Federal workers’ union wants Congress to investigate VA Choice contractors

The American Federation of Government Employees (AFGE) in a letter to congressional committee leaders urged the committees to investigate two private contractors operating the Veterans Affairs Choice Program.

The Choice Program, created by the Veterans Access, Choice, and Accountability Act of 2014, privatizes some VA health care services.

In its letter, the union accuses the two contractors TriWest Healthcare Alliance and Health Net Federal Services of defrauding the government.

The accusation stems from the results of an audit of the Choice Program. TAFGhe audit uncovered “tens of thousands of duplicate cases” and inflated reimbursement claims resulting in overcharges of more than $89 million.

 

The contractors’ overcharges “have directly harmed veterans and undermined the capacity of the VA health care system to provide them with the exemplary care that they have earned with their service,” states the union’s letter.

The audit, which began in March 2017, was conducted by the VA’s Office of the Inspector General after it was discovered that the Choice Program’s funds were running low.

The results of that audit were published in a September 2017 memorandum from the inspector general to the Secretary of Veterans Affairs.

The audit found that TriWest and Health Net had been over paid because of their questionable billing practices and because of the VA’s lack of oversight.

TriWest and Health Net were selected by the VA in 2014 to operate the new Choice Program, which diverts some veterans seeking VA health care services to private health care providers.

The two companies’ responsibilities include referring veterans to private health care providers and paying claims resulting from these referrals.

The companies are then reimbursed by the VA for the claims they pay.

According to the inspector general’s memo, “our audit work to date demonstrates the existence of tens of thousands of duplicate payments.”

According to the memo, the companies began submitting duplicate claims after convincing VA management that the VA wasn’t paying the companies’ claims quickly enough.

In order to speed up payments, the VA agreed to forego its customary review of claims and allow the companies to submit their claims in bulk with only a cursory review.

“Information obtained from the (companies) during our audits indicates that neither has effective processes for preventing duplicate payments,” states the inspector general’s memo.

Another questionable practice involved overcharging the VA for reimbursement.

The VA’s contract with the two companies says that reimbursement payments will be based on the Medicare reimbursement rate.

But in some instances, the companies negotiated deals with health care providers to accept payments below the Medicare reimbursement rate.

The companies then submitted reimbursement claims based on the higher Medicare rate to the VA.

The VA’s inspector general isn’t the only one that has taken an interest in the Choice Program’s billing practice.

The Arizona Republic reports that TriWest, a Phoenix-based company, is the subject of a federal grand jury investigation concerning irregularities in the Choice Program.

According to the Republic, the grand jury is investigating TriWest for “possible wire fraud and misuse of government funds” in two VA-administered health care programs.

When asked by the Republic if TriWest committed fraudulent billing practices, David McIntyre, TriWest’s CEO and a former aide to Sen. John McCain, replied, “absolutely not.”

But the Republic also reports that TriWest in 2011 paid $10 million to settle allegations by the Justice Department that the company defrauded TRICARE, the US Defense Department’s health care plan for the military, military members’ dependents, and military retirees.

Law 360 reports that the Department of Defense in 2012 decided to drop TriWest as a TRICARE contractor “just months after TriWest agreed to pay $10 million over fraudulent billing.”

Health Net also has had its problems.

Sen. Debbie Stabenow of Michigan told the Detroit News that Health Net’s performance running the Choice Program in Michigan has been “a disaster.”

She said that she has received a number of calls from veterans complaining of long waits when seking medical treatment through the Choice Program and that Michigan health care providers are having problems with delayed payments or not getting paid at all.

Some rural clinics in Michigan have stopped participating in the Choice Program because of Health Net’s payment problems, said Stabenow.

Health care providers in Alabama, Florida, and Wyoming also have stopped participating the Choice Program because of payment problems with Health Net.

In its letter to members of Congress, AFGE noted that “despite overwhelming evidence of abusive practices by both contractors, . . . the VA gave them contract extensions through September 30, 2018.”

The letter urges the committees with oversight responsibilities to take action before the companies are awarded further extensions.

The committees must act “to protect veterans and taxpayers from these improper and wasteful practices,” concluded the union’s letter.

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Union calls for more hiring at VA health care facilities and no more privatization

Veterans Affairs (VA) health care workers in Kerrville, Texas joined a growing number of VA hospital workers protesting plans to privatize the VA.

The VA workers on November 29 rallied outside the gates of the Kerrville VA Medical Center located in the Central Texas Hill Country.

Earlier in the month, VA health care workers, members of the American Federation of Government Employees (AFGE), rallied in Dallas, Temple, and Austin.

They have joined a national movement of union workers protesting plans to privatize the VA and demanding that the VA administration fill 49,000 vacant staff positions at VA health care facilities across the US.

