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In this episode, a psychiatrist discusses the narrow window of time for interventions that can help prevent suicide by lethal means related to a recent VA OIG report. Plus highlights of the VA OIG's work from December 2022.
Veteran Oversight Now is an official podcast of the Department of Veteran Affairs, Office of Inspector General. Each episode features interviews with key stakeholders, discussions on high-impact reports, and highlights of recent oversight work. Listen regularly for the inside story on how the VA OIG investigates crimes and wrongdoings, audits programs that provide benefits and services to veterans, and inspects medical facilities to ensure our nation’s veterans receive safe and timely health care.
Fred Baker
Welcome back to another podcast episode of veteran oversight now, an official podcast of the VA Office of Inspector General. I’m your host, Fred Baker.
Fred Baker
Each month on this podcast, we’ll bring you highlights of the OIG has recent oversight activities and interview key stakeholders in the offices critical work for veterans. Joining me today is Dr. Beth Winter. Dr. Winter is a psychiatrist located in our Baltimore Office of Healthcare Inspections. She is incredibly accomplished, having worked in private practice, community settings, and academia, and was the codirector of the prestigious Johns Hopkins Hospital anxiety disorders clinic. Welcome, Dr. Winter.
Dr. Beth Winter
Hi. thank you so much, Fred.
Fred Baker
It is certainly a pleasure to have you here. We’re here to talk a little bit about a report that we recently published on a very important topic. But before that, I want to talk a little bit about you, your path to the OIG, and your role here. So, give me a little bit about your history, how you came about becoming interested in being a doctor, how you became interested in the VA OIG. And then we’ll talk a little bit about what you do here.
Dr. Beth Winter
Okay, wow. How I wanted to be a doctor—that’s going back aways.
Fred Baker
So how far back did it go? When did you know that you wanted to be a doctor?
Dr. Beth Winter
I knew I wanted to do something healthcare related from childhood really. But initially, I was actually interested in becoming a veterinarian, and specifically an exotic animal veterinarian. I actually worked at a local zoo when I was in high school with the veterinarian there and sort of have that experience. But then I went away to college, and you know, I went to Johns Hopkins. They did not have a pre-veterinary program. But I got more and more interested in human physiology and human psychology. I majored in cognitive science, and sort of gradually switched over to thinking more about becoming a people doctor instead of an animal doctor.
Fred Baker
So, tell me a little bit about your childhood as it relates to wanting to be a vet. What sparked that interest?
Dr. Beth Winter
I think every kid loves animals or gets excited about animals in some way. I always had animals in my life. I lived in Texas for nine years, and we always had dogs. We had a cat. There were horses at my neighbors. There were there were always animals around. I ended up moving to New Jersey, and in New Jersey, gosh, we had fish, we had hamsters, we had rabbits, we had a cat. We had two dogs, Bird and Hedgehog. So, I was always surrounded by animals and interested in them and excited by working with them.
Fred Baker
So, at this zoo, what was the most exotic animal that you worked with?
Dr. Beth Winter
So, with the Turtle Back Zoo in New Jersey—and I don’t know if it was the most exotic—but my favorite was a penguin named Gorbachev, and the penguin spent a lot of time in the infirmary unfortunately.
Fred Baker
What year was this?
Dr. Beth Winter
This was 1995, 1996.
Fred Baker
Yeah. How did I know that? Yeah. Okay, go ahead. So, yeah, a penguin named Gorbachev. …
Dr. Beth Winter
So unfortunately, Gorbachev spent a lot of time in the infirmary, and so he and I had a lot of time to become friendly. And really, Gorbachev was a lot like a feathered dog. I mean, you know, Gorbachev would follow me around the infirmary and, you know, sort of was always sort of honking and clacking at me. And, you know, was a great buddy to have around when I was at the zoo.
Fred Baker
So, what was your role there?
Dr. Beth Winter
Yeah, it wasn’t anything particularly glamorous. I mean, I was still in high school. So, you know, wasn’t working sort of one-on-one with the animals, wasn’t really able to help out with any kind of technical veterinary care or anything like that. There was a lot of cleaning. And it was a lot of feeding, but it was time with animals. And that was really all that mattered to me.
