Today's Article
On occasion the VA hired
or retained ineligible
health care providers,
states the Government
Accountability Office
(GAO).
The American Spark
VA Sometimes Hired Unqualified Health Care Providers

By Cliff Montgomery - Feb. 28th, 2019

The U.S. Department of Veterans Affairs (VA) runs the Veterans Health Administration (VHA), which operates
a massive health-care system serving almost 9 million veterans every year. For veterans, it is an essential
lifeline.

The VHA runs a credential verification process which is supposed to ensure that the doctors and other health
care providers it hires are qualified professionals. This process includes a check on whether a provider has
been disciplined by a licensing board.

Though most providers were correctly approved by the VHA process, on occasion the Administration hired or
retained ineligible providers,
according to a study released today by the Government Accountability Office
(GAO).

GAO discovered that officials in a number of VHA facilities “who were involved in verifying providers’
credentials and hiring them were unaware of the policy regarding hiring a provider whose license has been
revoked or surrendered for professional misconduct or incompetence, or for providing substandard care.”

The result? Those facilities “hired or retained” a number of ineligible providers, stated the GAO report.

Below, the
American Spark quotes a number of key sections from the revealing GAO study:


The Department of Veterans Affairs’ (VA) Veterans Health Administration (VHA) operates one of the
largest health-care systems in the nation, serving almost 9 million veterans annually in recent years. To
care for these veterans at its more than 1,200 medical facilities, VHA officials said that the agency has
approximately 165,000 licensed health-care providers, such as physicians and nurses.

“Oversight for these facilities is the responsibility of 18 regional offices, referred to as Veterans Integrated
Service Networks (VISN). [...]

“To help ensure the quality of care provided by its staff, VHA requires each of its medical facilities to
determine whether providers have the appropriate professional qualifications and clinical abilities to care
for patients. This begins with the process of credentialing providers before they are hired.

“VHA hiring officials are to examine information derived from the provider’s application, state licensing boards,
professional references, and the National Practitioner Data Bank (NPDB), among other information. [...]

Why GAO Did This Study

“VHA provides health services to almost 9 million veterans at medical facilities nationwide. Through the
credentialing process, VHA facilities determine whether providers have the appropriate professional
qualifications to provide care.

“The NPDB is one information source VHA uses to determine whether providers have been disciplined by a
state licensing board or a health-care facility. Such discipline results in ‘adverse actions,’ that may disqualify
providers from practicing at VHA.

“GAO was asked to review how allegations of provider misconduct are resolved. GAO examined (1) how
officials at VHA facilities responded to adverse-action information received through NPDB, (2) how VHA
facilities adhered to polices regarding providers with adverse actions, and (3) steps VHA has recently taken to
ensure that providers meet licensure requirements. [...]

What GAO Found

“GAO found that Veterans Health Administration (VHA) facilities responded in various ways to adverse-
action information from the National Practitioner Data Bank (NPDB) for the 57 providers reviewed, and in
some cases overlooked or were not aware of adverse action.

  • In some cases, providers had administrative or other non-disqualifying adverse actions reported in the
    NPDB, but VHA facilities determined they could be hired. For example, VHA hired a physician who had
    surrendered his physical-therapy license for not completing physical-therapy continuing education.
    Although his license surrender resulted in an adverse action in NPDB, VHA determined that there were
    no concerns about the provider’s ability to perform as a physician.

  • VHA facilities disciplined or removed providers when they learned about adverse actions reported in
    NPDB. In addition, after GAO raised questions about certain providers’ eligibility, based on GAO’s
    examination of adverse-action information, VHA facilities removed five providers that it determined did
    not meet licensure requirements.

  • In some instances, VHA facilities overlooked or were unaware of the disqualifying adverse-action
    information in NPDB. In these cases, VHA facilities inappropriately hired providers, but some providers
    were no longer working at VHA at the time of GAO’s review. For example, VHA officials told GAO that in
    one case, they inadvertently overlooked a disqualifying adverse action and hired a nurse whose license
    had been revoked for patient neglect. This nurse resigned in May 2017.

“VHA facilities did not consistently adhere to policies regarding providers with adverse actions. Among other
issues, GAO found that some facility officials were not aware of VHA employment policies.

“Specifically, GAO found that officials in at least five facilities who were involved in verifying providers’
credentials and hiring them were unaware of the policy regarding hiring a provider whose license has been
revoked or surrendered for professional misconduct or incompetence, or for providing substandard care.

“As a result, these five VHA facilities hired or retained some providers who were ineligible.

“VHA provides mandatory onetime training for certain VHA staff, but not for staff responsible for credentialing.
The absence of periodic mandatory training may result in facility officials who are involved in credentialing and
hiring not understanding the policies and hiring potentially ineligible providers.

“VHA officials described steps they have taken to better ensure that providers meet licensure requirements.
For example, VHA completed a onetime review of all licensed providers beginning in December 2017 and
removed 11 providers who did not meet the licensure requirements as a result of this review.

“[But] VHA officials said these types of reviews are not routinely conducted, and noted the review was labor
intensive. Without periodically reviewing those providers who have an adverse action reported in NPDB, VHA
may be missing an opportunity to better ensure that facilities do not hire or retain providers who do not meet
the licensure requirements.

What GAO Recommends

“GAO is making seven recommendations, including that VHA ensure that facility officials responsible for
credentialing and hiring receive periodic mandatory training, and periodically review providers who have an
adverse action reported in NPDB. The agency concurred with GAO’s recommendations.”



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