Federal investigators are examining allegations that thousands of veterans who applied for health care benefits had their applications purged improperly by the national Veterans Affairs enrollment eligibility office based in Atlanta, according to VA employees interviewed by The Atlanta Journal-Constitution.
The allegations come amid a national scandal engulfing the VA over delays in veterans getting timely medical care and allegations that hospital leaders harmed veterans when they altered records to hide wait times. The latest allegations and investigation involving the Health Eligibility Center (HEC) in Atlanta threaten to open a new front in a scandal that has exposed mismanagement and manipulation of records by VA leaders across the country, and led to dismissals or resignations of top VA officials.
A whistleblower employee who has been interviewed by auditors and criminal investigators from VA Office of the Inspector General told the AJC that IG officials’ questions about the eligibility center include suspicions that more than 10,000 veterans health applications may have been purged from a data system overseen by the center.
Based in a nondescript Dekalb County office building just north of I-85, the center oversees the critical process by which millions of veterans nationwide seek care within the VA medical system. That system is facing a backlog of more than 600,000 veterans who have filed applications for medical care and are pending approval by the VA; once approved a veteran can gain access to the VA health care system at any VA facility. While the center doesn’t process every application, it manages the national enrollment computer system and helps provide enrollment guidance and oversight for the 152 VA hospitals across the country.
The whistleblower, Scott Davis, a program specialist at the HEC, started filing complaints in January alleging mismanagement at the center and possible fraud in federal government contracts.
Davis complained that management overseeing the center became consumed for more than a year with meeting Affordable Care Act performance goals linked to VA enrollment to help meet their bonus targets. He said the center has a “flavor of the month” management style that spent millions to promote ACA to veterans at the expense of core programs.
Programs managed by the center that suffered, Davis said, included the Veterans Health ID cards used to get care at VA facilities and an online benefits handbook to assist veterans, which has been temporarily discontinued because of funding shortages. And he said the loose electronic record system within the VA made veteran enrollment records vulnerable to manipulation.
Davis, a Morehouse College graduate who received exemplary job performance reviews, said seeing how veterans are treated scraped away the idealism he had when he joined the VA in April 2011.
“We don’t discuss veterans,” Davis said. “We do not work for veterans. That is something that I learned after working there. Our customer is the VA central office, the White House and the Congress. The veterans are not our priority. So whatever the initiatives are or the big ticket items that is what we focus on.”
Deputy Chief Business Officer for Member Services Lynne Harbin, whose duties include overseeing the HEC, did not return phone calls left at her Atlanta office last week. A communications director who works in the Atlanta office emailed to confirm they are cooperating with investigators from the VA Inspector General’s office.
“We take seriously any allegations regarding our processes in determining eligibility for Veterans,” said Floretta Hardmon, a spokeswoman in Harbin’s office.
Davis told the AJC he spoke to IG investigators as late as last Wednesday and they have also asked questions about his allegations about mismanagement of a federal contract worth $5 million.
The VA Inspector General’s office would not discuss specifics of its investigation.
“We received many allegations regarding the Health Eligibility Center,” said Catherine Gromek, a spokeswoman for the VA Inspector General. “They are under review and we will report out when the work is complete.”
The HEC plays an especially important role for veterans in metro Atlanta. The Atlanta VA Medical Center is one of a handful of local VA hospitals across the country that have turned over the processing of their online applications to the center.
Documents examined by the AJC show a disagreement erupted in April inside HEC over a management directive to purge some applications in the electronic system. Some employees raised concerns that it would erase an audit trail and compromise system integrity as well as be inefficient, documents show. It’s unclear from the documents whether that purge ever occurred.
Applications from veterans that were purged in the electronic system could become lost, and a veteran could be left with no way to trace it within the VA system.
Another VA employee with knowledge of the allegations the IG is investigating told the AJC that some applications may have been purged to make room within the eligibility data system for a flood of applications from veterans that were expected to come in after a costly marketing campaign to enroll veterans in the Affordable Care Act. This employee, who spoke on condition of anonymity for fear of retaliation against whistleblowers in the VA, said investigators are looking into the alleged purge of as many as 17,000 veterans health applications.
The ACA campaign goal was to encourage veterans to sign up for health care, either through the VA or through ACA marketplaces, or to pass along information to family members and others who may need coverage (family members of veterans are generally not covered by VA health care). One estimation by the HEC anticipated 175,404 veterans would enroll in the first year to meet the ACA requirement that Americans without health insurance obtain coverage.
The campaign, however, led to confusion among thousands of veterans already with VA coverage, who sent in unnecessary duplicate applications that had to be processed by the center, Davis said. That diverted attention away from applications already pending and caused them to languish, Davis said. The agency has a five-day turnaround for applications, but struggles to meet that deadline even during normal operations.
