VA contractor health care program needs tighter controls

The federal workforce includes vast numbers of veterans—about a third of feds are vets and can use services through the Department of Veterans Affairs, with still more in federal families. In short, what happens at VA matters to feds—especially in VA health care options.

A new report from the Government Accountability Office spotlights a continuing area of concern in VA health care options: the safety of outside, contracted care.

Since the 1990s, the VA and its Veterans Health Administration component have undergone a series of modernizations and expansions of preventive and treatment services that include growing use of outside, non-VA providers. In recent years the lead such initiative—the Veterans Choice Program, or VCP—has been supplanted by the Veterans Community Care Program, or VCCP. The GAO report scrutinizes concerns with the VCCP scheme.

“VA has faced challenges in ensuring that its providers, including providers participating in the VCCP, deliver safe and effective care to veterans,” the GAO report states. “We have previously identified situations where providers who were removed from employment by VA medical facilities for quality of care concerns went on to provide care outside VA and to enroll in a community care network of providers, allowing them to care for veterans.”

The central concern here is that providers with revoked licenses or other serious derogatory marks on their records in some cases continue to function under VCCP.

“VA’s contracts with [certain] contractors do not require the verification of providers’ history of license sanctions, including a revoked license, in all states during credentialing,” the GAO report warns, regarding the VCCP. “Only one of the two contractors has a process that includes verifying providers’ licensure history in all states and neither has a sufficient process for continuously monitoring provider licenses.”

The two contractors examined by name in the report include TriWest and Optum, among others.

The GAO report spotlights the urgency and possible scope of the issue, by noting massive and rapid growth in VA-facilitated use of outside health services. “While veterans still receive most of their care from VA medical facilities,” the report said, “the number of veterans that have received community care has increased 77 percent from 2014 through 2019.”

“The Secretary of Veterans Affairs, in concert with the Undersecretary for Health, should require the Community Care Network contractors to amend their credentialing policies,” the report concludes. The report adds specifically VA authorities must move “to ensure that providers who have violated the requirements of medical licenses that resulted in the loss of … medical licenses in any state are excluded from providing care to veterans through the Veterans Community Care Program.”

The report offers other recommendations on how VA can tighten the requirements and contracting procedures used by VCCP—improving the safety of veterans who utilize the program.

For more information on the VHA’s VCCP program, go to the program’s website—and for more on career opportunities for veterans in the federal workforce, go to the Feds Hire Vets website.

Reader comments

Thu, Feb 11, 2021

In general, conractor scheme go wrong.

Tue, Feb 9, 2021

DOD uses tricare and they furnish you a list of doctors. The VA just needs to let TRI Care provde this service and vet can go to locate drs for all services.

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