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The Veterans Administration is governed by more than 66,000 regulations

January 12, 2018

The Veterans Administration takes action to provide the best quality of care for veterans. For the last 25 years, Verisys Corporation has set the gold standard in health care for proactive screening, monitoring and credentialing of licensed professionals, entities and individuals. There has been extensive news and numerous investigations into the Veterans Administration’s policies. VA Secretary, David Shulkin is looking into ways to improve the quality of health care provided by the VA.

CheckMedic MEDPASS Remedy: A three-stage process using Verisys’ CheckMedic MEDPASS data and technology would start with:
1) Screening, credentialing, privileging and enrolling all new practitioners followed by monitoring through the comprehensive CheckMedic platform issuing a MEDPASS to ensure that the VA is only hiring currently licensed practitioners completely clear of adverse actions.
2) Use CheckMedic to begin monitoring all currently hired practitioners and address policy governing practitioners with an impaired license. Remove those practitioners who are unlicensed based on an exclusion related to harming patient.
3) Once the practitioner base has been reviewed and those involved in patient endangerment are removed, then participate in daily monitoring through CheckMedic against more than 5,000 primary source publishers to ensure that VA practitioners of all license types i.e. nurses, pharm techs, PAs, are compliant.

In another USA Today article published December 21, 2017, the continued investigation reveals that the Veterans Administration has been hiring doctors with revoked licenses. Here is the article:

“The Department of Veterans Affairs has allowed its hospitals across the country to hire health care providers with revoked medical licenses for at least 15 years in violation of federal law, a USA TODAY investigation found.

“The VA issued national guidelines in 2002 giving local hospitals discretion to hire clinicians after “prior consideration of all relevant facts surrounding” any revocations and as long as they still had a license in one state.

“But a federal law passed in 1999 bars the VA from employing any health care worker whose license has been yanked by any state.

“Hospital officials at the VA in Iowa City relied on the illegal guidance earlier this year to hire neurosurgeon John Henry Schneider, who had revealed in his application that he had numerous malpractice claims and settlements and Wyoming had revoked his license after a patient death. He still had a license in Montana.

More: USA TODAY Investigation: VA knowingly hires doctors with past malpractice claims, discipline for poor care

More: VA conceals shoddy care and health workers’ mistakes

“The VA moved to fire Schneider Nov. 29 after inquiries about his case from USA TODAY. He resigned instead. The VA said at the time that Iowa City hospital officials had received “incorrect guidance” green-lighting his hiring in April. The agency conceded this week that it was national policy.

“VA Secretary David Shulkin said in an interview that he has ordered the rewriting of the guidelines and launched a nationwide review to identify and remove any other health care workers with revoked licenses.

“‘It’s very clear to me that our job is to have the best quality doctors that we can provide to take care of veterans, and that’s going to be our policy,” he said.

“Shulkin said health care providers with prior sanctions against their medical licenses short of revocation — suspensions or reprimands, for example — also will be reviewed to ensure they are providing quality care to veterans at the VA. 

“The USA TODAY investigation published earlier this month found that in addition to hiring Schneider, VA hospitals have knowingly hired other health care providers with past license discipline. In some cases, they have gone on to harm veterans.

“A VA hospital in Oklahoma hired a psychiatrist previously sanctioned for sexual misconduct who went on to sleep with a VA patient. The VA in Tomah, Wis., hired a psychiatrist previously disciplined for medication violations who went on to overprescribe narcotics to veterans. A Louisiana VA clinic hired a psychologist with felony convictions. The VA ended up firing him after determining he was a “direct threat to others” and the VA’s mission.

More: Senators call for VA probe after USA TODAY found doctors hired despite past poor care

More: Iowa senators seek answers on VA hiring after ‘disturbing’ USA Today report

“USA TODAY reported that the malpractice claims against Schneider included cases alleging he made surgical mistakes that left patients maimed, paralyzed or dead, and that his veteran patients in Iowa already have suffered complications. One of those patients, 65-year-old Richard Joseph Hopkins, died from an infection in August after four brain surgeries by Schneider in a span of four weeks.

“Schneider denied in an interview that he had provided substandard care and blamed poor patient outcomes on other providers or unfortunate complications that can occur in neurosurgery.

“Hopkins’ daughter Amy McIntire told USA TODAY this week that she is furious Schneider was hired in the first place and floored by the national policy that allowed it.

“‘I’m appalled by the ineptitude at the VA,” said McIntire, a registered nurse who noted that an agency so large has numerous staff to write policies and ensure they comply with federal law. “For it just to be ignored, it’s crazy.”

“Nearly 50 members of Congress have called on the VA for answers since USA TODAY’s story ran.

“A group of 14 senators from both parties wrote to Shulkin earlier this month asking about the hiring and oversight of health care workers with known histories of malpractice and license discipline. That followed missives from Montana Democratic Sen. Jon Tester and Iowa Republican Sens. Joni Ernst and Chuck Grassley, who said it was “unacceptable that it was only as a result of USA TODAY’s report that the VA determined that hiring this neurosurgeon was illegal.”

