Subscribe
Share
Share
Embed
In this episode, host Fred Baker chats with James Ross, DAIG for the Office of Investigations, about his path from Orlando police officer to VA OIG special agent to senior executive leading the organization’s field operations and proactive investigation divisions. Plus Sept. 2022 highlights.
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.
Each month on this podcast, we’ll bring you highlights of ’the OIG’s recent oversight activities and interview key stakeholders in the office’s critical work for veterans.
Joining me today is James Ross, the deputy inspector general for the Office of Investigations here at the VA Office of Inspector General. James, thanks for joining me today.
James Ross:
Thank you, Fred. It’s a pleasure to be here.
Fred Baker:
James, tell me a little bit about yourself before we get into the organization. Talk about what you do, what your role is, and a little bit about your road to the Office of Investigations.
James Ross:
Currently, I am one of the deputy inspectors general for investigations within VA OIG’s Office of Investigations. I help oversee our field operations and our proactive investigator divisions. I’ve been with the Office of Investigations for about 18 years. I came here from the US Secret Service, which is where I started my career as a special agent.
And I got into law enforcement in Orlando, Florida, with the city of Orlando Police Department. And I’m a native Floridian. So, I was happy to be able to serve in my hometown.
Fred Baker:
So, you got into law enforcement out of college?
James Ross:
I did. Right out of college.
Fred Baker:
And have you always wanted to be a law enforcement officer?
James Ross:
I have. Yeah. That’s always been a colleague of mine.
Fred Baker:
As a kid?
James Ross:
As a kid.
Fred Baker:
Walk around playing good cop, bad cop?
James Ross:
No. I’m going to date myself, Fred, but it was CHiPs patrol, if you want to know the truth.
Fred Baker:
CHiPs?
James Ross:
Yeah. Wanted to be a motorcycle cop.
Fred Baker:
Frank Poncherello
James Ross:
And John Baker.
Fred Baker:
Absolutely. Who didn’t love that show?
James Ross:
No one.
Fred Baker:
Did you watch the movie when it came out?
James Ross:
I did. And I have to admit that I liked it.
Fred Baker:
Awesome. Awesome. I did, too. Yeah, that show made everybody want to ride motorcycles.
James Ross:
It did
Fred Baker:
In California.
James Ross:
They made it look pretty cool.
Fred Baker:
So, you got out of college, went into law enforcement, and then transitioned to Secret Service?
James Ross:
I did.
Fred Baker:
How’d that happen?
James Ross:
It’s honestly, that’s what I had always wanted to do up until that point in my life, you know. It felt like that would be a nice career, and I was honored and excited to have that job. And I spent some time in the New Orleans field office, the San Francisco field office, and, honestly, I thought that VA OIG was a better fit for me.
Fred Baker:
How long did you spend in Secret Service?
James Ross:
About five years.
Fred Baker:
About five years. And then you decided to transition to the VA OIG?
James Ross:
I did.
Fred Baker:
And when you talk about a better fit, why was that?
James Ross:
Well, the mission was more in line with what I wanted to do. Secret Service is a very important mission, but it’s a dual mission. They obviously have their protection responsibilities, which is very important. They have, you know, criminal investigative responsibilities. A lot of people don’t know that they have primary responsibility over counterfeit currency investigations. They also work a lot of credit card fraud, financial crimes.
That’s what interested me the most. Having a career in law enforcement. After having served for a few years, I was less interested in a career in physical protection as I was in full time criminal investigations, which the VA OIG focuses on exclusively.
Fred Baker:
Do you have a veteran connection?
James Ross:
I don’t. I never served. My father is a veteran of the US Air Force, and I come from a long line of military veterans. I never myself served, and that is a regret, if you want to know the truth.
Fred Baker:
So, you do have a veteran connection to your family?
James Ross:
I do.
Fred Baker:
Does that give any additional meaning to what you do?
James Ross:
Oh, certainly it does. I mean, we protect the programs that protect veterans, and that’s a pretty cool mission.
Fred Baker:
Tell me about the Office of Investigations organizationally. What’s that look like? How many people. Give us give me an idea of the scope and the role that it plays within the within the VA Office of Inspector General.
