(PRESS RELEASE UPDATE) DELAY, DENY, UNTIL I DIE: The waiting room is the new combat zone.

June 18, 2014 12:00 pm Published by

Scandal, controversy and problems at the VA have existed for years.

The FBI is now involved in a criminal investigation of the Veterans Affairs Department, joining an ongoing review by the VA inspector general. The VA’s inspector general investigation has found distressing systematic problems in how the VA’s mismanagement has led to delayed scheduling of beneficiaries for medical appointments, expanding the investigation to include 69 facilities. In the Phoenix area alone, the report found 1,700 veterans “at risk of being lost or forgotten” after being kept off the official waiting list.

Key findings project a staggering 57,436 newly enrolled veterans could be expected to wait a minimum of 90 days for medical care. Additionally, 63,869 veterans who enrolled over the past decade and requested an appointment have never been scheduled.

This poses an eligibility problem for veterans that have served our country.

38 CFR § 1725 is the statutory authority by which the VA shall reimburse a veteran for emergency treatment furnished to the veteran in a non-VA facility. For an emergency claim to be reimbursed for non-VA care, one of the striking eligibility requirements for the veteran is as follows:

(2) A veteran is an active Department health-care participant if—
(A) the veteran is enrolled in the health care system established under section 1705 (a) of this title; and
(B) the veteran received care under this chapter within the 24-month period preceding the furnishing of such emergency treatment (emphasis added.)

These unofficial waiting lists impede veterans from receiving medical care, resulting in a windfall of veteran non-VA claims being denied. If veterans must wait several years for medical care, how can they qualify under the 24 month care eligibility requirement?

In essence, the VA’s misconduct and mismanagement circumvents federal law and the VA’s duty to veterans seen at non-VA emergency net providers.

WANTED: Non-VA facilities and providers.

The U.S. House unanimously approved legislation last week to permit veterans experiencing long wait times for medical appointments to seek care at non-VA facilities.

Yet the VA has always had the ability to contract with non-VA facilities. Title 38 of the United States Code delineates the authority by which the VA can purchase health care services on a fee-for service or contract basis when services or resources are unavailable at VA facilities (38 CFR § 1703 (a)(3); 38 CFR § 17.52.)

In a 2011 report, the Office of Inspector General found the VA to have spent about $4.6 billion on health care services from non-VA entities with an available budget of $48 billion.

It is clear the firestorm of allegations at the VA Phoenix trickle down to local Fee Basis Units, who engage in unfair payment practices such as:

  • Denying emergency and poststabilization veteran claims when VA facilities are unavailable
  • Denying emergency and poststabilization veteran claims as non-emergent, stating the veteran could have been seen at the VA (days earlier)
  • Delaying reimbursement to non-VA emergency providers AND
  • The disturbing trend of refusing to issue a statutory mandated Statement of the Case when appeals are upheld, which deny the veteran access to care, due process, hearing and representation rights.

VA fatalities in the waiting room.

Our investigation of local VA Long Beach and VA Greater Los Angeles encompasses an astounding 90 veteran claims in which we have sent a written appeal, or Notice of Disagreement, to the Agency of Jurisdiction (AOJ). However, we have been unable to proceed to the next step of completing a substantive appeal due to the AOJ’s failure to furnish a Statement of the Case, thus impeding the veteran and provider’s right to appear before the Board of Veteran Appeals.

What is more distressing is that the list of uncompensated veteran cases is growing from the original 90. This raises a red flag, causing suspicion on whether the above VA Fee Basis Units are in fact reexamining initial appeals when submitted by providers or their representatives as required by federal law.

Veteran Affairs (VA) Secretary Eric Shinseki has resigned in the wake of misconduct and mismanagement at the VA’s medical facilities.

Before submitting his resignation, Shinseki fired senior leaders at the Phoenix VA, where the allegations first came to light. The former Secretary also cancelled this year’s performance bonuses for Phoenix VA’s management, a scheduling-based incentive that may have attributed to the secret wait lists and the troubling delays our veterans experienced. In an effort to expedite access to care, the VA is now attempting to contact every veteran waiting for care in Phoenix to schedule appointments, oftentimes scheduling with private and non-VA providers.

But is it enough?

Can veteran lives be entrusted in the hands of local VA hospital fee basis units in the wake of the SOC Scandal?

Only time will tell.

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This post was written by Magali Godfrey