The Kerrville VA workers said that allowing so many vacancies to persist puts the health and safety of their patients at risk.

Cheryl Eliano, national vice president AFGE District 10, said that the failure to fully staff VA facilities and the effort to privatize the VA go hand in hand.

“The lack of hiring is a strategic move to justify privatizing the VA,” said Eliano to the San Antonio Express News. “If they gave the VA the resources to do our jobs, the lines for veterans to get services wouldn’t be so long.”

The VA has been in the sights of privatization advocates since 2014 when the media began reporting that some veterans were having to wait too long for medical appointments at VA facilities.

A number of right-wing, pro-privatization groups used the long wait periods as an excuse to ramp up efforts to privatize the VA.

At the time, David J. Cox, Sr., national president of AFGE blamed the long wait periods on understaffing.

“When we look deeper into this issue of extended wait times for veterans to receive an appointment, we have to recognize that understaffing is a major culprit, Cox said.

In order to reduce long wait periods, Congress passed a bill that did two things: it increased VA health care funding so that VA facilities could hire more staff and upgrade its facilities, and it created a privatized alternative called Veterans Choice.

Veterans Choice, which provides veterans with vouchers to use with private health care services, was supposed to be a temporary alternative for veterans to use until the VA fixed its understaffing problem.

But plans are underway to expand it and make it permanent.

In June, the Senate Committee on Veterans Affairs held hearings on a bill that expanded VA Choice and made it permanent.

At the hearing representatives of congressionally charted veterans group voiced their opposition to VA Choice and their support for the VA.

“The American Legion supports a strong VA that relies on outside care as little as possible and only when medically necessary, rather than a move toward vouchers and privatization,” said American Legion Assistant Director Jeff Steele at the hearing.

“Even with the additional options of the Choice program, veterans in general overwhelmingly prefer to use VA,” said Disabled American Veterans Deputy National Legislative Director Adrian Atizado to the committee. “DAV strongly urges this committee, Congress, and the administration to honor the clear preference of the vast majority of veterans who choose to use the VA health care system–a system created to meet their unique needs.”

Despite the veterans groups’ support of the VA, the Republican leadership in Congress, President Trump, and the VA administration are moving ahead with other plans to privatize VA health care services.

In November, word leaked out about secret meetings between President Trump’s administration and the VA’s administration.

Out of the meetings came memos that proposed a plan for merging VA Choice with Tricare, the military’s health care system for troops, their dependents, and retirees.

In a letter to VA Secretary David Shulkin, five Democratic members of Congress, who are veterans, told the secretary that had “grave concerns” about a Tricare-VA merger.

“A Tricare-VA merger could compel veterans entitled to care provided by the VA system to instead seek care through the private sector, a shift that could unfairly force veterans to pay out-of-pocket costs that they wouldn’t otherwise be required to bear,” wrote representatives Ruben Gallego (D-AZ), Salud Carbajal (D-CA), Anthony Brown (D-MD), Ted Lieu (D-CA) and Collin Peterson (D-MN).

While all of this activity aimed at privatizing the VA has been taking place, the VA has done little to deal with the understaffing problem that originally caused the long waits.

In fact, the understaffing problem has gotten worse. In 2016, there were 42,000 vacant positions at VA facilities. By the end of 2017, that number had grown to 49,000.

“If . . . Secretary (Shulkin) were interested in improving the care veterans receive, he would stop trying to outsource to for-profit providers and instead focus on filling the more than 49,000 vacancies plaguing the VA nationwide,” said AFGE’s Cox. “The men and women who served our country were promised a health care system that fulfills their needs, not a voucher to go stand in the back of the line at private providers ill-equipped to treat them.”

VA nurses expose under staffing that poses risks to patients

Nurses at the Little Rock Veterans Affairs (VA) hospital recently stood up for their patients by calling attention to a severe under staffing problem at the hospital.

Thirty nurses, members of the American Federation of Government Employees (AFGE) Local 2054, filed a complaint with the VA’s Inspector General and the Arkansas State Board of Nursing charging that the hospital’s under staffing puts patients at risk.

Then on June 26, two dozen nurses held an informational picket at the hospital to call attention to the risks faced by patients.

“We are down 150 nurses. Floating to areas we aren’t skilled in is at an all-time high,” said Barbara Casanova, president of Local 2054 and a registered nurse at the hospital. “We can’t deliver appropriate care under those circumstances.”

“We promised to keep our veterans safe, but we’re very worried that something could go wrong,” continued Casanova.

David Cox, Sr., AFGE president, said that the under staffing problem in Little Rock is not unique; it’s a problem at VA hospitals and clinics all over the US.

According to Cox, there are currently 49,000 unfilled positions at VA hospitals across the country.

“Every vacancy is a missed opportunity to make good on our promise to care for those who have borne the battle,” said Cox, Sr. “One vacancy is a tragedy; 49,000 is a national disgrace.”