“On Monday, 31 members of the U.S. House of Representatives fired off letters to the VA secretary expressing “extreme concern.”

“The hiring of doctors who have had their medical licenses revoked in any state is already prohibited,” 30 of the lawmakers wrote, including Democratic and Republican members of the House Veterans Affairs Committee. “However, it appears the laws and regulations establishing that prohibition are not being followed by VA.”

“Rep. Mike Coffman, R-Colo., demanded in his own letter that Shulkin launch a nationwide review to identify other VA health care workers with malpractice complaints and settlements or sanctions for poor care.

“Coffman said in an interview that he worries the VA has become a “dumping ground” for such providers, who may not be able to find work or secure malpractice insurance in the private sector if past claims or discipline render them too risky. The agency doesn’t require medical workers to have malpractice insurance — the VA pays claims with taxpayer dollars.

“The dumping ground for all these folks is the VA,” Coffman said.

“It’s unclear exactly how widespread the hiring of practitioners with past problems has been at the VA. But for patients and their family members like McIntire, one is too many.

“The national guidelines governing VA hiring have stretched to 1,267 pages with additions and addendums added since their first issuance in 2002. One paragraph, on page 239, gives hospitals permission to hire health care workers with past license discipline, including revocation, despite the 1999 law prohibiting it.

“Shulkin said the agency has 66,000 regulations, and he has launched an effort to reduce them by 80%.

“‘I don’t know how any organization or any human being could appropriately understand and follow 66,000 policies,” he said. “If we don’t deal with these root-cause issues such as these ambiguous policies, we’re going to see problems like this just pop up over and over again.”

“VA officials declined USA TODAY requests to interview Iowa City VA hospital officials about why they hired Schneider, given his record, regardless of policy.

More: USA TODAY Investigation: VA knowingly hires doctors with past malpractice claims, discipline for poor care

More: VA conceals shoddy care and health workers’ mistakes”

In auditing 5 of the 150 Veterans Administration (VA) hospitals, the Government Accountability Office (GAO) found that eight out of nine health care practitioners had adverse behavior on their records that wasn’t reported to the mandated state and national data bases according to a Healthcare IT News article on November 28, 2017.

The unfortunate result of this behavior that the U.S. Department of Veterans Affairs has made common practice is that practitioners who would otherwise not be allowed to practice medicine are allowed to continue practice within the Veteran’s Administration’s network of facilities.

Additionally, when a practitioner who would normally be excluded or sanctioned from practicing medicine according to the laws that require reporting adverse provider and entity behavior to the National Provider Data Bank (NPDB) and the OIG’s List of Excluded Individuals and Entities (LEIE), practitioners who leave the Veteran’s system enter the practitioner populous as an employed or private practice provider and continue to cause harm to patients until the time they are ultimately reported.

In the article that references the Government Accountability Office report, oversight of Veterans Administration healthcare is lacking. The GAO recommends that documented, timely audits be conducted via a standardized protocol. The sample size of the review was 148 providers over three plus years from October 2013 through March 2017.

In early November, the introduction of a bipartisan bill would require the VA to report adverse actions to licensing boards and the NPDB. The state licensing boards can then decide to revoke a practitioner’s license when warranted. A revoked license triggers exclusion, which will then appear on the LEIE.

In a USA Today article published October 11, 2017, the VA’s actions were characterized as a cover up and described in heart-breaking detail irreversible damage to veteran patients by practitioners who continue to practice in other institutions.

The cover-up was facilitated in three ways: 1) Not reporting medical mistakes and acts of patient endangerment to the NPDB, 2) Not reporting medical mistakes and acts of patient endangerment to licensing boards, 3) Paying settlements (bribes) to those who would otherwise report adverse behavior by health care providers to the NPDB, licensing boards or law enforcement.

Even with the limited requirement of provider-type, reporting adverse behavior to the NPDB is mandated, but not enforced, so its accuracy relies on self-reporting without any checks in place to monitor correct reporting. While federal law requires institutions report medical doctors and dentists to the NPDB, that law leaves out every other licensed, certified and registered health care practitioner who all have capacity to harm patients.

This has a compounding effect on fraud and patient endangerment in the U.S. health care system with the Veterans Administration being the largest employer of health care providers.

The databases that are available and federally mandated for use by health care institutions to use for screening and monitoring health care practitioners, the NPDB and the OIG’s LEIE, do not offer enough information to understand the full picture on a health care practitioner.

The Fraud Abuse Control Information System (FACIS) dataset, created and maintained by Verisys Corporation, reveals an historical and full view of a practitioner whether licensed, certified or registered. Verisys, for its FACIS dataset, has been collecting and aggregating data on health care practitioners across all jurisdictions and taxonomies since 1993, and actively acquires data from some 5,000 primary source publishers in real time.

The results of a FACIS search reveal exclusions, debarments, disciplinary and all types of sanctions nationwide and historical.

FACIS is the first and most effective defense against practitioners continuing harmful treatment of patients because of a lack of data. FACIS tags most of the behaviors common to practitioners with adverse history of practice such as state hopping, licensure switching, using alias names, and multiple NPI numbers.

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