James Ross:
Sure. Well, as you know, we’re one of several directorates, subcomponents, of the VA OIG charged with oversight of VA’s programs. In our world, that translates into criminal investigations primarily. We’re made up of 260 special agents and other professionals. We have 37 offices nationwide. We’re headquartered in Washington, DC. We have 15 divisions.
And primarily our workforce is special agents, but we also employ investigative analysts, forensic accountants, investigative attorneys, and data analytics professionals, just to name a few.
Fred Baker:
So, given the size of VA, right, the programs and services, how do you manage to cover that?
James Ross:
Well, we have to set priorities, and we have to look at the things that are important to VA and to see where we can have the most impact. And that’s really the only way we’re able to make the most of the resources that we have, because they are limited.
Fred Baker:
What are some things that you say that are most important? Give me some examples of some high priority types of work.
James Ross:
I mean, it will start with where VA spends the most money. I mean, that’s the best place to start. And those are going to be areas like compensation and pension. I think in every state across the country the VA spends the largest portion of its budget on compensation and pension benefits.
The procurement of goods and services from the private sector is another area where VA spends a lot of money and may be vulnerable to fraud. The construction of its new facilities and rehabilitation of existing facilities is another area. And most recently for us, health care. In the last seven or so years, there have been two key pieces of legislation that have increased VA’s health care budget, and in response to that, you know, VA has increased its expenditures in healthcare programs in the community to allow veterans greater access to privatized health care. That’s not really been seen, at least to any great degree, by the VA in history. So, in anticipation of that, you know, we saw that VA was on the cusp of being possibly victimized by the same types of fraud schemes that had been plaguing Health and Human Services CMS programs for years. So, one of our new initiatives is we set up a healthcare fraud division just to focus on the various programs that VA delivers its health care through to veterans—inpatient, outpatient, through direct delivery from its hospitals or in the community. And that’s headed up by a Special Agent in Charge Latisha Cleveland, who I think was a guest on a previous podcast.
And in that division, we have several criminal investigators. We have a nurse consultant, statistician, performance auditor, and investigative analyst, who are all there to help us kind of get a handle on VA’’s expenditure of healthcare money.
Fred Baker:
So, I want to back up just a little bit. You said that you were in charge of the proactive investigations division. Talk about what that is. What does that mean, a proactive investigation?
James Ross:
I think when most people historically think of a police response or a law enforcement response to criminal activity, it’s just that—it’s a response. It’s reactive in nature. What we’d like to do is dedicate some subject matter expertise to the programs where we think VA are the most vulnerable. And they may not be tomorrow what they are today. So, it’s an evolving, moving target for us.
And, you know, we allow folks to focus on those programs, to learn the roles, to learn the schemes that might plague those programs, and then to look for trends of fraud through data analytics and other investigative expertise, and then to come up with instances where there may likely be fraud that they can give to our field officers to work out full investigations on—to see if there actually is an indication of fraud there, like we originally anticipated.
Fred Baker:
Have you had some successes in that?
James Ross:
We have.
Fred Baker:
Can you talk about a few of them?
James Ross:
Yeah, sure. We’ve had especially in the education front, you know, as you note, VA pays a lot of money out to institutions to provide education under the post-9-11 GI Bill program. And we’ve had, you know, several cases that have been sentenced. They were large dollars cases where, for example, in Texas we had a for a for profit trade school named Retail Ready that defrauded VA of, at that time, what was the largest single dollar amount that the VA’s education program had ever been defrauded of, $72 million.
Our Dallas office worked it, and we were able to obtain a conviction at trial. And the owner of the school was ordered to 20 years in prison and to repay all $72 million to VA. And that’s exactly the kind of thing that we want to look for proactively.
Fred Baker:
Speaking of big wins, you’ve had some other big wins over the last year or two. Can you talk about a few of those?
James Ross:
We have. You know, we were responsible for investigating the largest COVID-related fraud scheme in Department of Justice history to date.
In addition to that, we’ve had a couple of very significant cases involving patient harm. And unfortunately, one of those was the Reta Mays investigation. She was a VA nursing assistant in West Virginia. She pleaded guilty to causing the deaths of seven of her veteran patients by injecting them with unprescribed insulin, and she received seven life sentences as a result of that investigation.
