VA Health Care
Status of Inspector General Recommendations for Health Care Services Contracting Gao ID: GAO-08-61R October 31, 2007The Department of Veterans Affairs (VA) operates one of the largest health care systems in the nation. For fiscal year 2007, VA estimates that it will provide health care to more than 5 million veterans, either in its own facilities or through other health care providers. During the past decade, the numbers of VA patients and the costs for treating them have increased rapidly, due in part to an expansion in the number of veterans eligible to receive care. The Veterans Health Administration (VHA)--the VA entity responsible for the health care of veterans--spends about $35 billion a year providing health care to veterans, including more than $7 billion to acquire health care services and products. In its own health care facilities, VHA contracts for a broad range of medical services such as anesthesiology, for other services that support the delivery of medical care such as facility maintenance and laundry services, and for products such as medical equipment, food, and hospital linens. It also contracts for medical care for veterans provided in non-VA hospitals and community based clinics. Contracting for services at VHA represents a large and growing proportion of total contract spending. In an effort to improve the operation of VHA's health care system, VA's Inspector General (IG) conducted reviews of individual VHA facilities through structured site visits with teams of IG officials from fiscal year 1999 through fiscal year 2006. These teams included officials from three IG offices--Audit, Health Care Inspections, and Investigations. These reviews, known as the Combined Assessment Program (CAP), focused in part on actions to increase the efficiency and effectiveness of VHA's contracting. The IG issued a summary report in September 2006 on the results of these CAP reviews, including summaries of recommendations made to address systemic, recurring deficiencies in the planning, management, and oversight of service contracts. In addition the IG issued other reports in recent years on weaknesses in VHA health care contracting. Congress requested that GAO review the recommendations made by the VA IG to improve the award and administration of service contracts for veterans' health care, and VA's efforts to implement these recommendations. In this report GAO identifies (1) the recurring themes among the key recommendations from recent reports of the IG concerning VHA's award and administration of service contracts for veterans' health care, and (2) the current status of VHA's implementation of the recommendations, according to VA data.
GAO identified five recurring themes among the 214 key recommendations contained in recent VA IG reports concerning service contracts for veterans' health care. Three of these themes track the phases of the procurement process--pre-award, award, and post-award--and account for about 61 percent of the key recommendations identified. For the pre-award phase, the IG recommended that contracting officers request pre-award audits when needed, and that VHA facilities ensure that legal and technical reviews are conducted on large-dollar contracts. In awarding contracts, the IG recommended that contracting officers explain the rationale for the award in price negotiation memoranda and conduct background checks once a contractor is selected prior to contract performance. The post-award recommendations focused mostly on payment issues such as verifying invoices and taking action to identify and recover overpayments. In addition to these themes, GAO also identified two other overarching recurring themes--human capital and management concerns--that account for about 39 percent of the key recommendations identified. About one quarter of the key recommendations involved human capital issues--such as ensuring the timely appointment and ongoing training of contracting officers' technical representatives, the staff who oversee contractor performance--while the remainder focused on the need to ensure compliance with applicable laws and regulations through management oversight of contracting activity. According to VA data, all the key acquisition-related recommendations identified in recent VA IG reports have been implemented. In general, managers of the VHA facilities that were reviewed as part of the IG's Combined Assessment Program had taken at least some action in response to the IG's recommendations before the reviews had been completed or in some cases had prepared plans for taking action, as detailed in the IG reports. Analysis of the key recommendations shows that the IG made the same or similar recommendations at many VA facilities. The VA IG Office of Audit told GAO that the issues that led to the same or similar recommendations being made at many facilities may be evidence of recurring and systemic issues throughout VA, and is therefore changing the way it conducts reviews to take a more agencywide approach to these issues.
