VA Health Care

GAO recommended in a report (GAO/HRD-93-39) that the Department of Veterans Affairs (VA) actively enforce federal ethics requirements, which generally prohibit managers from participating in the award or administration of contracts from which they have received employment income. In general, GAO is encouraged by VA's actions, which should improve enforcement of federal ethics requirements. GAO is troubled, however, by VA's position that supervision of contract physicians for quality of care purposes by VA managers who are also employed by medical schools is not a conflict-of-interest.

GAO found that: (1) the Secretary of Veterans Affairs has acknowledged that conflict-of-interest situations may have occurred and that enforcement of existing ethics rules involving dual employment may have been inadequate; (2) although VA believes medical centers' affiliations with medical schools were unique and beneficial, increased controls are needed to avoid conflict-of-interest situations; (3) recent VA efforts to strengthen ethics enforcement have included the establishment of a task force to deal with dual employment conflict-of-interest, an office for medical specialist contract oversight, and guidelines and revised federal ethics rules for contract-related activities; (4) VA needs to ensure that the new federal ethics guidelines and procedures monitor part-time VA managers' dual employment and contractor activities; (5) VA disagreed that ethics requirements prohibit VA managers' supervision of contractor activities; and (6) VA has not provided adequate guidance and needs to improve its overall oversight of medical center managers' dual employment and establish clear guidelines on what activities are permissible.