VA misled public, vets on health care backlog
Top
officials downplayed the backlog as staff warned of misleading vets and the
public.
BEN GRAYWhistleblowers across the
VA have been filing record claims of retaliation this year. They have been
instrumental in highlighting problems at the agency that administrators and
senior leaders have tried to keep hidden. Daphne Ivery is the president of
union at the national Health Eligibility Enrollment Center in Atlanta started
wearing a whistle this summer to show support for those speaking out. BEN GRAY
/ BGRAY@AJC.COM
Senior VA
officials pushed untrue and misleading information to veterans, the public and
Congress to blunt a potential scandal involving a backlog of hundreds of
thousands of applications for access to VA health care, an Atlanta
Journal-Constitution investigation has found.
The misinformation
came from top officials at the VA’s national Health Eligibility Center (HEC) in
Atlanta and senior officials in Washington, and contradicted what the VA’s
staff was reporting to their superiors about the application backlog.
The
officials misrepresented data to downplay the number of veterans waiting for a
health enrollment decision from VA. They tried to assert that many of the
veterans in the backlog had not actually applied for healthcare when internal
documents showed those statements to be false.
The
findings come as new VA Secretary Robert McDonald is trying to restore
credibility to a beleaguered agency tarnished by long waits for veterans at VA
health facilities, mismanagement and retaliation against whistleblowers.
McDonald, through a spokesman, declined to be interviewed for this story.
Last
month, the VA’s acting inspector general Richard Griffin testified before a
Senate committee about lies told
to investigators about scheduling delays and problems in the health care
system. And Congress has accused the agency of repeated falsehoods.
In the
spring and summer of 2012, analysts at the Health Eligibility Center in Atlanta
discovered that as many as 47,000 ... Read More
Rep. Jeff
Miller, R-Florida, who chairs the House veterans’ affairs committee, said the
deceptions uncovered by the AJC fit into the broader problem at VA where agency
officials try to mislead in the face of any investigation that targets the
quality of their service to veterans.
“A great
deal of the information that they do supply to the committee is either
factually wrong or at best misleading,” Miller said. “If they will lie or
mislead Congress, I can not imagine what they would do to a veteran.”
The
problems with the backlog of health applications remained largely under the
radar, thanks to the low-profile VA agency in Atlanta that oversees the
enrollment process for a system serving 8.9 million veterans. That changed this
summer after an AJC investigation exposed the extent of
the backlog and the failure of an online enrollment system rolled out four
years ago. The problems, largely ignored by VA leaders for more than two years,
delayed veterans access to the health care that they had earned through
military service.
CHRIS O'MEARA
U.S.
Secretary of Veterans Affairs Robert A. McDonald, right, speaks earlier this
month as U.S. Rep. Jeff Miller, R-Fla., Chairman of ... Read More
The
backlog is also the target of separate investigations by the VA Office of
Inspector General and the House veterans’ affairs committee.
By May of
this year as many as 896,000 veterans health applications were stuck in an
administrative limbo without an enrollment decision from the VA. Veterans
cannot use VA medical care until they have been approved for eligibility. As
many as 47,786 of veteransin the
backlog were deceased as of 2012, raising the possibility that some veterans
died before they could access care.
Following
the AJC’s
Aug. 17 article, VA officials posted information to a blog on the VA’s official
website — under the heading “VA Fact” — that claimed the backlog contained only
216,736 applications, a quarter of what it had reported to Congress the
previous month.
Whistleblower
Scott Davis has been speaking out since the summer about problems at the
national VA Health Eligibility Center in Atlanta. ... Read More
The post,
targeted at veterans, claimed that only 25 percent of the pending applications
were “true applications.” The claim has been repeated by VA’s senior public
relations officials in Washington, including acting assistant secretary for
public affairs Josh Taylor.
An
internal VA analysis reviewed by the AJC contradicts the claim.
The internal
analysis by the HEC staff, obtained from whistleblower Scott Davis,
said the agency actually had no way to determine how many of the hundreds of
thousands of pending records were not applications. It said that many in the
backlog represented veterans who applied for health care and that the “bottom
line is that we did have 896,237 pending as of May 2014.”
HEC
employees were concerned about the misinformation from top officials and they
found their statements to be misleading, according to interviews and records
reviewed by the AJC.
“It was a
willful attempt to deceive the nation’s veterans,” said Davis, a program
specialist in the HEC. “They’ve known about this for years. They cut and pasted
information to suit their purposes. The time we’ve spent covering this up we
could have actually addressed the problem.”
Stephanie
Mardon, the acting chief business officer for the Veterans Health
Administration, said she stands by her Aug. 17 blog post, including the
assertion that only 25 percent of the pending records are “true applications.”
“That’s
the information and research at the time,” Mardon said. “We’re continuing to
conduct additional research. But no, it’s not in any way, shape or form, in my
opinion, in anything misleading. It’s an assumption we made based on the best
research we had at the time and continue to have relative to what’s in a
pending status.”
Data flaws
The VA
has not provided the AJC with records from the studies they cite to support the
assertion that the backlog is much lower than 890,000. The central argument put
forth by Mardon and Deputy Chief Business Officer Lynne Harbin is that only 25
percent of the applications are “true applications” because those are the only
ones that have an application date associated with them in the enrollment
system.
But the
internal analysis prepared in August states that the date field is not reliable
to establish if an application is valid or not. Many applications lack dates
because of data integrity flaws.