Fred Baker
Okay, so you went to medical school?
Dr. Beth Winter
I did. So, for undergraduate, I went to Johns Hopkins, which, at least at the time, did not have a pre-veterinary track. But I knew I was going to do something biologically related, and I always figured I could take pre-vet classes in the summers or something like that. I became very interested in cognitive science and, and spent more and more time learning about human psychology, and human cognition, and human physiology. And I ended up deciding that that was where I wanted to focus my efforts and decided to apply to medical school. And I was lucky enough that at Hopkins, I had the opportunity to participate in research as an undergrad. So, I did research with a cognitive neuropsychologist on the Hopkins undergraduate campus and with a neurologist at the Hopkins hospital campus. And got to participate in all kinds of interesting, you know, preclinical and clinical activities that really sort of fed into that desire to go to medical school, and be a neurologist, actually, is what I originally thought I wanted to be,
Fred Baker
And what changed your mind?
Dr. Beth Winter
So, in the first year of medical school, we had an intro to psychiatry course. And we had lectures, big lectures, just like for the rest of our courses, but we also had small groups where a preceptor would come in, and they would bring volunteer patients into those small groups and do these interviews so that we could watch that experience and learn from how, sort of, these master clinicians were engaging with patients in this way. And I know you know this, Fred, and people who know me know this, but I love stories. I love narrative. I love storytelling. And psychiatry is, I believe, the most narrative form of medicine. And I really became entranced by that, and by the care and the miraculous work that was being done by the psychiatrist and decided, nope, no more neurology for me. Psychiatry it is. That’s what I’m going to do.
Fred Baker
What were you hoping to do with that?
Dr. Beth Winter
I wasn’t sure. Not all psychiatrists have a specialty. Most are actually general psychiatrists. It wasn’t until I got into sort of the meat of my psychiatry residency that I really got very interested in anxiety disorders, specifically, and also mood disorders.
Fred Baker
And where did that take you?
Dr. Beth Winter
My original plan, after graduating residency, was actually to move to London. I had been accepted to King’s College London to do a master’s degree in medicine and literature. And I was working out . . .
Fred Baker
Wow, two loves.
Dr. Beth Winter
And I was working out a position with the Institute of Psychiatry in London to do an anxiety disorders fellowship. And sort of through a series of unfortunate events. I wasn’t able to move to London to do those things. And sort of career moved in a different direction, but that was where originally it was going to take me.
Fred Baker
So how did you end up going from there to coming to the OIG?
Dr. Beth Winter
So, when I say my career moved in a different direction, it sort of—it wasn’t a linear direction. I graduated residency and opened a private practice where I was doing not only medication management, but also psychotherapy, which was really important to me to be able to offer both. And after a couple of years in private practice, I was asked to come back to Hopkins part-time to be the codirector of the anxiety disorders clinic there. And I did go back and very happily. I love teaching. I love working with residents and love training them how to do psychotherapy, and combined medication management. So that was a really easy decision.
But after several years, I ended up leaving private practice and taking a job as a medical director of a dual diagnosis treatment program while still working at Hopkins. And it was a totally different experience than being in private practice. This dual diagnosis program was outpatient, and had a boarded partial hospitalization program. And I learned a ton about administration skills, about management skills, about working with a board of directors, about, you know, handling a budget of millions of dollars, about program development. And got really excited about stretching myself in that way, in a totally different aspect of medicine that I hadn’t really considered before.