GAO-08-61R, VA Health Care: Status of Inspector General Recommendations for Health Care Services Contracting
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October 31, 2007:
The Honorable Bob Filner:
Chairman:
The Honorable Steve Buyer:
Ranking Member:
Committee on Veterans' Affairs:
House of Representatives:
Subject: VA Health Care: Status of Inspector General Recommendations
for Health Care Services Contracting:
The Department of Veterans Affairs (VA) operates one of the largest
health care systems in the nation. For fiscal year 2007, VA estimates
that it will provide health care to more than 5 million veterans,
either in its own facilities or through other health care providers.
During the past decade, the numbers of VA patients and the costs for
treating them have increased rapidly, due in part to an expansion in
the number of veterans eligible to receive care.[Footnote 1] The
Veterans Health Administration (VHA)--the VA entity responsible for the
health care of veterans--spends about $35 billion a year providing
health care to veterans, including more than $7 billion to acquire
health care services and products. In its own health care facilities,
VHA contracts for a broad range of medical services such as
anesthesiology, for other services that support the delivery of medical
care such as facility maintenance and laundry services, and for
products such as medical equipment, food, and hospital linens. It also
contracts for medical care for veterans provided in non-VA hospitals
and community based clinics. Contracting for services at VHA represents
a large and growing proportion of total contract spending.
In an effort to improve the operation of VHA's health care system, VA's
Inspector General (IG) conducted reviews of individual VHA facilities
through structured site visits with teams of IG officials from fiscal
year 1999 through fiscal year 2006. These teams included officials from
three IG offices--Audit, Health Care Inspections, and Investigations.
These reviews, known as the Combined Assessment Program (CAP), focused
in part on actions to increase the efficiency and effectiveness of
VHA's contracting. The IG issued a summary report in September 2006 on
the results of these CAP reviews, including summaries of
recommendations made to address systemic, recurring deficiencies in the
planning, management, and oversight of service contracts.[Footnote 2]
In addition the IG issued other reports in recent years on weaknesses
in VHA health care contracting.[Footnote 3]
You requested that we review the recommendations made by the VA IG to
improve the award and administration of service contracts for veterans'
health care, and VA's efforts to implement these recommendations. In
this report we identify (1) the recurring themes among the key
recommendations from recent reports of the IG concerning VHA's award
and administration of service contracts for veterans' health care, and
(2) the current status of VHA's implementation of the recommendations,
according to VA data.
To identify recurring themes among key recommendations from recent
reports on VA's award and administration of veterans' health care
service contracts, we used a multistep process. First, we identified
relevant IG reports. We identified 190 IG reports on the IG's Web site
concerning VHA during fiscal years 2004, 2005, and 2006. Second, we
reviewed each report to identify the 410 recommendations that concerned
the award and administration of service contracts for veterans' health
care. Third, we identified which of these were key recommendations
based on factors that our prior work has shown to be important
components of a sound acquisition system, such as clear requirements,
open competition, adequate contract surveillance, and sufficient
numbers of trained acquisition professionals.[Footnote 4] Fourth, we
identified recurring themes among the key recommendations by analyzing
whether there were any discernable patterns or logical groupings among
those recommendations and determining the frequency with which the
recommendations fell into various categories.
To determine the status of VA's implementation of the key
recommendations, according to VA data, we reviewed the comments
contained in the CAP reports from the responsible facility director on
plans to implement each recommendation. We also reviewed the system
maintained by the VA IG for tracking implementation of recommendations
and VHA's system for tracking such implementation. To test the data in
both systems, we compared the information from the IG's written reports
to the information in both systems, compared information in each system
to the other, and discussed the information with IG and VHA officials
who maintain their respective systems to determine the disposition of
any unimplemented recommendations as of March 31, 2007. We determined
that the data were adequate for our purposes. We did not independently
verify the implementation status of any of the recommendations, nor did
we assess their merit. We conducted our review from March through
October 2007 in accordance with generally accepted government auditing
standards.
