In a report that is likely to stoke a long-running controversy over the health care services that the VA has contracted-out, GAO has now said the umbrella contracts under that program may “may not consistently exclude all ineligible providers from participating.”
Under the latest version of the program as authorized by the 2018 “Mission Act” providers may not participate in the Veterans Community Care Program if they have lost a state medical license, for example, as a result of revocation or termination for cause or due to concerns about poor quality of care.
“However, VA’s contracts with these contractors do not require the verification of providers’ history of license sanctions, including a revoked license, in all states during credentialing. Only one of the two contractors has a process that includes verifying providers’ licensure history in all states and neither has a sufficient process for continuously monitoring provider licenses,” GAO said.
VA itself began tracking providers in May 2019 who may not meet the eligibility restrictions and has deactivated 136, but that tracking does not address providers removed from VA before then, it said. GAO said that its own research identified another 227 dating back to 2016.
GAO said that VA management generally agreed with its recommendations to require contractors to have credentialing and monitoring policies that ensure compliance with Mission Act license restrictions and that it assess the risk to veterans when former VA providers with quality concerns continue to provide VCCP care.
The Mission Act program and its predecessor were authorized on grounds of making it more convenient for veterans to obtain care who otherwise would have to wait too long for an appointment and/or travel an excessive distance to get care at a VA facility. However, the AFGE union, which represents a large portion of the VA medical workforce, and some congressional Democrats have asserted that the program’s main effect has been to hold down in-house employment and set the stage for contracting out more of the care currently being provided by the department’s own employees.