The Government Accountability Office made a series of recommendations to improve the Veterans Health Administration credentialing to stop disqualified providers from delivering care to veterans.
In a review of the program, GAO discovered that VHA was not consistent in how it responded to adverse-action information from the National Practitioner Data Bank (NPDB). In some cases, VHA facilities were unaware of adverse action, including administrative or other nondisqualifying adverse actions.
The recommendations, which the agency agreed with, suggested VHA perform periodic mandatory training for officials who handle credentialing and hiring and review providers who have an adverse action reported in the NPDB.
Despite a recent spotlight on the VHA program, which cares for about 9 million veterans, the GAO found that VHA facilities don't consistently adhere to policies in terms of credentialing. That includes not reviewing the NPDB, which offers information about providers disciplined by state licensing boards and healthcare facilities. VHA entities don't consistently review the NPDB to avoid providers disciplined for "adverse actions."
The privatization debate has put a spotlight on the VHA as federal leaders debate whether to allow veterans to have easier access to private healthcare. A 2014 Congressional Budget Office report showed that already about 70% of veterans in the VHA system received some care from private providers.
Congress created the Veterans Choice Program in 2014 after the wait time scandal. The program offers veterans the option to get care from private providers. The Trump Administration has recently provided additional criteria to determine when veterans can get care outside the VHA, as well as proposed access standards.
GAO also found that some facilities weren't aware of VHA employment policies. That included at least five facilities that hired providers "unaware of the policy regarding hiring a provider whose license has been revoked or surrendered for professional misconduct or incompetence, or for providing substandard care," GAO said.
GAO provided another example of the VHA hiring a doctor who had given up his physical-therapy license after not completing physical therapy continuing education. His license surrender appeared in the NPDB, but VHA still hired the doctor.
VHA does perform credentialing reviews occasionally, including a one-time review in December 2017. Despite the labor intensiveness of these reviews, GAO suggested they should be performed regularly.
"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," GAO said.