendation | Status |
|---|---|---|
| Department of Veterans Affairs | The Under Secretary for Health should establish a timeline for finalizing and implementing a policy regarding DEA employment waivers. (Recommendation 1) |
When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
|
| Department of Veterans Affairs | As the Veterans Health Administration develops a DEA employment waiver policy, the Under Secretary for Health should ensure that the policy includes guidance for determining whether employees have access to controlled substances. (Recommendation 2) |
When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
|
| Department of Veterans Affairs | As the Veterans Health Administration develops a DEA employment waiver policy, the Under Secretary for Health should ensure that the policy specifies that an employment waiver is required to employ any individual in a position with access to controlled substances who, at any time, has been convicted of a felony offense related to controlled substances, had an application for a DEA registration denied, or had a DEA registration revoked or surrendered for cause, and does not presently hold an active DEA registration. (Recommendation 3) |
When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
|
| Department of Veterans Affairs | After implementing a DEA employment waiver policy, the Under Secretary for Health should review the individuals still employed at VHA among the 50 we confirmed had controlled substance-related criminal history to determine whether they have access to controlled substances as part of their assigned duties and thus need DEA employment waivers. (Recommendation 4) |
When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
|
| Department of Veterans Affairs | After implementing a DEA employment waiver policy, the Under Secretary for Health should review the approximately 12,500 employees we identified with indications of controlled substance-related criminal history—but for whom we did not confirm controlled substance-related felony convictions—to determine whether they need DEA employment waivers. (Recommendation 5) |
When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
|
| Department of Veterans Affairs | The Under Secretary for Health should implement control procedures to ensure that suitability adjudicators use information regarding undisclosed criminal history in compliance with OPM regulations and VA policy, including policies requiring that adjudicators document their assessments of the materiality and intent of undisclosed information and their rationale for not referring cases involving nondisclosure to OPM. (Recommendation 6) |
When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
|
| Department of Veterans Affairs | The Under Secretary for Health should establish oversight procedures to ensure that adjudicators follow up on applicants' active warrants before hiring and notify the appropriate VISN suitability coordinator on the active warrant before rendering a favorable determination. (Recommendation 7) |
When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
|
| Department of Veterans Affairs | As VA implements the Rap Back Program, the Secretary of Veterans Affairs should develop control procedures to ensure that PAA notifications are routed and resolved appropriately. (Recommendation 8) |
When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
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| Department of Veterans Affairs | As VA implements the Rap Back Program, the Secretary of Veterans Affairs should develop control procedures to document follow-up work conducted on a PAA notification in a VA system such as VA-CABS. (Recommendation 9) |
When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
|
| Department of Veterans Affairs | The Under Secretary for Health should establish control procedures to ensure that employee background investigations are completed as required by OPM regulation and VA policy. (Recommendation 10) |
When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
|
| Department of Veterans Affairs | The Assistant Secretary for Human Resources and Administration/Operations, Security and Preparedness should develop and implement policies that establish who is responsible for documenting employee background investigations in eOPF in accordance with OPM guidance and VA policy and control procedures to ensure that these policies are followed. (Recommendation 11) |
When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
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| Department of Veterans Affairs | The Under Secretary for Health should ensure that background investigations are completed and documented as required for the employees among the 329 we examined (i.e., those from our sample and those we identified with DEA registration actions or active warrants) and who we found did not have completed investigations or whose investigations were not documented in eOPF. (Recommendation 12) |
When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
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| Department of Veterans Affairs | The Under Secretary for Health should review the approximately 12,200 employees we identified with indications of controlled substance-related criminal history—but whom we did not examine—to ensure that employees who may require DEA employment waivers have completed background investigations. (Recommendation 13) |
When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
|
| Department of Veterans Affairs | The Under Secretary for Health should review the approximately 12,200 employees we identified with indications of controlled substance-related criminal history—but whom we did not examine—to ensure that background investigations were documented in eOPF for employees who may require DEA employment waivers. (Recommendation 14) |
When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
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