Davis said in a complaint he filed this spring that the center had to pay overtime to employees to process the applications and they moved employees off other tasks to help out. He said in the complaint that only 1,650 new applicants were generated out of 80,000 returned applications as a result of the ACA campaign.
“I saw that programs were pushed aside, deadlines were continually pushed back for other programs, for us to focus on ACA,” Davis said.
Davis’s duties at the HEC included managing content for its websites, coordinating communications with enrollment coordinators at VA hospitals and serving as IT liaison for the center. He received excellent marks on his three annual performance reviews he shared with the AJC.
His most recent review in October gave him an “outstanding” performance rating overall, the highest possible rating on the review form. His review noted a “unique ability” to communicate with all employees in the organization from staff to leadership. It also noted that he was often called on to represent leadership in various settings and he was regularly concerned and involved in ensuring proper attention was given to securing information appropriately.
The review said he participated in “ACA-related planning meetings, staff meetings and project discussions.”
“In a short period of time he has developed a solid understanding of the enrollment process,” his reviewer wrote.
Davis said VA officials have retaliated against him as a result of his whistleblower complaints. He said they placed him on paid administrative leave a couple months ago and when he returned in mid-June, he went on medical leave as a result of the stress from his experience at the VA.
He has a case under review with the Office of Special Counsel (OSC), an independent federal agency that protects whistleblowers. The office has more than 50 pending cases from VA whistleblowers across the country, according to a letter from the OSC to President Obama last week. In the letter, Special Counsel Carolyn N. Lerner said she was troubled by a pattern among VA officials to downplay problems brought by whistleblowers, particularly those related to veterans health.
Davis is a former chairman of the South DeKalb Republican Party who advocated for transparency about contaminated landfills in the area. He ran unsuccessfully for the state House in 2002, and he said he hasn’t held a leadership position in the party in the past decade.
He said he sent his concerns to top leadership in the VA, members of Congress and the White House. He said he’s struggled to break through to anyone who would listen, and decided to turn to the press as a last resort to bring attention to the problems at HEC.
“It is a nightmare being a whistleblower,” he said. “You will find that nobody wants to hear what you have to say.”
About The Health Eligibility Center, Department of Veterans Affairs
- Mission: The Health Eligibility Center is VHA’s authoritative source for enrollment and eligibility activities which supports the delivery of VA health care benefits.
- Vision: The Health Eligibility Center provides national leadership for advancing business practices that support patient care by managing eligibility and enrollment activities for VA’s health care benefits package and services.
- Staff: About 300 full-time employees
- Location: 2957 Clairmont Rd. N.E., Atlanta
Source: Department of Veterans Affairs
The story so far
Earlier this month auditors for the Department of Veterans Affairs reported that veterans across the country faced lengthy delays for care; in some cases veterans waited more than three months to be seen. More damaging, auditors found evidence that VA health care centers deliberately manipulated waiting list records to conceal delays veterans were waiting to be seen.
A criminal investigation is underway in Phoenix over allegations some veterans died before they could be seen by the VA center there. The Atlanta VA has also been singled out for further scrutiny; new patients at the center wait an average of 64 days for primary care, the VA audit found.
Top VA officials, including former VA Secretary Eric Shinseki, have resigned or been terminated in the past two months. Last week, the VA’s acting under secretary for health care and its general counsel announced departures. The House Veterans Affairs Committee, meanwhile, has held hearings on millions of dollars of bonuses awarded to VA executives, despite the problems uncovered at health centers across the country.
Today, the AJC reports that the VA agency that oversees veteran enrollment for access to VA medical care is under investigation for allegations of improper deletion of 17,000 veteran health care applications. A whistleblower alleges the mismanagement stemmed in part because agency leadership was more concerned about bonuses tied to Affordable Care Act enrollment than its core mission of determining health care eligibility for veterans.
About the reporter
Brad Schrade, an Atlanta native with 20 years of journalism experience, rejoined the AJC last fall as an investigative reporter. In 2013, he won a Pulitzer Prize as part of a team at the Minneapolis Star Tribune that uncovered safety breakdowns within the state’s child care system that caused a rash of infant deaths. The series led to system reforms that reduced the number of children dying in care. He has investigated abuse of elderly and vulnerable adults. He worked at the Nashville Tennessean as a reporter and editor where he investigated numerous problems and agencies within state and local government, including corruption in the Tennessee Highway Patrol. Schrade worked as a reporter at the AJC for three years in the late 1990s. He is a graduate of the University of Georgia.