Another one would be Dr. Robert Levy, who was the chief of pathology at a medical center in Arkansas. He was convicted and pleaded guilty to misdiagnosing thousands—he misdiagnosed thousands of his patients because he was impaired by a substance that mimicked the effects of alcohol but wasn’t detectable on typical screening tests. The result of those misdiagnoses resulted in VA patients either undergoing medical treatment they didn’t need or possibly not receiving the critical, inadequate medical treatment that they did need or dying. And unfortunately, as a result of that matter, several patients did die. That was worked by our Little Rock office. And the Reta Mays investigation was due to the work of our Washington, D.C. office.
Fred Baker:
So, you mentioned earlier forensic analysts. You talk about the use of data. Your organization has been pretty active in that arena, right? Can you talk a little bit about who they are and what they do?
James Ross:
In terms of data analytics?
Fred Baker:
Uh-huh.
James Ross:
Yeah. You know, I think that VA’s move towards electronic health records and use of data in general means that there is information out there for us to be able to use to proactively find trends and indicators of fraud. It’s incumbent upon us to do so. So, within VA OIG, we have our Office of Data and Analytics, which has the primary responsibility of providing data analysis services to all the directorates to include us. They’ve been a very valuable resource to us. In-house in our HealthCare Fraud Division we have our own statistician, our own medical coder, our performance auditor, who provides kind of a second level review of some of those things.
And I think the more sophisticated an organization is at data analytics, the more successful it’s going to be at finding fraud and hopefully deterring and preventing it later.
Fred Baker:
What other types of roles come into play? You know, you have your investigators, you have your forensic analysis. What other type of individuals do you recruit to the Office to Investigations?
James Ross:
Sure. Like I said, we’re primarily a criminal investigative organization. So as such, we have more special agents than we do other job series.
But the other job series that we do have are critically important to our success from, off the top of my head, I think of our forensic accounting division. We have a team of forensic auditors throughout the country who are there to support our fraud investigations, through cash flow analysis, and that’s extremely vital to our success. Those folks are experienced professionals by the time they get to us in the field of forensic accounting, and they do a fantastic job, and that division has grown exponentially over the last several years.
We wouldn’t be where we are without the work of our investigative analysts. We have several assigned to our headquarters divisions. We have some assigned to our proactive divisions. And they’re there to provide kind of a second level review of the data that we get in raw format to help breathe life into it, to interpret it, to look for it from kind of an investigative mind and to help package leads together before they go to the field and then to provide some support to the field after they might get a lead to follow up on for investigation.
We have an investigative attorney who oversees our False Claims Act program, as well as our Program Fraud Civil Remedy Act program. I think the role of an investigative attorney can’t be overstated. And in addition to that, we also have, like I mentioned before, the data analytics folks, support services specialists throughout the country. We have a lot of opportunities within the Office of Investigations that aren’t directly related to law enforcement.
Fred Baker:
Dave Johnson, the assistant inspector general for investigations, was on a panel a few months ago, and he was talking about how the VA Office of Inspector General has a little bit of a different mission or is a little different than some of the other OIGs. Can you speak to those differences?
James Ross:
Sure. First and foremost, you know, the mission we have is unlike any other agency out there because like I mentioned earlier, we protect the programs that protect veterans. It’s a pretty noble mission in that regard.
But, more importantly, VA’s programs are so diverse that our oversight of them has to be equally diverse. And what that means is there are so many different types of crimes and other violations of law for an agent to investigate. There’s really something here for everyone. Whether it’s fraud, whether it’s violent crime, whether it’s a drug offense, whether it’s cybercrime, whether it’s child exploitation. A lot of OIGs, and I think this is probably what Mr. Johnson was referring to, they focus, and their scope is extremely narrow, and they’re very good at what they do. Our scope is extremely wide. So, we have to have a wider breadth of knowledge, and we have to have professionals on staff who can investigate all of those things because they’re all equally important.
Fred Baker:
Speaking to someone who might be a part want to be a part of our team, what does it take to join the VA Office of Inspector General or the Office of Investigations?
James Ross:
Well, I can tell you that we’re looking for the best, the brightest, and the most diverse workforce possible.
