Up to 227 medical providers dismissed from the Department of Veterans Affairs over poor-quality care may be treating veterans through the VA’s networks of private physicians, a Government Accountability Office review has found.
As a requirement of the VA Mission Act, the department began tracking providers in May 2019 to make sure they were eligible to care for veterans. Disqualifiers included being dismissed from the VA for providing poor care or having lost their medical licenses.
But the monitoring did not address providers removed from the VA before that date, leaving up to 227 providers who had been fired by the department eligible to care for veterans under community care programs, according to a GAO report released Monday.
The reasons clinicians may be removed from practice range from quality-of-care concerns such as deficiencies in clinical performance or patient abuse, the GAO noted.
Since the VA began tracking community care providers, it has barred 136 clinicians from participating in the program. But VA officials told the GAO they had no plans to review the additional providers identified by the watchdog agency, adding that they are eligible to participate in the program because they were fired by the VA before the Mission Act went into effect.
The VA contracts with two companies, Optum and TriWest, to manage its community care provider networks under the Mission Act. The contractors are required to ensure that their physicians meet quality-of-care standards, but GAO analysts said they lack adequate systems for ensuring eligibility is met under the law.
The companies’ contracts don’t require them to verify providers’ license histories, including revocation, although TriWest does verify its providers’ license history in the state in which they practice medicine, according to the report, “Immediate Actions Needed to Ensure Health Providers Associated with Poor Quality Care Are Excluded.”
Neither contractor has a process in place for continuously monitoring health care providers in their networks, the report noted.
“There is a continued risk that former VA providers associated with quality of care concerns are participating in the [community care program],” the report states.
The GAO made several recommendations, including that the VA require contractors to institute credentialing and monitoring policies or improve the ones they have. It also recommended that the department assess the risk to veterans when former VA providers who generated quality concerns continue to provide care as network doctors.
In the response to the findings, VA officials said they largely agree with the GAO’s recommendations and plan to implement them.
VA spokesman Randy Noller said the department is “committed to ensuring our nation’s heroes receive safe and appropriate health care from qualified community providers.”
‘[We] will continue to partner with third party administrators for the Veterans Community Care Network to exclude those not meeting high credentialing standards,” Noller said in an email to Military.com on Monday.
He added that the contractors are required to notify the VA within 15 days if they learn that a provider’s licensing has been revoked and the provider is excluded from providing care under the community program.
In addition, he added, the VA conducts monthly audits of the contractor network to ensure that it meets Mission Act requirements.
“VA also reviews a list of former Veterans Health Administration providers on a biweekly basis to ensure any new additions to the list who do not meet standards for participation in the Veterans Community Care Program are excluded,” he said.
In response to the GAO report, VA officials said they would implement the recommendations by April 2021. They added that they had reviewed a list of 56 providers furnished by the GAO and have taken action to ensure that they meet Mission Act requirements.