Results in Brief:
We identified five recurring themes among the 214 key recommendations
contained in recent VA IG reports concerning service contracts for
veterans' health care. Three of these themes track the phases of the
procurement process--pre-award, award, and post-award--and account for
about 61 percent of the key recommendations we identified. For the pre-
award phase, the IG recommended that contracting officers request pre-
award audits when needed, and that VHA facilities ensure that legal and
technical reviews are conducted on large-dollar contracts. In awarding
contracts, the IG recommended that contracting officers explain the
rationale for the award in price negotiation memoranda and conduct
background checks once a contractor is selected prior to contract
performance. The post-award recommendations focused mostly on payment
issues such as verifying invoices and taking action to identify and
recover overpayments. In addition to these themes, we also identified
two other overarching recurring themes--human capital and management
concerns--that account for about 39 percent of the key recommendations
we identified. About one quarter of the key recommendations involved
human capital issues--such as ensuring the timely appointment and
ongoing training of contracting officers' technical representatives,
the staff who oversee contractor performance--while the remainder
focused on the need to ensure compliance with applicable laws and
regulations through management oversight of contracting activity.
According to VA data, all the key acquisition-related recommendations
we identified in recent VA IG reports have been implemented. In
general, managers of the VHA facilities that were reviewed as part of
the IG's Combined Assessment Program had taken at least some action in
response to the IG's recommendations before the reviews had been
completed or in some cases had prepared plans for taking action, as
detailed in the IG reports. Our analysis of the key recommendations
shows that the IG made the same or similar recommendations at many VA
facilities. The VA IG Office of Audit told us that the issues that led
to the same or similar recommendations being made at many facilities
may be evidence of recurring and systemic issues throughout VA, and is
therefore changing the way it conducts reviews to take a more
agencywide approach to these issues.
VA reviewed a draft of this report and stated that it agreed with the
facts as presented.
Background:
VA's Office of Inspector General (IG) was established under the
Inspector General Act of 1978.[Footnote 5] Under this act, the IG is
responsible for, among other things: (1) conducting and supervising
audits and investigations; (2) recommending policies to promote economy
and efficiency in program administration, and to prevent and detect
criminal activity, waste, abuse, and mismanagement in VA programs and
operations; and (3) keeping the Secretary of Veterans Affairs and
Congress fully informed about problems and deficiencies in VA programs
and operations and the need for corrective action. In addition, the IG
has the authority under the Inspector General Act to inquire into all
VA programs and activities as well as the related activities of persons
or parties performing under grants, contracts, or other agreements.
These inquiries may include audits, investigations, inspections, or
other special reviews.
In January 1999, the Combined Assessment Program (CAP) was established
as part of the IG's efforts to ensure that quality health care services
are provided to our nation's veterans by fostering integrity,
accountability, and excellence and to recommend actions to address
issues impacting VA's programs and activities. CAP reviews from fiscal
year 1999 through fiscal year 2006 provided for oversight of services
provided to veterans through Veterans Administration Medical Centers
(VAMC) and VA health care system operations. Assessments of key
operations and programs at VA medical facilities were conducted by IG
teams that consisted of representatives from the Offices of Healthcare
Inspections, Audit, and Investigations, who:
* evaluated how well VA facilities were accomplishing their missions of
providing veterans convenient access to high quality medical services;
* determined if management controls ensured compliance with VA and
executive-branchwide regulations and VA policies, assisted management
in achieving program goals, and minimized vulnerability to fraud,
waste, and abuse; and:
* provided fraud and integrity awareness training to increase employee
understanding of the potential for program fraud and the requirement to
refer suspected criminal activity to the IG.
Between fiscal years 2004 and 2006, the focus of our report, the IG
conducted CAP reviews at virtually all 160 VA facilities. The IG also
did 15 revisits. In total, this effort resulted in the issuance of 178
CAP review reports. The IG also issued 12 other reports on VHA service
contracting. In addition, the IG submitted semiannual reports to
Congress highlighting the activities and accomplishments of the IG for
the period, including a summary of the CAP reports issued as well as
the disposition of unimplemented recommendations.
The requirements that apply to VHA service contracting are contained in
the Federal Acquisition Regulation (FAR) and in the agency-specific
Veterans Affairs Acquisition Regulation (VAAR). For example, Part 873
of the VAAR implements 38 U.S.C. § 8153, which provides authority for
VA to enter into contracts for the mutual use or exchange of use of
health care resources between the department and any health care
provider or other entity. In addition, VA has various departmental
policies and guidance materials that govern specific aspects of the
acquisition process.
