Did 307,000 vets die while awaiting care?

As many as 307,000 veterans might have died while awaiting care from the Department of Veterans Affairs, according to a report from the agency's Office of Inspector General. However, faulty data makes it difficult for the OIG to fully assess the scope of VA's enrollment backlog, and it exacerbates the problem of triaging the vets who are most in need of care.

The report substantiates allegations by whistleblowers that 867,000 records were marked as pending and that 47,000 veterans died while awaiting care. But because of deficiencies in the records, the OIG can't know when applications were made or whether the "pending" records are associated with applications to enroll in VA's benefits system.

The report was released to the public Sept. 2.

"As this issue demonstrates, whistleblowers have proven to be a valuable information source to pursue accountability and corrective actions in VA programs," said Linda Halliday, VA's deputy IG.

VA auditors arrived at the 307,000 figure by comparing applications marked as pending with people who were reported as deceased in the Social Security Administration's Death Master File. The report notes, however, that "due to data limitations, we could not determine specifically how many pending [Enrollment System] records represent veterans who applied for health care benefits."

The report criticizes the lack of controls in VA's enrollment system. There are no limits on how long applications can be marked as pending before a ruling can be made, for example. Additionally, related systems at VA allowed claims processors to delete or improperly mark incomplete applications. Some deletions were required to eliminate duplicate applications, but the report notes that the lack of a built-in audit trail makes it difficult to rule out manipulation of data as a motivation for expunging records.

The investigation was launched at the direction of Rep. Jeff Miller (R-Fla.), chairman of the House Committee on Veterans' Affairs. Many lawmakers reacted to the report with outrage.

"VA Secretary Bob McDonald was brought on board over a year ago to fix these problems," Sen. John McCain (R-Ariz.) said in a statement. "Despite Congress providing tens of billions of dollars to the VA in additional funding for more employees and information systems, it is clear that he has not done so."

The report recommends an overhaul of data management, including controls to guarantee data integrity and rules to govern how long an application may be marked as pending. According to the OIG, VA has an institutional problem with reporting deaths of individuals. Of the 307,000 deceased vets the auditor identified, more than 80 percent have been dead for four years.

"Overstated pending enrollment records create unnecessary difficulty and confusion in identifying and assisting veterans with the most urgent need for health care enrollment," the report states.

The internal reporting tool developed by the Office of Information and Technology to manage the workload and productivity of VA enrollment personnel lacked adequate controls and logs to support the reconstruction of suspicious events, the OIG report states. The auditors recommend that VA CIO LaVerne Council ensure the collection and retention of audit logs on the system and make sure they are backed up on a monthly basis.

In comments made Aug. 10 in response to a draft of the report, Council said controls would be in place by Aug. 15 and a backup system would be active by the middle of October. Additionally, she said representatives of VA's OI&T and Office of Accountability Review would meet to discuss whether to take administrative action against any senior IT officials responsible for the lack of controls built into the system.

A VA spokesperson did not confirm whether the proposed changes had been implemented, or if the personnel meeting had taken place.

"Where issues in the report require additional review and accountability actions, VA will act as necessary and pursue them and afford all concerned appropriate due process," the spokesperson said in a statement.