“Having
an application date in the Enrollment System has no bearing on whether the
Veteran has requested care or submitted an application,” the report said,
adding that “many Veterans who have actually applied for health care do not
have an application date in our systems.”
The
report acknowledged that some of the 890,000 in pending status may not be
applications of veterans waiting for health care. But it made clear that figure
is unknown.
“Many
records in a pending enrollment status represent Veterans who actually applied
for health care, while some records do not,” the internal analysis said. “The
inability to identify which records represent an actual application for health
care makes our challenge greater.”
‘Skirt the issue’
The day
after Mardon’s August VA blog post, senior leaders at the HEC in Atlanta called
a series of “town hall” meetings with the agency’s 300 staff members.
HEC
director Benita Miller and her management team presented slides with talking
points about the application backlog and touted their efforts at transparency.
She asked staff to raise their hands if they thought the agency leaders had
been transparent. Only a handful of employees did, according to two people who
witnessed the meetings.
“It was
like a comic on stage that told a joke that fell flat,” said Daphne Ivery, the
union president at the HEC, and one of the whistleblowers who has spoken to
investigators about problems at the HEC. “Really? Are you serious? You really
want us to buy into this again. What they need to do is come clean. Say ‘We
screwed up.’ Until they acknowledge that, admit there’s a problem, they can’t
fix it.”
Documents
reviewed by the AJC show that the agency also hasn’t been transparent with
veterans service organizations such as the American Legion.
When the
American Legion requested to know how many veterans were waiting on a decision
about their health care eligibility in late 2013, Harbin, who oversees the HEC,
directed her staff to prepare a presentation for a meeting with veterans
service groups.
A version
of Harbin’s slide presentation had a glaring omission. It failed to provide the
total number of applications awaiting action from the VA. The omission was intentional.
“I don’t
think I want to go into the total number of pending records and will try to
skirt the issue, should they try to raise it,” Harbin wrote in a December 2013
e-mail to her staff.
In an
interview with the AJC, Harbin said she wanted to avoid the subject in the
meeting because the total number “doesn’t tell the entire story” and that to
represent them all as applications is wrong.
“I
believe in the meeting we actually did talk about the total number,” Harbin
said. “We also talked about the actions we’re taking to try to outreach to
veterans in pending status regardless of whether or not they actually did
apply.”
Roscoe
Butler, an official with the American Legion who attended the meeting with
Harbin, had a one-word reaction when Harbin’s email about skirting the backlog
was read to him: “Wow.”
“That
just suprises me, particularly with the spotlight on the VA right now,” he
said.
Getting
to the bottom of the backlog may require an outside audit by an independent
agency, said Butler, the Legion’s deputy director for health care.
Butler
and another American Legion official met again earlier this month with Harbin
and her staff about the backlog. He said it’s hard to believe that so many
pending records are not applications, and that the Legion wants clarification.
“We want
them to be forthright regardless whatever the consequences are,” said Butler,
who retired from VA’s chief business office in 2011. “They should be forthright
and tell us what the issues are…That’s the only way as veterans’ services
organizations we can help. If we go into meetings with them and they are not
truthful with us, then we’re not able advocate for our veterans.”
‘Not backlogged’
By 2012,
the backlog had become a major concern across VA’s 152 hospitals and medical
centers. A flaw in a new online application rolled out in 2010 exacerbated the
problem because it had no way for veterans to upload their discharge papers
that prove their military service. In internal communications to enrollment
coordinators across the VA, the HEC staff laid out these problems and made it
clear that they were delaying veterans access to health care.
Yet,
publicly, senior VA leaders can’t even bring themselves to refer to hundreds of
thousands of applications in their files as “a backlog.” In response to
questions from Congress, the VA in July said the applications were “not
backlogged,” a position Harbin and other senior officials have reiterated in
interviews with the AJC.
“As we’ve
learned more about these records we know they are not backlogged,” Harbin said.
“They are processed to their fullest extent and we are committed to that.”
If HEC
leaders have their way, the problem may soon disappear. They are advancing a
plan that would allow them to remove veterans from the backlog if they don’t
respond to a letter. A separate outreach campaign begun last year has enrolled
16,692 veterans from the pending list.
The
latest plan will require regulatory approval at the highest levels of VA in
Washington. A decision could come as early as this month. If approved, the HEC
office in Atlanta would expand the mail campaign to all veterans on the pending
list. Some have been on the list for years. If the veterans don’t respond to
the outreach within a year, the agency can remove them from pending status.
“Our plan
is once we require a regulatory change in order to be able to move them out of
a pending status,” Harbin said. “Once that occurs their status might change.”
Harbin’s
own slide presentation created last December said letters are “effective, but
only 8% of Veterans respond”.
HOW WE GOT THE STORY
The
Atlanta Journal-Constitution has been the leading media outlet in the country
to expose problems at the VA’s Health Eligibility Center in Atlanta, which
oversees the eligibility process for veterans seeking access to the VA’s
network of medical facilities. The AJC was the first to report on the backlog
of health care applications from veterans, and the newspaper’s reporting helped
bring forward whistleblowers who have provided information to Congress and investigators.
For this story, investigative reporter Brad Schrade reviewed hundreds of pages
of internal VA records and interviewed key VA leaders about his findings. The
AJC will continue to investigate this national story.
Log on to
MyAJC.com to read the VA’s own analysis of the backlog of pending health care
applications, and letters from Congress to VA leadership critical of the
agency’s transparency.
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