“What GAO Found
GAO found vulnerabilities in the controls used by the Department of Veterans Affairs’ (VA) Veterans Health Administration (VHA) and its contractors to identify health care providers who are not eligible to participate in the Veterans Community Care Program (VCCP), resulting in the inclusion of potentially ineligible providers.”
“GAO is making ten recommendations to VA, including that VA enhance existing controls, consistently implement controls as described in standard operating procedures, and assess the fraud risk of invalid provider address data. VA generally agreed with GAO’s ten recommendations.”
“The Under Secretary for Health should ensure that Community Care Network contractors perform automated monthly checks for all VCCP providers against the HHS OIG LEIE using SSN, date of birth, and other unique identifiers. (Recommendation 1)…”
“The Under Secretary for Health should ensure that the VHA Office of Community Care revises its Provider Exclusion Standard Operating Procedures to require automated matching of providers in PPMS to the SAM Exclusions file using both TIN and NPI as identifiers. (Recommendation 3)…”
Source: Veterans Community Care Program: VA Should Strengthen Its Ability to Identify Ineligible Health Care Providers – January 13, 2022. GAO.