And then from there, I went to the University of Maryland, where I was a psychiatrist on the inpatient mental health unit—again, very different from outpatient work, either at the dual diagnosis program or private practice. And I have to say, with full respect to psychiatrists who work on inpatient mental health units, the pace is grueling. And it can be occasionally disheartening. And working on the inpatient mental health unit, they’re really—I got very interested in thinking about the social determinants of health that impacted my patients, and all of the things that were happening to them before they came into the hospital and after they left the hospital, that were totally out of my control as their clinician that had dramatic impact on their mental health, on their ability to access treatment, on their ability to remain in treatment. And I knew that that was something that I wanted to explore further. So, at that point, I had worked in private practice doing therapy and medication management. I had run a dual diagnosis program and learned lots of administrative skills. I had worked on an inpatient mental health unit and gotten familiar with hospital administration and with hospital practices, and began thinking seriously about more widespread social determinants of health and how they impact patients. And I decided I wanted to find something that married all of those interests and skill sets. And I had no idea how to do that. And so that prompted a not insignificant search on my part for what that next step in my career was going to be. And when I found the listing for a physician at the VA OIG it seemed like an opportunity to pull these very seemingly disparate experiences that I had together and make something cohesive and really meaningful that I can move forward with.
Fred Baker
Many people who come to the VA OIG have some type of intersection with veterans, or a connection. Did you have any previous connection with veterans or veteran care before coming?
Dr. Beth Winter
In terms of veteran care, my medical internship had an agreement with the Bronx VA, and I did spend some rotations out there. I did have some direct veteran care experience. And in terms of other connections with veterans, my grandfather was in the Air Force, and my father was Navy. And so, we have military service members in my family. Veterans felt like a population that not only could I relate to, but that I cared very deeply for.
Fred Baker
You bring a lot of experience, right, a lot of varied experience to the table. Would you say that there’s anything unique about what you do here because it’s specific to veteran care?
Dr. Beth Winter
That is interesting. I think that veterans are a unique population. I think that the stressors that they undergo from the moment that they sign up to the moment that they separate from military service is unparalleled. Really, I can’t imagine sort of any other situation in which people have those kind of collective experiences together. And I think that they truly shape people. Whether, I think, overwhelmingly, hopefully, for the better, but unfortunately, there are often extremely traumatic events that occur that can also shape people. And so I do think that that unique collective experience of being a veteran and having served in the military is very different from anything else that I’ve encountered in my career.
Fred Baker
Well, thank you, Dr. Winter. So we’re here to talk about the report. Deficiencies in Lethal Means Safety Training, Firearms Access Assessment, and Safety Planning for Patients with Suicidal Behaviors by Firearms. It was published November 17, 2022. Before this report was published, you actually wrote a white paper on the topic a few years earlier. Can you speak to that?
Dr. Beth Winter
Sure. Before I speak to that, though, I do want to acknowledge by name the absolutely amazing team that I worked with and producing this report, Dr. Terri Julian, Dr. Amber Singh, Stephanie Beres, Kelli Toure, and Dr. Dannette Johnson. These women and I really labored over this report, in order to produce something I hope has significant impact. And I could not have done it without them. But it did have its genesis in this white paper that you mentioned. So back in 2019, there was, unfortunately, a series of veteran suicides, on campus suicides, that garnered a lot of media attention. And so the other psychiatrists in OHI and I wanted to look and see whether there were any themes that connected these suicides and something that we should be considering or looking out for. And really, the only common thread that we found was that these were overwhelmingly firearm related suicides. And, sadly, that shouldn’t be surprising considering almost 70 percent of veteran deaths by suicide are firearm related. But it was still something that I felt was important and something we needed to be talking about and thinking about. And so I wrote this white paper looking at firearm related suicide, lethal means access, lethal means safety counseling, and a history of lethal means related legislation and the impact that it had on suicide prevalence.
Fred Baker
So, tell me a little bit about the outcomes of this. How long did it take you to produce this white paper? And what was the end state? What were the outcomes of it?
Dr. Beth Winter
It was a large literature review. It took me several months to complete and polish. And it was shared with OHI leadership and with Mr. Missal. And while we all agreed on, obviously, the gravity and the importance of the topic, we couldn’t necessarily wrap our arms around exactly what project we wanted to grow out of this white paper and out of this topic, and so it was sort of decided that it would be something we’d continue to talk about. And while I was writing this white paper, I had a few exploratory conversations with people at VHA who were working on staff training related to lethal means access, on lethal means safety counseling. And so, I knew that VHA was also interested in this topic, and that they were also interested in thinking about how to make an impact in this area. And so, it was a conversation with Dr. Terri Julian and I in which we were thinking about this and really trying to figure out what angle we could approach this project from, and we decided to think about staff training. How the staff training was implemented. And to think about the perspectives of staff who were actually having these conversations with veterans, and the review that we did grew from there.
