Electronic Health Records

Policy & Regulation News

Data Governance Failures Exposed in VHA Eligibility System

By Frank Irving

Ineffective management of business processes prevented consistent creation and maintenance of essential data at the Veterans Health Administration (VHA)’s Health Eligibility Center (HEC), according to a report filed Sept. 2 by the VA Office of Inspector General (OIG).

“Enrollment program data were generally unreliable for monitoring, reporting on the status of healthcare enrollments, and making decisions regarding overall processing timeliness, in spite of the costs to collect the data and maintain the ES [Eligibility System],” wrote OIG Deputy Inspector General Linda Halliday in her report.

OIG evaluated allegations of mismanagement at HEC at the request of Rep. Jeff Miller (R-FL), chairman of the U.S. House Committee on Veterans’ Affairs.

OIG substantiated that ES contained about 867,000 pending healthcare application records as of Sept. 30, 2014. However, due to data limitations — 55 percent of the pending applications did not have application dates — OIG could not reliably determine how many records were associated with actual enrollment applications.

OIG confirmed that more than 307,000 pending ES records matched up with individuals reported as deceased by the Social Security Administration. VHA lacked adequate procedures to identify date-of-death information and implement necessary updates to applicants’ status.

In addition, OIG found that HEC employees incorrectly marked unprocessed applications as completed in some instances and possibly deleted at least 10,000 transactions from the agency’s Workload Reporting and Productivity (WRAP) tool over the past five years. “WRAP was vulnerable because the HEC did not ensure that adequate business processes were in place, did not manage WRAP user permissions, and did not maintain audit trails to identify review and approvals of deleted transactions,” the report stated.

OIG also discovered a backlog of more than 11,000 unprocessed healthcare applications and about 28,000 update transactions as of January 2013.

OIG recommended establishment of a multiyear project management plan to address the accuracy of pending ES records and improve the usefulness of system data. Among the provisions: HEC should properly secure the WRAP tool and implement policies to manage access rights and privileges, and monthly comparisons between WRAP and ES should be conducted to ensure timely processing of applications and related documents.

VHA anticipates assigning a senior official by Sept. 30 to implement a corrective plan for the data integrity issues in ES. An approved project management plan with milestones is also expected to be in place by Sept. 30.

OIG’s report stated, “We will monitor implementation of planned actions and will close recommendations when we receive sufficient evidence demonstrating progress in addressing the issues identified.”

In federal fiscal year 2014, the HEC received about $47.2 million to provide eligibility verification, policy implementation, outreach, medical facility support and enrollment processing activities.

In an Aug. 14 memo to OIG, after reviewing the alleged mismanagement at HEC, VHA Under Secretary for Health David Shulkin, MD, wrote, “We regret the inconvenience and potential hardship [placed] on applicants for health care and we are working hard to restore Veteran’s confidence and trust in VA’s systems and staff. We have and will continue to take timely and appropriate steps to improve our services to ensure we meet the expectations of those whom we have the honor of serving.”

 

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