Enhancing Oversight in Veterans Health Administration
The Veterans Health Administration (VHA), a cornerstone of healthcare delivery for over 9 million veterans, has embarked on significant restructuring efforts to address its longstanding oversight challenges. As outlined in the Government Accountability Office (GAO) report, the VHA has undertaken organizational changes aimed at enhancing the efficiency and accountability of its oversight functions. The central aim of these reforms is to eliminate fragmentation, overlap, and duplication across its oversight offices, ensuring better management of risks, compliance, internal audits, and medical investigations. Despite these efforts, the GAO report underscores that significant gaps remain in risk management practices, staffing adequacy, and governance frameworks.
One of the central findings of the GAO review is that the VHA has partially implemented leading practices for risk management. The Office of Integrity and Compliance, tasked with managing risks, has trained employees on a risk management framework but has not fully developed an agency-wide risk identification system. This shortfall means that critical risks, both clinical and operational, may go unnoticed or unaddressed, potentially jeopardizing timely and quality healthcare for veterans. The fragmented approach to risk management, where different offices and medical centers use disparate systems, further exacerbates the problem. To mitigate these risks, the GAO recommends that the VHA adopt a more unified and comprehensive approach to risk identification and assessment.
The GAO also highlights issues with the VHA’s Office of Internal Audit, established in 2016. While the office has produced several reports addressing system-wide concerns, its effectiveness is hampered by an unclear reporting structure and a lack of independence. As part of the 2024 reorganization, the office was administratively aligned under the Office of Integrity and Compliance but was supposed to report directly to the Under Secretary for Health. However, this reporting line has not been finalized, and the dual role of the Chief Compliance and Integrity Officer as acting head of internal audits raises concerns about potential conflicts of interest. Without clear boundaries and independent oversight, the internal audit function risks being underutilized and may fail to provide objective insights into critical areas requiring improvement.
Governance issues also extend to the Audit, Risk, and Compliance Committee, established to guide VHA’s oversight functions. Despite its strategic importance, the committee has fallen short in reviewing key oversight findings and making system-wide improvement recommendations. The GAO notes that the committee did not regularly incorporate findings from the Office of the Medical Inspector or external entities such as the VA Office of Inspector General. This lack of integration weakens the committee’s ability to prioritize and address critical system-wide issues effectively.
Staffing challenges across oversight offices further complicate the VHA’s reform efforts. The report reveals that the VHA has not developed a strategic workforce plan to address vacancies and skill gaps within its oversight functions. For instance, the Office of Internal Audit faces persistent staff turnover, while the Office of Integrity and Compliance struggles to clearly define roles and responsibilities. These staffing issues undermine the capacity of oversight offices to fulfill their mandates effectively, leaving the VHA ill-equipped to respond to emerging risks and maintain high standards of care.
The GAO makes several recommendations to address these deficiencies. It urges the VHA to adopt comprehensive risk management practices, clearly define the purpose and scope of the internal audit function, and ensure the Audit, Risk, and Compliance Committee plays a more proactive role in guiding oversight efforts. Additionally, the VHA should develop a workforce plan to ensure oversight offices are adequately staffed and equipped with the necessary skills to carry out their responsibilities.
The implications of these findings are profound. Effective oversight is critical to ensuring the timeliness, safety, and quality of healthcare services provided to veterans. Without addressing these systemic issues, the VHA risks falling short of its mission to serve those who have served the nation. Implementing the GAO’s recommendations could pave the way for a more robust and responsive oversight framework, enhancing the VHA’s ability to deliver on its commitments to veterans.
This blog post provides a summary of the GAO’s findings for informational purposes only. It does not guarantee accuracy and should not be construed as legal advice.