Fred Baker
I want to be clear about what we’re talking about and I want to use a few facts from the report— non-veteran firearm involved suicide deaths decreased from 2001 to 2018, while firearm involved suicide deaths rose 3 percent among male veterans and 13 percent among female veterans. Eighty-five percent, about 85 percent of individuals who attempt suicide with firearms die from their injury. And specific to this report, the time interval between deciding to act and attempting suicide can be just five or 10 minutes. And this, this report emphasizes that some relatively simple interventions can increase the time between the decision to act and the act itself. And that alone can be critical in preventing suicide, correct?
Dr. Beth Winter
Yes, that’s correct. And that’s not just unique to this report, that has been played out across the academic literature, and been shown to be over and over again.
Fred Baker
So, can you speak to those interventions? Can you illustrate because we use a lot of medical terminology in the report? What does it actually look like?
Dr. Beth Winter
So, we’ve been careful to use the language lethal means access because while firearms are the most lethal method of suicide, they are not the only method of suicide. And so, when you think about suicide and access to methods of suicide, you also have to consider other methodologies like overdose on medication or some other kind of poison ingestion. You have to think about strangulation by hanging. You have to think about self-inflicted injury, like cutting, for example.
Fred Baker
Sure.
Dr. Beth Winter
And so lethal means access is meant to encompass all of those things, including firearms. And you are exactly right, over and over again interviews with people who have survived a significant suicide attempt revealed that, as you said, that time between making the ultimate decision to act on thoughts of suicide, and actually attempting the act itself is extremely short, five minutes, so much shorter than you would imagine. Now, that’s not to say people might not have been having thoughts of suicide for far longer than that. But it’s that window is really between the decision to act and the action itself. And what we also know is that if there was some barrier to accessing a person’s initial method for suicide, for example, a gun lock, or a gun being placed in a safe, or a gun being separated from ammunition within the house, for example, that gives people a time to either reconsider their action, or they might make the attempt with a method that’s significantly less lethal. And people who survive a significant suicide attempt are highly unlikely to try again. So, if we can increase that window between the decision to act and the action itself, we significantly increase the possibility of that person’s survival.
Fred Baker
What are the ways that VA has identified in attempting to do that? In November 19, they implemented a suicide risk identification strategy that included standardized suicide risk screening, and if the patient screened positive for a suicide risk, they did a comprehensive suicide risk evaluation. A year later, they implemented one-time mandatory lethal means safety education and counseling for, required for all VHA health care providers, including vet center counselors. And then in March 2022, they implemented a one-time LMS, again lethal means training, within 90 days of employment for all new health care providers and any the current provider has not completed the course. What did we find with respect to that training?
Dr. Beth Winter
Well, what we found was that generally VHA staff was compliant with doing the training and with doing the suicide risk screenings. However, those screenings and that training are only as successful as a person’s utilization of that training. Are you actually having the conversation about access to lethal means? Are you actually talking about plans for safe storage of those lethal means when you’re completing a safety plan? And so, to examine that, we actually reviewed 480 patients who either had a fatal firearm related suicide or a non-fatal firearm related suicide behavior in order to see whether these electronic health records had documentation of these types of conversations. Were they being asked about their access to firearms? Were there safety plans, including information about how to try and mitigate that access in a safe way? And unfortunately, there was a not insignificant percentage of electronic health records that didn’t include that documentation. And so, as I said, the training is excellent, requiring the completion of these suicide risk screening and safety planning is excellent, but it’s only as useful as the implementation.
Fred Baker
So what were the final recommendations from this report?
