VA leaders botched plan to fix backlog for health benefits

Credit: Hyosub Shin

Credit: Hyosub Shin

Leaders of a Veterans Affairs project to clear a backlog of hundreds of thousands of health care applications deliberately suppressed critical information from VA hospitals that would have allowed them to help veterans gain access to care, according to interviews, internal records and recordings of private meetings obtained by The Atlanta Journal-Constitution.

VA officials acted in their own interest and harmed veterans as they pursued a plan to rapidly delete the backlogged applications, the records and interviews suggest. Sen. Johnny Isakson, R-Ga., who chairs the Senate Committee on Veterans’ Affairs, has asked the VA secretary to fix the enrollment problems so veterans don’t suffer from the agency’s mistakes.

The backlog project launched 13 months ago followed a scathing inspector general's investigation that criticized the agency's national health care enrollment center headquartered in Atlanta. The national center was reeling after the investigation confirmed what an AJC report revealed the year before: Hundreds of thousands of veterans health applications were backlogged because of a stall in the enrollment process.

The current VA secretary, David Shulkin, an undersecretary for VA health care until this year, vowed at the time to fix the problems. The agency tapped one of Shulkin's executives, Matt Eitutis, to implement a correction plan and a March 2016 press release touted the new team's efforts to restore trust and improve access for veterans.

But an AJC review reveals multiple problems, mismanagement and efforts by leaders to withhold information from front-line hospital workers tasked with helping fix the enrollment breakdowns. VA officials who oversaw the program seemed more preoccupied with purging the records of about 300,000 deceased veterans so as to avoid the embarrassment of enrolling any of them, than signing up eligible veterans who were still living, according to a whistleblower and recordings of internal meetings obtained by the AJC.

"They did not want to validate the findings of the inspector general report that veterans died before receiving their health care benefits," said Scott Davis, a whistleblower who testified before Congress in 2014 about problems in the enrollment system.

The ongoing turmoil of the HEC enrollment process, a critical link in how veterans access health care benefits at VA hospitals and facilities, represents another challenge for the administration of President Donald J. Trump, who made veterans' care a cornerstone of his campaign and singled out VA for funding increases in his first budget.

Despite pledges to fix problems, improve care and reduce wait times, VA officials have continued to face a steady drumbeat of criticism from some veterans' groups, members of Congress and whistleblowers such as Davis. The enrollment problems at the HEC in Atlanta go to the heart of VA's mission to serve veterans.

“The documents show VA senior leadership deliberately deceived veterans about their efforts to reimburse them for health care costs while the applications were in the pending backlog,” Davis said. “They lied and said we have a plan for equitable relief.”

VA leaders, including Eitutis, defended their handling of the backlog in interviews with the AJC.

“We don’t believe we’ve made any errors,” he said. Eitutis said the VA leveraged the entire VA health care system to enroll as many veterans as possible.

But internal emails and phone calls tell a different story.

In one such email, a senior VA analyst in Atlanta who monitors the enrollment system grew so frustrated by the deception that he wrote an accusatory note to Eitutis Feb. 21. He said leadership was aware of the “wrongdoing” but was only concerned with purging hundreds of thousands of veterans records as quickly as possible.

"This urgency appears to only benefit you and VA leadership," Dane Cornelius wrote in the email obtained by the AJC. "There is no plausible argument for how this benefits Veterans. Leaders should not make decisions that are only in their self-interest."

Eitutis responded to Cornelius, an Army veteran who served in Gulf War I, eight minutes after he sent his email and proposed a meeting to review his concerns. He thanked him for his “concern for the Veteran,” his email said.

Backlog grew over time

Roughly 8.9 million veterans depend on the agency for their health care from a vast system of 168 VA hospitals across the country.

The majority of veterans enter the system by applying in person at a VA medical facility or through an online portal. A smaller number apply by phone or through the mail.

The Health Eligibility Center (HEC), which operates out of a five-story building in the Century Center office park near Clairmont Road and I-85 in DeKalb County, oversees the enrollment process for the entire country.

If all goes smoothly with an application, the VA enrolls the veteran for care or sends them a denial letter based on a determination that they did not meet eligibility qualifications to receive VA services. Of the roughly 600,000 veterans who apply each year, more 400,000 receive a definitive answer.

About 120,000 or so veterans each year end up in the backlog — they are neither enrolled nor sent a denial letter. This backlog expanded over the past decade as VA leaders increasingly centralized the enrollment process through Atlanta and the agency failed to provide enough guidance to veterans and VA hospitals.

In 2014, the AJC and whistleblowers exposed these problems, leading to a Congressional hearing and investigation as well as the inspector general's report in September 2015. Eitutis was brought in that fall to overhaul the enrollment process and clear up the backlog.