Cox said that it has been difficult to attract candidates to fill the vacant VA positions because of two things: a constant barrage of anti-government rhetoric by politicians and special interest groups that want to privatize the VA and “pay and benefit cuts that scare away qualified doctors, nurses, and other health care professionals.”

The anti-government rhetoric is being transformed into policy by the Trump administration, and its actions have exacerbated the VA’s under staffing problem.

One of the President’s first orders of business when he took office was to freeze hiring by government agencies like the VA.

That freeze was lifted in April, but its  effects continue to linger as the VA tries to catch up with a hiring backlog.

Health care professionals who might be interested in taking those jobs may think twice about doing so because those jobs could end up being cut if the VA continues to privatize more services.

President Trump is a big fan of privatization, and his proposed budget for the VA reflects his predilection for privatization.

His budget boosts funding for the VA’s Choice program, which the American Legion’s National Commander calls a “stealth privatization attempt,” by $2.9 billion in 2018 and $3.9 billion in 2019.

To help pay for the increase in funding for the Choice program, which allows local VA administrators to divert patients to private health care providers, the President’s proposed budget cuts veteran disability benefits by $3.6 billion.

“We are alarmed by the cannibalization of services needed for the Choice program,” said Schmidt. “It is a ‘stealth’ privatization attempt which The American Legion fully opposes.”

In addition to the threat that their jobs could be privatized, VA nurses and other federal employees have had to put up with pay freezes and benefit cuts, which Cox said also makes it difficult to fill open positions.

Between 2010 and 2013, all federal employees including those at the VA had their pay frozen.

Between 2010 and 2016, federal employees also suffered lost wages due to furloughs caused by budget impasses and higher pension contributions.

Now President Trump is seeking even more cuts to federal employees’ wages and benefits.

His proposed budget raises pension contributions for most federal employees to 7 percent of an employee’s salary, a 900 percent increase.

Higher pension increases will mean less take-home pay.

If the Trump budget were to be enacted, a federal employee hired before 2013 and earning $50,000 a year would see her pension contribution increase from $400 a year to $3500 a year, amounting to a 6 percent pay cut.

Trump’s proposed budget would also reduce future pensions and eliminate cost-of-living adjustments.

Back in Little Rock, the nurses’ actions that brought attention to the under staffing problem seems to have done some good.

Hospital management at the Little Rock VA said that 54 new nurses have been hired at the facility.

Casanova has been encouraged by the recent hirings, but if President Trump’s budget becomes a reality and privatization increases and wages and benefits decrease, the Little Rock VA and others will be hard pressed to close the staffing gap that endangers the health of its patients.

VA workers rally to stop privatization and closure of VA hospitals

Veteran Administration workers held 38 rallies at VA hospitals across the US to protest a proposal that if enacted would privatize health care services for veterans and shut down all VA hospitals and medical centers.

The proposal was drafted by seven members of the Commission for Care, a commission appointed by Congress in 2014 to recommend ways to improve care and accessibility at the VA.

Members of this rump group, which met in private, include executives from four for-profit hospital companies and an employee of the Koch brothers, the right-wing duo, who have spent millions funding political candidates who support privatizing government services.

The commission will soon release its recommendations, and VA workers and veterans are concerned that the commission’s recommendations will reflect the thinking expressed in the report from the rump group.

“Even though the vast majority of veterans oppose privatizing the VA, there are many people who would benefit financially from dismantling the VA and forcing veterans into a network of for-profit hospitals and insurance companies,” said AFGE National President J. David Cox Sr., president of the American Federation of Government Employees (AFGE), the union that represents 230,000 VA employees. “VA employees across the country are speaking out against these corrupt business interests with a clear message: it’s time to put people ahead of profits.”

Veteran’s groups have also expressed opposition to the proposals in the report, which has been dubbed “the strawman document.”

Recently, eight leaders of veterans organization signed a letter to the Commission for Care chairperson expressing their opposition to ideas in the document.

“On behalf of our combined 5 million members, the vast majority of whom use the VA health care system, we write to express our grave concerns with the ‘proposed strawman document’ that was discussed and disseminated during your March meetings in Washington, DC,” reads the opening sentence of a letter.

Among other things, the veteran groups’ leaders were concerned about the proposal on pages 19-20 of the document that calls for closing VA hospitals and medical centers, halting all construction of new VA facilities, halting all renovations of existing facilities,  and transitioning veterans in need of care to private hospitals and care providers.

The document envisions that in twenty years all VA hospitals and medical centers will be closed, and the VA will exist only to write voucher checks to private health care providers.

The Commission for Care was created in 2014 when the media reported that veterans were experiencing long waits for care at VA hospitals.