Dr. Beth Winter
We made seven recommendations to the undersecretary for health related to our evaluation. And these involved things like compliance with suicide risk screening, and training requirements. But I think what was most important was that we asked that it be ensured that when clinicians complete these suicide risk evaluations, that someone is making sure that they include this discussion, and documentation about access to lethal means, about access to firearms, and safe storage, and that someone is monitoring the compliance with that aspect of these suicide risk screenings and safety planning. We also asked that the undersecretary for health evaluate perceived barriers to completing these parts of the suicide risk identification and the safety plan because I don’t want to assume that staff are not doing it for whatever reason. We know that people experience barriers to having these conversations, whether they are cultural barriers or educational barriers. We should figure out what those are from a systems perspective, and address that in order to help staff better help veterans.
Fred Baker
Dr. Winter, this is a tough topic, and I really appreciate you being here to have this conversation about it. How receptive was VA to the findings of this report?
Dr. Beth Winter
So, I was actually really, really pleased. VHA actually received this report very well. They seemed to appreciate reading it. They certainly appreciated the amount of effort and analysis that went into our findings and recommendations. They actually asked for our data so that they could look at it and help along some of their analysis that they had already been doing in parallel with our report. And I’m really hopeful that there will be a significant impact for veteran care and suicide prevention that comes out of this.
Fred Baker
Dr. Winter, this is an excellent example of the very important oversight work that our Office of Healthcare Inspections conducts, as well as the VA OIG in general. Again, I appreciate you being here. Thank you very much.
Dr. Beth Winter
Thank you so much.
Fred Baker
Before I turn the podcast over to Adam for this month’s highlights, I would like to mention that if you’re a veteran in crisis, or concerned about one, please call the Veterans Crisis Line dial 988 and then press 1. Remember, you’re not alone. Veterans Crisis Line is here for you. You don’t have to be enrolled in VA benefits or health care to call.
With that, I’ll now turn the podcast over to Adam Roy for this month’s highlights.
Adam Roy:
Thanks, Fred. Now some highlights of the work the VA OIG completed in December 2022. I’ll start with recent investigative updates related to education fraud.
In the first one, a defendant was sentenced for their role in multiple education benefits fraud schemes. A proactive investigation by the VA OIG identified an individual who served as a school-certifying official and course director for a for-profit, non-college-degree-granting diving school and later became a consultant and an instructor for another diving school. The investigation revealed that the defendant made false representations to VA regarding the schools’ hours of instruction for each of their VA-approved courses, attendance and course completion dates, payments received from non-VA students, and compliance with the “85/15 rule.” To qualify for Post-9/11 GI Bill funding, a school must certify that no more than 85 percent of the students in any course are receiving VA benefits. This requirement, commonly referred to as the “85/15 rule,” is intended to prevent abuse of GI Bill funding by ensuring that VA is paying fair market value tuition rates since at least 15 percent of the students would be paying the same rate with non-VA funds. The defendant was sentenced in the Southern District of Georgia to over four years in prison, three years of probation, and restitution of more than $6 million.
In another education-related fraud scheme, a VA OIG investigation resulted in a civil complaint alleging that a company that provides technology education courses violated the False Claims Act by knowingly submitting inflated tuition benefit claims to VA. Under the Post-9/11 GI Bill, VA pays the actual net cost for tuition and fees charged by the school after it has applied any scholarships, waivers, grants, or other assistance to defray those costs. This requirement is commonly referred to as the “last payer rule,” which ensures that VA is the payer of last resort and receives the benefit of any tuition-based financial support available to a student. The complaint alleges that the company repeatedly reported tuition and fees to VA on student invoices that did not include deductions for the tuition scholarships, grants, or waivers it provided to certain veterans. The “last payer rule” was allegedly violated by the company at five school locations in Illinois, Ohio, and Michigan. The civil complaint was filed in the Eastern District of Michigan.
