Hotline Cases Reviewed by OIG
A Pie Chart Representing the percentage of Hotline cases reviewed by OIG offices in FY 2013:
- Criminal Allegations 80%
- Healthcare Concerns 9%
- Administrative Issues 11%
Out of the 27,000 Hotline contacts received annually, the Hotline refers approximately 2,000 of the most serious Hotline complaints to OIG reviewers for consideration. These referrals resulted in approximately 422 internal OIG cases in FY 2013. Most Hotline cases reviewed by the OIG are based on allegations of criminal wrongdoing likely to result in prosecution. The second largest group of cases reviewed by the OIG are based on administrative compliance and conduct issues. The results of the latest OIG Hotline work are included in the OIG's Semiannual Reports to Congress: www.va.gov/oig/publications/semiannual-reports.asp
A Pie Chart Representing the percentage of Hotline cases reviewed by VA Management in FY 2013:
- Veterans Health Administration 54%
- Veterans Benefits Administration 32%
- Other VA Offices 14%
Hotline Cases Reviewed by VA Management
In addition to Hotline cases completed by OIG reviewers, another 805 cases were referred in FY 2013 to VA management for review and response to the Hotline. VHA reviewed 54 percent of external Hotline cases, and VBA reviewed 32 percent. The OIG evaluated the adequacy of these VA reviews prior to case closure. VA reviewers substantiated 40 percent of Hotline cases closed in FY 2013. Closed Hotline cases reviewed by VA produced a total of 704 administrative and corrective actions and $10 million in monetary benefits in FY 2013. The Hotline directs complaints not resulting in cases back to VA management either directly or by providing the complainant the location of a VA organization to address their concerns.
The following are examples of recent Hotline cases substantiated as a result of external reviews:
Social Worker Falsifies Medical Records and Misuses Government Vehicle
A review by the VA Great Lakes HCS substantiated that a Chicago-area VA social worker systematically created bogus medical record entries to falsely indicate that he met, or performed services for, 6 Veterans on a total of 131 occasions between July 2011 and January 2013. The review also found that the social worker used a Government vehicle without authorization 12 times during FY 2013. As a result, the VAMC initiated appropriate administrative action to address the issues.
Philadelphia VAMC Paid Excessive Charges for Sleep Studies
A review by VISN 4 substantiated that the Philadelphia, PA, VAMC paid $287,958 in excessive charges for sleep studies by the affiliated Hospital of the University of Pennsylvania for FY 2009 through 2011. The overpayments occurred, in part, because the University continued to bill VA for studies at a flat annual contract rate, even though the contract had expired in FY 2008. As a result of the review, the VAMC discontinued services under the expired contract and initiated collection for the overpayments.
Hotline Review Terminates Compensation for Unsupported Condition
A review conducted by the St. Petersburg, FL, VARO found that a Veteran's medical records did not support his claimed disability of Lou Gehrig's disease, for which he was receiving 100 percent disability compensation since January 2012. As a result, the VARO terminated the benefits resulting in an estimated cost savings of $238,859 over a 5-year period.
Hotline Reviews in Minnesota Uncover Improper Receipt of VA Benefits
Hotline reviews by the St. Paul, MN, VARO identified improper payments to two persons that would have totaled $224,674 over a 5-year period if not reported and stopped. The first case identified a surviving spouse who improperly continued to receive DIC benefits because she concealed from VA her April 2007 common-law marriage. The second case involved a Veteran who improperly received VA pension benefits because he concealed from VA his Social Security income beginning in February 2010.
VARO Reduces Compensation for Incarcerated Veteran Following Hotline Tip
A review conducted by the Houston, TX, VARO substantiated that a Veteran receiving disability compensation did not report his December 2011 incarceration and projected release date of May 2026 to the VARO. The case resulted in the reduction of his benefits and an estimated 5-year savings of $216,144.