As it turns out, the long waits were not typical of the system, and the media reports were a bit exaggerated; nevertheless, Congress acted to address the problem by appropriating funds to hire more staff and improve VA facilities. It also allowed veterans facing delays in service to seek help from private providers.

As a result, the VA has added 14,000 health care workers, opened up 3.9 million more square feet of clinical space, and added 20 million provider hours of care.

It also cut its compensation and claims backlog by 87 percent and overhauled its scheduling system.

Those who have actually studied the VA’s performance such as RAND have concluded that “the quality of care provided by the VA health system generally was as good as or better than other health systems on most quality measures.”

But the authors of “the strawman document,” chose to ignore the progress made and good work done by the VA and, instead, to pursue their own agenda.

According to the veterans’ leaders, veterans want to see improvements at the VA but not at the cost of eliminating VA facilities and the “veteran-centric” services they provide.

The veteran leaders also criticized “the strawman document” for ignoring wishes of veterans “who would choose to receive care at VA medical facilities rather than seek care from disparate community providers.”

The VA rallies by AFGE members, many of whom like Cox are veterans themselves, was meant to call public attention to the possibility that VA services could be privatized for the benefit of private interests rather than for veterans themselves.

“Veterans should not be reduced to a line item on a budget sheet,” said Cox. “They have served our country with honor and distinction, and their medical care shouldn’t be left to the whims of profiteers and claims adjusters.”

 AFGE locals have organized 38 rallies to date in 19 states: Alabama, Alaska, California, Illinois, Indiana, Louisiana, Maryland, Michigan, Minnesota, Montana, Nevada, New York, North Carolina, Ohio, Pennsylvania, Texas, Washington, West Virginia, and Wisconsin.

 

Union blames understaffing for VA problems

The American Federation of Government Employees blamed understaffing for the long waits for medical care at Veterans Administration hospitals and urged Congress to act quickly on a recently introduced bill that will fund the hiring of more frontline staff.

“The prevalence of long wait lists are a symptom of the vast understaffing of VA medical facilities,” said David Cox, president of AFGE. “In order to reduce wait times and improve access to VA care that veterans earned through service to our country, we must fix the number one cause of this crisis: understaffing. There is no solving the wait list issue without first solving the staffing issue.”

USA Today reports that more than 57,000 veterans in need of medical care have had to wait more than 90 days to see a doctor. An additional 64,000 veterans who sought care over the last ten years at VA facilities never got to see a doctor.

According to AFGE, since 2009 2 million veterans have entered the VA health system but over the same period of time staffing has increased only 9 percent.

The VA’s inability to keep up with its rapidly rising caseload is due to Congress’ failure to properly fund the services that the VA provides.

To address this problem, Sen. Bernie Sanders and Sen. John McCain have crafted a bill that increases VA funding by $500 million. The funding would be used to hire more doctors and nurses.

“The measure provides for the hiring of new medical personnel in an expedited manner at hospitals and clinics that lack enough doctors, nurses and other medical staff to provide quality care in a timely manner and ensures dedicated funding is available to hire health care professionals,” said Sanders.

The bill will also allow the VA to lease 26 new medical facilities that would expand access to care and give veterans living more than 40 miles from a VA hospital or clinic to use private clinics instead of the VA.

Sanders said that the bill whose title is the Veterans Access to Care Through Choice, Accountability, and Transparency Act of 2014 is not perfect but it is a good first step toward improving veterans health care.

“While this is not the bill that I would have written, we have taken a significant step forward with this agreement,” said Sanders.

One problems with the bill is that it expands the outsourcing of health care services.

“As many Veterans Service Organizations have expressed, such a move could jeopardize the quality of patient care since veterans will be left largely on their own to navigate care between providers lacking specialized knowledge of this population, without the critical care coordination for their complex medical needs that only the VA can provide,” said Cox.

Cox said that outsourcing should be used only as a last resort and pointed to the great strides that the VA has made in expanding access in rural areas through smart investments in telehealth and mobile clinics.

“We need to double-down on these proven systems and deliver to our veterans the quality, specialized care they earned through their service to our nation,” he said.

Cox also said that while it’s good that the bill allows for the hiring of more doctors and nurses, it should have increased funding for more support staff and more clinic space.

“The proposed $500 million to hire new doctors and nurses is critical to getting veterans in the door and provided with quality care,” said Cox. “However, we cannot forget that our medical teams need the proper infrastructure to ensure quality care, patient privacy and clinic productivity. Therefore, as VA increases the number of front-line providers at its facilities, it also needs to provide them with enough support staff and clinic space to get the job done.”

Sanders is hopeful that the Senate will take action on the compromise soon, but there may be a problem with its passage in the House.

The House recently passed its version of the VA bill, but it doesn’t included the $500 million for hiring new staff that is the key feature of the Senate bill.