It has been nearly a decade since the U.S. Government Accountability Office added the Veterans Health Administration to its List of High-Risk Programs and Operations That Are Vulnerable to Waste, Fraud, Abuse or Mismanagement , or that need a transformation. GAO’s recent analysis makes several recommendations for improvement and leaves VHA on the high-risk list.
TO GAO report noted that since its high-risk designation, the VHA has undergone several organizational changes in offices responsible for carrying out select oversight functions, with the goal of eliminating fragmentation, overlap, and duplication among oversight offices. “These reorganizations, however, also highlighted the need for a workforce plan to clearly assess the number and type of staff needed to perform the work of each office and the overall staffing needs of the supervisory offices as a whole,” says the report. “With such a plan, the VHA would be better positioned to ensure that its oversight offices can effectively carry out oversight functions that help it understand how well particular aspects of the health care system are working.” VHA.
The VHA Office of Integrity and Compliance has taken steps to provide a more complete picture of clinical and non-clinical risks to the VHA healthcare system, rather than considering risks in silos. However, GAO found that the office only partially follows leading practices for risk management, limiting its ability to identify, assess, and communicate risks. “By fully complying with leading practices for risk management, VHA can better identify and mitigate risks in the delivery of health care services,” the report says.
Similarly, GAO found that the Office of Internal Audit has taken steps to carry out VHA’s internal audit function. However, the office’s policy directive lacks details about the purpose of the role, in light of the VHA’s most recent organizational changes. “By clearly defining the purpose of its internal audit function, including identifying a clear reporting structure and a defined oversight role, the VHA has the opportunity to make the function more effective by providing input to VHA leadership.” about emerging trends and issues that may impact your healthcare system. ”GAO said.
VHA created its Audit, Risk and Compliance Committee to guide compliance, risk management and internal audit functions and is making changes to the committee, consistent with its 2024 reorganization. But GAO found that the committee has not reviewed the relevant oversight findings, such as those from medical research, and has not provided recommendations for system-wide improvements. “By taking steps to review relevant oversight findings and make recommendations, as appropriate, the committee can help the VHA leverage the work done by its individual oversight offices and others to provide better strategic direction for its health care system.” . “These steps are particularly important to help address VHA’s historically fragmented oversight approach and to help ensure that VHA can provide quality health care to veterans,” the report says.
Recommendations for executive action
The GAO made four recommendations to the VHA:
• The Under Secretary of Health should develop a workforce plan for his or her oversight offices based on an assessment of the personnel needed to effectively carry out compliance, risk management, internal audit, and medical investigation functions. (Recommendation 1)
• The Under Secretary for Health should take steps to fully comply with leading practices for risk management as the Office of Integrity and Compliance implements the agency’s risk management function. (Recommendation 2)
• The Under Secretary for Health should clearly define the purpose of VHA’s internal audit function in an updated policy directive for the Office of Internal Audit. Such a policy should include a clear reporting structure and a defined oversight function with the types of audit activities and priorities for which the office is responsible. (Recommendation 3)
• The Under Secretary for Health should take steps to ensure the ability of the Audit, Risk and Compliance Committee to monitor oversight findings and provide recommendations to VHA leadership to help inform potential system-wide improvements, as appropriate. (Recommendation 4)
Agency comments
After reviewing a draft of this report, the VA responded to the recommendation. Regarding the first recommendation, VA stated that the agency will evaluate resources and associated workloads so that its oversight offices develop a workforce plan. Subsequently, the VHA Office of Integrity and Compliance will report the actions of its workforce plan on a quarterly basis to relevant governing bodies, such as the Audit, Risk and Compliance Committee.
Regarding the second recommendation, VA stated that the Office of Integrity and Compliance is taking a multi-year approach to implementing the VHA risk management function, consistent with Office of Management and Budget requirements. The office will continue its agency-wide collaboration on risk management activities, as well as monitor and report its progress to relevant governance bodies, such as the Audit, Risk and Compliance Committee.
Regarding the third recommendation on clearly defining a purpose for VHA’s internal audit function, VA stated that the agency will revise VHA Directive 1370 to include a clear reporting structure and a defined oversight role. As part of the review, the Office of Integrity and Compliance will obtain input from VHA internal audit staff and leadership. The office plans to report quarterly on its progress to relevant governance bodies, such as the Audit, Risk and Compliance Committee.
Regarding the fourth recommendation regarding the Audit, Risk and Compliance Committee, VA stated that the Office of Integrity and Compliance will strengthen the committee’s processes by reviewing its charter and membership roles and responsibilities. Through this committee or a successor oversight committee, the office will also clarify the committee’s role related to reporting systemwide improvements and monitoring oversight findings.