Credit: Ken Foskett

Credit: Ken Foskett

Email: ‘years of mismanagement’

A year and a half later, new problems stymie that effort.

In his Feb. 21 letter to Eitutis, Cornelius said he had been optimistic the backlog would be remedied when he first reported problems to the inspector general in late 2013.

Instead, Cornelius said, he saw the same “old ideas” being recycled and he expressed deep concern about a plan to simply delete the records of veterans in the backlog.

“The pending backlog is a result of years of mismanagement and lack of oversight, and requires a thoughtful approach to resolve,” according to Cornelius’s analysis offered in his email to Eitutis, his direct supervisor.

Cornelius’s message came just weeks after a critical breakdown in the campaign to clear up the backlog was brought to the attention of senior VA leadership. On Dec. 28, Eitutis notified Shulkin and then-Deputy VA Secretary Sloan Gibson via email of a major mistake in the outreach campaign to the 545,000 living veterans in the backlog.

VA had launched the campaign in March 2016 and planned to give veterans 365 days to respond before they began purging their records and applications from the backlog.

But Eitutis told superiors in the Dec. 28 email that he had just learned of the breakdown, roughly three months after a VA employee notified three top officials at the HEC in Atlanta that there was a major problem.

The VA had sent letters to 440,410 veterans asking for the wrong information for enrollment, he said. As the result of a coding mistake, some who needed to prove eligibility through income verification instead received letters asking them to prove their military service record. And others who needed to send information showing proof of military service had been sent letters asking for income verification information, according to Eitutis’ email.

‘Apologies for the error’

The mix-up threatened to undermine the entire project to clear the backlog for hundreds of thousands of veterans.

“No action was taken by any of the leaders that were notified in the email from September,” Eitutis wrote on Dec. 28.

When the same employee again sent an email in December, the new HEC Director brought the issue to Eitutis’ attention, he said in the Dec. 28 email to Shulkin and Gibson.

Eitutis said he had a meeting scheduled for the next day to discuss the issue and a plan to send out a new batch of letters “ASAP,” he wrote.

“My apologies for the error,” he said.

In addition to notifying the inspector general of the problem, Eitutis said in his email he had initiated a fact finding and internal audit by his compliance office.

Shulkin declined interview requests about the backlog.

A VA spokesman said last month that the internal review launched by Eitutis found the letters sent were “reasonable and appropriate.” In a March 29 interview, Eitutis echoed that official response and struck a very different tone from the urgent concerns he raised in the Dec. 28 email to Gibson and Shulkin.

Eitutis said he was heavily involved in the outreach efforts to veterans and said VA enrolled more than 60,000 veterans from the backlog over the past year. He acknowledged that the concerns about the letter mix-up were serious, but said he had “full confidence” in what they’d done and he welcomed the inspector general’s review.

“I believe we enrolled every single veteran that was eligible for care,” said Eitutis, the Acting Director for Member Services with the Veterans Health Administration.

Credit: Curtis Compton

Credit: Curtis Compton

Congressional scrutiny

In February, the AJC broke the story about problems with the letter campaign and quoted whistleblower Davis, who asked Shulkin to halt the plan to purge records until a “legitimate awareness campaign” was done to inform veterans how to get their applications activated.

In a letter to Shulkin dated March 3, Isakson and other Congressional leaders asked the VA to halt the plan to purge records for another year until veterans could be informed about their options to enroll.

“Given the enormity of the impact on veterans, we urge you to take additional steps to further ensure veterans receive every opportunity to complete their applications,” the letter from Isakson and other leaders said.

The record shows their concerns were warranted.

Cornelius, the Associate Director for Analytics and Informatics, is the chief data analyst for the HEC. He declined an interview request.

In his email to Eitutis, Cornelius said many of the 64,000 veterans who were enrolled over the past year never responded to a letter from VA. That meant the agency already had the information in its systems to enroll them, he said. He wondered how many other veterans “could have been, and still can be, enrolled?”

“You and your directors have not done the required work, yet there is a rush to close out applications without addressing the issues, or to execute the process properly,” Cornelius wrote to his boss. “A project manager using a smiley face to request closing of applications, and invoking urgency based on what the HEC Director wants, as opposed to what best serves Veterans’ interest is the opposite of advocacy.”

Credit: Ken Foskett

Credit: Ken Foskett

Worries about enrolling dead veterans

Audio recordings of organizational meetings and conference calls of VA officials reveal concerns as far back as early 2016 about whether the project would succeed. Some raised concerns that the national project had only two officials dedicated to help assist and guide front-line hospital staff when they had questions about how to process the pending records.

