VA Health Care:

Steps Taken to Improve Practitioner Screening, but Facility Compliance with Screening Requirements Is Poor

GAO-06-544: Published: May 25, 2006. Publicly Released: Jun 15, 2006.

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In March 2004, GAO reported on gaps in VA's requirements for screening the professional credentials and personal backgrounds of health care practitioners (GAO-04-566). GAO found that VA's requirements did not ensure thorough screening of VA practitioners. VA concurred with four recommendations GAO made to improve practitioner screening. GAO was asked to determine the extent to which (1) VA has taken steps to improve practitioner screening by implementing GAO's recommendations and (2) VA facilities are in compliance with VA's practitioner screening requirements. GAO reviewed VA's current practitioner screening policies to determine if gaps remain, interviewed VA officials, and sampled about 60 practitioner files at each of seven VA facilities selected based on size and geographic location.

VA has taken steps to improve health care practitioner screening by partially implementing each of four recommendations made in GAO's March 2004 report; however, gaps still remain in VA's practitioner screening requirements. In response to two of GAO's recommendations, VA expanded its screening requirements for all VA applicants to include a verification of all state licenses and national certificates and requires facility officials to query the Healthcare Integrity and Protection Data Bank (HIPDB), which contains information on individuals involved in health care-related civil judgments and criminal convictions and licensing and certification actions. VA, however, has not yet expanded these screening requirements to apply to all health care practitioners currently employed at VA facilities, as GAO recommended. In response to the third GAO recommendation, VA issued a policy in August 2005 that requires individuals who previously were exempt from receiving any level of background investigation to have, at a minimum, their fingerprints screened against a criminal history database. As of October 19, 2005, 37 VA medical facilities had not fully implemented this new requirement because they had not obtained or installed the necessary electronic fingerprint equipment. Since then VA has made progress; as of February 1, 2006, 2 medical facilities had not installed the equipment. Finally, VA has partially implemented GAO's fourth recommendation to conduct oversight of its facilities' compliance with VA practitioner screening requirements; however, GAO found the oversight does not address all of the facility compliance issues GAO previously identified. GAO found poor compliance with four of the five selected VA practitioner screening requirements at the seven VA facilities visited in 2005. None of the seven facilities had a compliance rate of 90 percent or more for all five screening requirements GAO reviewed. Two facilities that had implemented VA's fingerprint-only background investigations--a relatively new form of background investigation--did not comply with VA's requirement to document that the results of the fingerprint check against a criminal history database had been reviewed and used to make a decision on the individual's suitability to work at a VA medical facility.

Recommendations for Executive Action

  1. Status: Closed - Implemented

    Comments: VA has partially implemented our recommendation--its Office of the Medical Inspector has developed a compliance assessment tool which it planned to pilot test at the Baltimore VA medical center in July 2007, then refine the tool and use it at eight other medical centers. VA's Office of Human Resources Management plans to continue to review facility compliance with VA's personnel screening requirements as part of its on-site HR inspections. However, until VA has completed its pilot and refinement of the assessment tool, we are unable to determine whether this will completely satisfy our recommendation. We have not been given updated information from VA on this recommendation. Update from July 2009: The Office of the Medical Inspector (OMI) reviewed compliance with credentialing requirements in fiscal year 2007 and analyzed the data to publish a White Paper in fiscal year 2009, recommending that a plan of action be developed to ensure compliance with all credentialing requirements. VA's office of Human Resources Management, Oversight and Effectiveness Service (OES) have made compliance with screening requirements a standard part of their review of facilities' human resources programs, and assessed 14 facilities in fiscal year 2006, 16 in fiscal year 2007, and 16 in fiscal year 2008. Additionally, VHA's System-wide Ongoing Assessment Review Strategy (SOARS) program includes background checks, personnel suitability, and credentialing in their site visit assessment process. OES will be giving the responsibility of the suitability program to the Office of Security and Law Enforcement.

    Recommendation: To better ensure the safety of veterans receiving health care at VA medical facilities, the Secretary of Veterans Affairs should expand the Office of Human Resource Management oversight program to include a review of VA facilities' compliance with screening requirements for all types of salaried and nonsalaried health care practitioners.

    Agency Affected: Department of Veterans Affairs

  2. Status: Closed - Implemented

    Comments: VA implemented this recommendation when it issued VA directive and handbook 0710 on May 18, 2007, standardizing operating procedures for its personnel screening process. The requirement includes use of VA's Screening Checklist to document that required screening activities have been completed and to initiate and adjudicate background investigations in a timely manner. VA medical facility officials also are required to establish local policies and procedures to ensure that personnel screenings are properly accomplished and to conduct quarterly file reviews to determine screening compliance.

    Recommendation: To better ensure the safety of veterans receiving health care at VA medical facilities, the Secretary of Veterans Affairs should standardize a method for documenting facility officials' review of fingerprint-only background investigation results and decisions regarding suitability to work in VA medical facilities.

    Agency Affected: Department of Veterans Affairs


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