I can tell you that there’s opportunities to join the Office of Investigations for just about anyone at any point in their career, whether they’re right out of college, whether they’re a seasoned professional journeyman, and whether they’re an experienced leader. But at a minimum, I would say that anyone with a college degree and a few years of responsible work experience in an area that might help support the mission and the type of fraud and crimes that we investigate and with a clean background would be a very competitive candidate for a position here.
Fred Baker:
And finally, before we log off, I’d be remiss—sometimes even within VA, people don’t recognize the VA OIG and what we do. Kind of speak to some things that someone should report and how would they go about doing that?
James Ross:
I think the best way to report anything is through our hotline. And of course, there’s a number you can dial. I would direct folks to our website, va.gov/oig, and in the upper right-hand corner they can click on “Report Wrongdoing”, and they can fill out a web submission. They can call the hotline. It is staffed with operators. Folks can remain anonymous if they like to. If they choose to give their names, they will be kept confidential unless they waive confidentiality.
So, you know, a whistleblower never has to worry about their identity being divulged. But that’s the best way to report it. And also on our website, you know, there’s a lot more information about career opportunities and, of course, a link to USAJOBS on there as well.
Fred Baker:
Great. James Ross, deputy assistant inspector general for investigations here at the VA Office of Inspector General, thank you for joining us.
James Ross:
Thank you, Fred. It’s a pleasure.
Fred Baker:
Now I’ll turn it over to co-host Adam Roy for this month’s highlights.
Adam Roy:
Thanks, Fred. Now highlight some of the work the VA OIG completed in September 2022.
Deputy Inspector General David Case testified again about the VA’s electronic health record modernization program, this time before the Senate Appropriations Subcommittee on Military, Construction, Veteran Affairs and Related Agencies. The September 21 hearing addressed the VA’s deployment of a new EHR, as well as the status of recommendations from all related OIG reports, including the 15 recommendations that have remained open for more than one year. Mr. Case emphasized that VA staff continue to implement work arounds in an effort to mitigate known issues, but these workarounds can lead to delays, increased errors, and deficiencies in care. He answered several questions about the true cost of the program, as well as about the timeline for implementation, emphasizing the ongoing need for an integrated master schedule.
As always, you can find Mr. Case’s written testimony on our website under the media tab, and we’ve included a link to the committee’s website in the September monthly highlights available under the publications tab if you’d like to watch a recording of the hearing.
Now for OI’s investigation updates. A multiagency investigation resulted in charges alleging that the president of a medical technology company conspired to improperly bill health care insurers for approximately $77 million in false and fraudulent claims for allergy and COVID-19 testing. The defendant and others allegedly schemed to manipulate the company’s stock price by making false claims concerning the company’s ability to provide accurate, fast, and cheap COVID 19 tests in compliance with federal and state regulations. It is further alleged that the defendant and others made numerous misrepresentations to potential investors about the COVID-19 tests and used a VA solicitation to further the stock manipulation scheme. The defendant was found guilty at trial in the Northern District of California of conspiracy to commit health care fraud, conspiracy to commit wire fraud, health care fraud, conspiracy to pay kickbacks, payments of kickbacks and securities fraud.
This investigation was conducted by the VA, OIG, USPS Inspection Service, FBI, Defense Criminal Investigation Service, and the Department of Health and Human Services OIG.
Now to another investigation, a VA OIG and VA police service investigation revealed that a former employee at the VA medical center in Philadelphia used his access to VA’s Concur travel reimbursement system to approve and certify false payments in the names of other VA employees. From December 2015 through to September 2019, the former employee directed approximately $487,000 in bogus travel reimbursement payments to various bank accounts under his control. The former employee was sentenced in the Eastern District of Pennsylvania to two years in prison, three years of supervised release, and restitution of over $462,000 after previously pleading guilty to theft of government funds.
Now reports. OIG published 18 reports in September. This includes inspections of information technology security at facilities in Louisiana and Texas, as well as two CHIP summary reports that evaluated medication management and care coordination programs at VHA facilities. Look for these reports on the OIG website.