Others expressed concerns about the lack of training and guidance to field staff at the 168 hospitals. VA officials encouraged hospital staff to be creative in processing the backlogged applications. The Veterans Enrollment Rework Project (VERP) manager, Nick Spantgos, who reported to Eitutis, however, said he couldn’t provide specific guidance.

At one point in a March 2016 conference call, he made clear that he’d been ordered not to answer questions that were coming in from hospital enrollment staff across the country about how to resolve the pending applications. Instead, Eitutis would convey whatever needed to be said in an upcoming meeting with senior VA hospital officials.

“I’ve been instructed to not respond to any of those messages even though I have really good responses to most of them,” said Spantgos, according to an audio recording of the meeting reviewed by the AJC. “I’ve been instructed, ‘I Do not respond.’”

He later told the group: “I can’t do some of the things I want to do on this project. You guys probably have great ideas that we’ve thought about and unfortunately we can’t implement.”

Local VA hospitals were told they should follow their existing policies to resolve the backlog. They were told they had to wait for a pre-approved list from the HEC.

Spantgos said during a February 2016 call that if hospitals didn’t wait there was a “significant risk” they could enroll or send a letter out to a deceased veteran on the list of pending applications.

“That can not occur,” he said.

Later on the same call, Spantgos, a pharmacist, returned to the concern about enrolling dead veterans.

“Before we get off this call I just want to reiterate,” Spantgos said. “I do not — please do not start working your old VISTA pending files to attempt to get ahead of the game. Doing that you incur significant risk of either mailing a letter out to a deceased veteran or enrolling a deceased veteran. So please do not work your old pending list to get ahead of this game. That entails a significant risk. I just want to make sure everyone understands that.”

Cornelius in his Feb. 21 email to Eitutis mentioned his concern about Spantgos withholding guidance from the field, saying Eitutis was the one who directed him. When asked on March 29, if he gave such direction, Eitutis told the AJC “absolutely not.”

“I don’t have all the background on that allegation in regards to what they believe Dr. Spantgos did or didn’t do,” he said. “I know Dr. Spantgos reported directly to me on the VERP project and I have 100 percent confidence in what he did.”

Credit: Hyosub Shin

Credit: Hyosub Shin

‘Effort of deception’ says whistleblower

Davis, the VA public affairs officer at the HEC, has been an outspoken whistleblower who has helped expose problems with the enrollment system. After getting tasked with fixing the problem in late 2015, Eitutis met with Davis several times and later publicly apologized to him in March 2016. 

"I took Scott's claims seriously and in very short order was able to validate the concerns that Scott had from over three years ago — that management was not up front about acknowledging those problems," Eitutis told the AJC last month.

But Davis said the problems at the enrollment center have continued under Eitutis.

He said the agency has made no effort to determine how many of the deceased applicants died while waiting to be enrolled, or taken any steps to compensate veterans who were denied the health benefits they earned. He said containing the scandal and downplaying the extent of the backlog were always the guiding strategy. Those who played along were rewarded with promotions, he said.

He said almost half the roughly 500,000 veterans who VA was required by law to notify by mail of their status in the backlog never even received a letter. And VA officials have known about problems in the letter campaign since at least the middle of last year but concealed them, he said.

On Wednesday, he sent the information to Isakson’s staff and others leaders in Congress who oversee VA.

“The so-called pending cleanup was just a ruse to get Congress and the media to stop asking questions about the pending backlog,” Davis said. “This was an effort of deception conducted by officials at the highest levels of the Department of Veterans Affairs and warrants a Congressional hearing to expose the truth of the hundreds of thousands of veterans who remain in a pending status.”

How we got the story

In 2014, AJC reporter Brad Schrade looked into problems at the VA’s national Health Eligibility Center headquartered in Atlanta. The center is a lynch pin in the VA health care system that serves 8.9 million veterans across the country. Using internal documents and whistleblower interviews, the newspaper exposed breakdowns that had stalled health care access for hundreds of thousands of veterans. The chief whistleblower in the stories testified before Congress, a VA inspector general investigation concluded the following year and the agency promised to fix the problems. Relying on internal records and whistleblower interviews, Schrade’s latest story examines why the promises to fix the enrollment system fell short.

The VA’s Health Eligibility Center

Mission: Manages and directs health care eligibility and enrollment across the Department of Veterans Affairs, serving 8.9 million veterans. The agency partners with the VA's 168 hospitals and is charged with improving and maintaining the agency's health care enrollment system.

Staffing: About 300 full-time employees

Headquarters: 2957 Clairmont Rd., N.E., Atlanta

Source: Department of Veterans Affairs