In a scathing report released on September 2, 2015 by the VA Office of Inspector General (OIG) entitled, “Veterans Health Administration Review of Alleged Mismanagement at the Health Eligibility Center,” the OIG reported that, “As of September 2014, more than 307,000 pending ES records, or about 35 percent of all pending records, were for individuals reported as deceased by the Social Security Administration.”
However, the OIG could not determine specifically how many pending ES records represent veterans who applied for health care benefits, due to faulty data maintained by the VA (the enrollment program did not effectively define, collect, and manage enrollment data and the VHA lacked adequate procedures to identify date of death information and implement necessary updates to the individual’s status).
The Veterans Health Administration’s (VHA) Health Eligibility Center (HEC) is the VA’s central authority for eligibility and enrollment processing activities and is the business owner for the Enrollment System (ES). The HEC and four VA medical centers process health care applications using ES. Although ES serves as the VHA’s official electronic system of record for veteran health care enrollment information, it also contains the names of all VA patients as well as applicants whose military service was not confirmed.
Mismanagement At The HEC
ES had about 867,000 pending records as of September 30, 2014 (the OIG determined that the number of pending records in ES was overstated and did not necessarily represent veterans actively seeking enrollment in VA health care; the OIG projected that at least 477,000 of the pending records did not have application dates). Because the enrollment program data were unreliable, the OIG could not reliably determine how many records were associated with actual applications for enrollment.
The OIG determined that the frequent lack of application dates makes ES unreliable for monitoring timeliness or determining if a record represents a veteran’s intent to apply for VA health care (most of the pending records have been inactive for years because the CBO did not establish limits on how long ES records could remain in a pending status before reaching a final determination).
The OIG report stated, “Unless VHA officials establish effective procedures to identify deceased individuals and accurately update their status, ES will continue to provide unreliable information on the status of applications for veterans seeking enrollment in the VA health care system.”
Nonetheless, the OIG was able to substantiate that employees incorrectly marked unprocessed applications as completed and possibly deleted 10,000 or more transactions from the Workload Reporting and Productivity (WRAP) tool over the past 5 years.
The OIG further substantiated that the HEC identified more than 11,000 unprocessed health care applications and about 28,000 transactions related to application updates, correspondence, and alerts in January 2013 (however, the oldest unprocessed health care application had a date of September 2012, only four months prior to discovery), and that the backlog developed because the HEC did not adequately monitor and manage its workload and lacked controls to ensure entry of WRAP workload into ES.
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