The VA OIG also issued two management advisory memorandums. The OIG issues these memorandums when urgent circumstances or areas of concern are identified by OIG hotline allegations or in the course of oversight work, particularly when immediate action by VA can help reduce further risk of harm to veterans or significant financial losses. The first memorandum follows up on a report issued in July 2018. At that time, the VA OIG found VBA disability claims processors did not consistently follow policy requiring that veterans’ medical examinations be requested only when necessary. VBA reduced the number of unwarranted re-examinations with the creation of batch jobs intended to automatically cancel re-examinations that met certain parameters. However, the OIG found that VBA carried out to batch jobs and mistakenly included re-examinations that were required by statute and should not have been canceled. So as a result, affected veterans potentially received incorrect monthly compensation benefits.
After the OIG raised concerns, the VA suspended a scheduled batch job and reestablish workload controls to determine if re-examinations were necessary. Since VBA took responsive action, the OIG did not further review the batch jobs and provided this management advisory memorandum for VBA leaders to further research and determine if additional actions are warranted. The OIG requested information on any further corrective actions taken.
The other memorandum relates to VA’s procedures for collecting debts for the compensation program. During a prior review, the OIG identified three scenarios in which VA improperly collected debts from veterans without first providing them with a legally required notice and due process. The VBA had changed veterans’ benefits, resulting in retroactive reductions in payment rates and debts to be repaid. In three example cases, VA improperly collected these debts by reducing retroactive payments or future monthly payments due the veteran without notifying veterans of the debt amount or of their right to dispute it or request a waiver.
VA agreed the debts were collected improperly due to automated actions in electronic debt management systems. In response to this OIG management advisory memorandum, in a request for information on corrective actions, VBA said that it plans to implement system upgrades to prevent veterans in similar circumstances from being subjected to improper debt collection and being denied notice and due process.
In another report, the OIG Office of Audits and Evaluations determined whether a Veterans Integrated Services Network 2 effectively followed VA policy when inspecting and maintaining boiler plants. The OIG selected VISN 2 because FY 2021 data showed this network had the most boiler plant components requiring maintenance and deficiencies associated with boiler plant components being operated past or expected lifespans. The OIG determined that VISN 2 did not fully comply with the VHA directive concerning useful life assessments in an operations testing and inspections. Also, VHA leaders lacked the information necessary for effective oversight. In this report, the OIG made six recommendations for facilities to manage the inspection and maintenance of boiler plants more effectively, including ensuring boilers needing useful life assessments are evaluated for safe operation.
The last two reports I’ll share with you were published by the VA’s Office of Health Care Inspections. The first one concerns a health care inspection conducted at the Veterans Health Care System of the Ozarks in Fayetteville, Arkansas, related to the community care coordination delays for a patient with oral cancer. The OIG determined that the facility’s Office of Community Care failed to act or delayed action on five community care consults, resulting in the patient waiting 205 days for surgery. The OIG substantiated that the facility OCC staff failed to coordinate the patient’s radiation therapy and delayed coordinating chemotherapy within the requested timeline. Facility staff canceled a community appointment, noting a lack of VHA Office of Community Care guidance on community care referrals. The patient was placed on palliative care and died. The OIG made one recommendation to the undersecretary for health related to standardizing community care coordination for follow up requests from community providers. The OIG also made two recommendations to the facility director related to completing consults and coordinating community care.
The second report covered a national review of the Intimate Partner Violence Assistance Program. This review evaluated the program’s implementation status and identified perceived compliance barriers. The OIG found that over half of VHA facilities did not have the required program protocol. The Intimate Partner Violence Assistance Program coordinator may be a collateral duty, and 82% of coordinators reported over half of their time was dedicated to this role.
The majority of coordinators reported that they provide training at fewer than half of new employee orientation sessions and to fewer than half of intimate partner violence screeners. And 14% of program coordinators reported not implementing routine, intimate partner violence screening.
The OIG also found that VHA did not establish standardized program evaluation methods or measures, and VISN champions identified the need for clearer role expectations, mandatory screening, and a designated VISN Intimate Partner Violence Assistance Program coordinator. About half of VISN lead coordinators reported dissatisfaction with VISN Champion support.
For more information about these and the other reports the VA OIG published in September, 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 encourage you to check out other episodes wherever you listen to podcasts. Thanks for listening.
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 one and speak with a qualified responder now.