Recently, the VA OIG published a Fraud Alert on stopping education benefits fraud. The VA OIG asks you to report any VA-approved school that is billing veterans (whose enrollment is funded by VA) a higher tuition rate than civilian students for the same courses. VA-approved schools that engage in education benefits fraud often advertise a lower tuition rate than they are billing VA for veteran student enrollments; offer discounts, tuition waivers, or scholarships exclusively to civilian students; or bill at least 20 percent more than non-VA-approved schools with similar course offerings. If these practices sound familiar or you know a veteran taking education courses from a school that may be engaging in education fraud, I encourage to submit a complaint to the VA OIG hotline. If you have any questions about the GI Bill and other VA education benefits, visit the GI Bill School Feedback Tool at va.gov or call 888-442-4551. This fraud alert is the third in a series of periodic alerts for fraud and other crimes. Visit the VA OIG website to learn more about potential indicators for 10 types of fraud.
Now an update on two recent settlements related to resolving False Claims Act allegations. In the first, a multiagency investigation resolved allegations that a cardiac monitoring company submitted claims to federal healthcare programs for heart-monitoring tests that were performed in part outside the United States, which violates federal law, and in many cases by technicians who were not qualified to perform such tests. The defendants entered into a civil settlement in the Eastern District of Pennsylvania under which the companies agreed to pay more than $44.8 million to resolve these alleged False Claims Act violations. Of this amount, VA will receive $681,000. The VA OIG, Office of Personnel Management OIG, Department of Health and Human Services OIG, and Defense Criminal Investigative Service conducted this investigation.
In the second, a healthcare device manufacturer agreed to pay $11.36 million to resolve False Claims Act allegations also in the Eastern District of Pennsylvania. The false claims were allegedly made in premarket approval applications submitted to FDA that pertained to radio frequency emissions generated by some of the company’s cochlear implant sound processors. VA was one of several federal agencies that purchased these systems containing the allegedly noncompliant sound processors. The $11.36 million civil settlement includes more than $5.6 million in restitution, of which VA will receive approximately $500,000. This investigation was also conducted by the VA OIG, Office of Personnel Management OIG, Department of Health and Human Services OIG, and Defense Criminal Investigative Service.
This month’s final investigative update focuses on pandemic-related fraud. In March 2021, a business owner made fraudulent misrepresentations in an attempt to secure orders from VA for face masks and other personal protective equipment (or PPE) that would have totaled more than $806 million. This individual promised that he could obtain millions of genuine 3M masks from domestic factories but knew that fulfilling the orders would not be possible. He attempted to acquire an upfront payment from VA of over $3 million and received approximately $7.4 million from state governments and private entities by making similar false representations regarding his ability to get the equipment. The defendant was sentenced in the Western District of New York to over 20 years in prison and restitution of $107 million after previously pleading guilty to wire fraud in connection with this COVID-19 scam and an unrelated Ponzi scheme. He also agreed to forfeit approximately $3.2 million that was seized by the VA OIG and Homeland Security Investigations.
In December, the VA OIG published eight reports, including a joint report published by the Pandemic Response Accountability Committee’s (or PRAC) Health Care Subgroup. I’ll highlight a few of them now.
The Office of Audits and Evaluations published a report titled VBA’s Compensation Service Did Not Fully Accommodate Veterans with Visual Impairments. In this review, the OIG examined whether VBA’s Compensation Service complied with accessibility requirements for communicating benefits-related information to veterans with visual impairments. We found that the Compensation Service did not fully comply with section 504 of the Rehabilitation Act, which requires that visually impaired veterans have “meaningful access” to federal programs, including benefit programs operated by VBA. A lack of coordination by the Compensation Service with relevant agencies, along with its failure to comply with VA-wide accessibility implementation requirements, will continue to make it more difficult for veterans with visual impairments to fully participate in the disability compensation program. The report listed five recommendations: (1) update the process for accommodating visually impaired veterans; (2) update the adjudication procedures; (3) develop and implement a quality assurance mechanism; (4) assign accessibility coordinators; and (5) coordinate a process to ensure visually impaired veterans are informed of the availability of accommodations.
