From the U.S. Government Accountability Office, www.gao.gov Transcript for: Immediate Action Needed to Protect Veterans from Unqualified Health Care Providers Description: While the Department of Veterans Affairs operates one of the largest health care systems in the country, it also allows veterans to receive care through community providers when they face challenges accessing care at VA facilities. However, the VA's oversight has some gaps that could potentially allow unqualified providers to deliver this care. We talk with GAO's Sharon Silas to learn more. Related GAO Work: GAO-21-71, Veterans Community Care Program: Immediate Actions Needed to Ensure Health Providers Associated with Poor Quality Care Are Excluded Released: February 2021 [Intro music:] [Sharon Silas:] There is a risk that unqualified providers may be able to provide care to veterans through the Veterans Community Care Program. [Holly Hobbs:] Hi, and welcome to GAO's Watchdog Report, your source for news and information from the U.S. Government Accountability Office, celebrating 100 years of fact-based, nonpartisan government oversight. I'm Holly Hobbs. While the Department of Veterans Affairs operates one of the largest health care systems in the country, it also allows veterans to receive care through community providers when they face challenges accessing care at VA facilities. However, the VA's oversight has some gaps that could potentially allow unqualified providers to deliver this care. Today we talk with GAO's Sharon Silas, an expert on veterans' health care issues and a director at our Health Care Team, about her new report on the Veterans Community Care Program. Thank you for joining us, Sharon! [Sharon Silas:] Thanks for having me. [Holly Hobbs:] So Sharon, what does the VA currently do to check that health care providers are qualified to provide safe and effective care? [Sharon Silas:] First when providers are hired, they go through a credentialing process. And in this process they determine whether the providers have appropriate clinical abilities and qualifications, including verifying that providers have valid state medical licenses. There also is a recredentialing cycle, which generally occurs every 3 years. And during that process, VA and its contractors will look at sanctions or disciplinary actions against a provider, including license revocations or restrictions. There's also ongoing monitoring-- including any sanctions, complaints, or quality issues. [Holly Hobbs:] So, VA is looking for both qualifications and negative reports on physicians. Where is this information located? Is there a national database that collects all this? [Sharon Silas:] So some of those sources are a federation of state medical boards or individual state medical board websites, and then also the National Practitioner Data Bank. All of these databases kind of serve a similar purpose, but the National Practitioner Data Bank is the only database where certain adverse actions against providers are required to be reported under federal law. [Holly Hobbs:] And what are some of the things that VA is looking for that would qualify or disqualify a provider? [Sharon Silas:] In June 2019, VA placed restrictions on certain health care providers from participating in the Veterans Community Care Program. Basically, there were two main exclusions one that VA and its contractors exclude providers who have lost a license for violating medical license requirements in any state, and also that VA and its contractors exclude providers that have been removed or suspended from VA employment for quality care concerns. [Holly Hobbs:] And do we know of situations where unqualified providers were caring for veterans? [Sharon Silas:] VA has identified and removed at least 136 providers which didn't meet these new requirements. And while we didn't identify situations where unqualified providers were caring for veterans during this review, we and others have done so in the past. So specifically, in a prior review, we identified providers who were removed from VA employment for quality concerns that were able to go on and provide care outside of VA, including in the VA's Community Care Program. [Holly Hobbs:] So then, are there gaps in VA's oversight that could allow unqualified providers to serve veterans in the Community Care Program? [Sharon Silas:] We found that VA's contractors' processes may not consistently exclude all ineligible providers. First of all, one of VA's contractors' processes does not ensure that providers who have lost a license in any state is excluded from participating in the Community Care Network. And then, second, we found that VA's contractors' policies also do not clearly outline continuous monitoring procedures so that they are able to identify ineligible providers between recredentialing cycles. [Music] [Holly Hobbs:] So it sounds like the VA's Community Care Program allows veterans to receive care in their communities, which can improve their access to health care and that the VA has processes in place to review providers, but that there are some gaps in VA's oversight that could potentially allow unqualified providers to enroll in these Community Care Networks and treat veterans. Sharon, did we make any recommendations to help VA better ensure that only eligible providers are providing care to veterans? [Sharon Silas:] Yes. One of the recommendations was that VA require their contractors have a process in place that ensures providers that have lost a medical license in any state are excluded from participation in the program. Another recommendation was that VA ensure that contractors have a process for continuous monitoring of provider care, such as using the National Practitioner Data Bank's continuous query function. [Holly Hobbs:] And last question, Sharon, what's the bottom line of this report? [Sharon Silas:] So, Congress established additional requirements to ensure that former VA providers that have had quality care concerns raised against them are disqualified from providing care. So, until VA requires their contractors to have a comprehensive process in place to ensure that their network providers are meeting these eligibility requirements, there is a risk that unqualified providers may be able to provide care to veterans through the Veterans Community Care Program. [Holly Hobbs:] That was Sharon Silas, talking about GAO's recent review of the Veterans Community Care Program. Thank you for your time, Sharon. [Sharon Silas:] Thank you. 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