In another review by the Office of Audits and Evaluations, we identified that improvements were needed to reduce duplicate payments by VHA and Medicare and ensure that VHA has authorized community medical services. We collaborated with the Department of Health and Human Services OIG—which is currently conducting its own review of duplicate Medicare payments—to better understand duplicate payments and confirm that they had occurred. The VA OIG determined that VHA and Medicare made potential duplicate claim payments for community care services that were authorized by VHA. Because VHA and the Centers for Medicare and Medicaid Services do not share healthcare claims data, neither agency is aware of claims paid by the other agency. Without an interagency system, the risk of duplication is increased, and it may be difficult to determine which agency should pay the claim and which agency can collect overpayments. The VA OIG recommended that VHA work with the Centers for Medicare and Medicaid Services to establish a data-sharing agreement with VA to limit duplicate claim payments. We also recommended identifying overpayments made for care provided to dual-eligible veterans that were not authorized by VHA and ensure documentation of care is completed or that VA seeks reimbursement for any unauthorized care. Finally, the OIG recommended making sure all nonemergent community care is preauthorized and that documentation for all authorizations is complete and properly stored before services are provided.
On December 1, 2022, the Pandemic Response Accountability Committee’s Health Care Subgroup published the report Insights on Telehealth Use and Program Integrity Risks Across Selected Health Care Programs During the Pandemic. The subgroup developed this report to share insights about the expansion—and the emerging risks—of telehealth in selected programs across six agencies during the first year of the COVID-19 pandemic. The programs included VHA, Medicare, TRICARE, Federal Employees Health Benefits Program, Office of Workers’ Compensation Programs, and Department of Justice prisoner healthcare services. The expansion of telehealth services clearly helped millions of individuals access health care during the crisis but also introduced several integrity risks associated with billing, including high-volume billing, duplicate claims, and inappropriate charges for the most expensive telehealth services. The study found that program integrity can be strengthened by implementing ongoing monitoring of telehealth services, developing controls to prevent inappropriate payments, educating providers and individuals about telehealth, collecting additional data to support oversight, and collecting and reviewing data about the impact of telehealth on quality of care. The PRAC’s Health Care Subgroup consists of the inspectors general from the Departments of Veterans Affairs, Justice, Defense, Labor, Health and Human Services, and the Office of Personnel Management.
Wrapping up reports, in December, the VA OIG also published two Comprehensive Healthcare Inspection Program, or CHIP, reports. These reports are one element of the OIG’s overall efforts to ensure that the nation’s veterans receive high-quality and timely VA healthcare services. The inspections are performed approximately every three years for each facility. December’s CHIP reports focused on the Louisville VA Medical Center and the Lexington VA Health Care System, both in Kentucky.
For more information about these and the other reports the VA OIG published in December, go to our website at va.gov/oig and click on reports under the Publications tab.
That’s it for this episode of Veteran Oversight Now. I want to extend a heartfelt thank you to our repeat listeners and encourage those who may be listening for the first time to subscribe to this podcast as well Inside Oversite, another VA OIG podcast that explores in detail some of our published reports. Find us on all major podcast directories like Apple, Google, and Spotify. All podcasts are also available on our YouTube channel—search for @VetAffairsOIG.
Like what you hear? Sign up for email alerts. We regularly send notifications when reports are published, updates to ongoing investigations as well as critical information impacting veterans like the fraud alert I mentioned earlier. You can sign up for email alerts right from our home page.
Wishing you a prosperous 2023 and, as always, thank you for turning in.
This has been an official podcast of the VA Office of Inspector General. Veteran Oversight Now is produced by the Office of Communications and Public Affairs and is available at va.gov/oig. Tune in monthly to hear how the VA OIG serves veterans, their families, and caregivers through meaningful independent oversight. Check out the website for more on the VA OIG oversight mission.
Read current reports and keep up to date on the latest criminal investigations. Report potential crimes related to VA waste or mismanagement; potential violations of laws, rules, or regulations; or risks to patients, employees, or property to the OIG online or call the hotline at 1-800-488-8244. If you are a veteran in crisis or are concerned about one, call the Veterans Crisis Line at 1-800-273-8255. Press 1 and speak with a qualified responder now.