Five Recurring Themes Identified Among Key IG Recommendations:
We identified five recurring themes among the 214 key recommendations
contained in recent VA IG reports concerning service contracts for
veterans' health care.[Footnote 6] Three of these themes track the
phases of the procurement process--pre-award, award, and post-award--
and account for about 61 percent of the key recommendations we
identified. Two other overarching recurring themes--human capital and
management concerns[Footnote 7]--account for about 39 percent of the
key recommendations we identified. See table 1 for recurring themes and
their component key recommendations.
Table 1: Recurring Themes and Key Recommendations:
Recurring themes: Phases of the procurement process (61 percent of all
key recommendations): Pre-award;
Key types of recommendations: Phases of the procurement process (61
percent of all key recommendations): Pre- award audits should be done
for all noncompetitive contracts with estimated values of $500,000 or
more;
Frequency of key recommendations: Phases of the procurement process (61
percent of all key recommendations): 22.
Recurring themes: Phases of the procurement process (61 percent of all
key recommendations): Pre-award;
Key types of recommendations: Phases of the procurement process (61
percent of all key recommendations): Obtain required legal and
technical reviews;
Frequency of key recommendations: Phases of the procurement process (61
percent of all key recommendations): 20.
Recurring themes: Phases of the procurement process (61 percent of all
key recommendations): Award;
Key types of recommendations: Phases of the procurement process (61
percent of all key recommendations): Prepare price analyses and
document the rationale for awarding contracts in price negotiation
memorandums;
Frequency of key recommendations: Phases of the procurement process (61
percent of all key recommendations): 31.
Recurring themes: Phases of the procurement process (61 percent of all
key recommendations): Award;
Key types of recommendations: Phases of the procurement process (61
percent of all key recommendations): Contracting officers must initiate
background investigations prior to contract performance;
Frequency of key recommendations: Phases of the procurement process (61
percent of all key recommendations): 12.
Recurring themes: Phases of the procurement process (61 percent of all
key recommendations): Post-award;
Key types of recommendations: Phases of the procurement process (61
percent of all key recommendations): Verify and certify the accuracy of
invoices prior to payment;
Frequency of key recommendations: Phases of the procurement process (61
percent of all key recommendations): 29.
Recurring themes: Phases of the procurement process (61 percent of all
key recommendations): Post-award;
Key types of recommendations: Phases of the procurement process (61
percent of all key recommendations): Review all contracts to identify
and collect actual overpayments;
Frequency of key recommendations: Phases of the procurement process (61
percent of all key recommendations): 17.
Recurring themes: Overarching themes (39 percent of all key
recommendations): Human capital;
Key types of recommendations: Overarching themes (39 percent of all key
recommendations: Provide contracting officers (CO) and COs Technical
Representatives (COTR) initial and annual refresher training on their
roles and responsibilities;
Frequency of key recommendations: Overarching themes (39 percent of all
key recommendations: 34.
Recurring themes: Overarching themes (39 percent of all key
recommendations): Human capital;
Key types of recommendations: Overarching themes (39 percent of all key
recommendations): Ensure COTRs are designated in writing and verify
that appointments are current and appropriate;
Frequency of key recommendations: Overarching themes (39 percent of all
key recommendations): 11.
Recurring themes: Overarching themes (39 percent of all key
recommendations): Management;
Key types of recommendations: Overarching themes (39 percent of all key
recommendations): Ensure all applicable Federal Acquisition Regulation
and Veterans Affairs Acquisition Regulation requirements are met;
Frequency of key recommendations: Overarching themes (39 percent of all
key recommendations): 29.
Recurring themes: Overarching themes (39 percent of all key
recommendations): Management;
Key types of recommendations: Overarching themes (39 percent of all key
recommendations): Ensure contracting officers do not exceed their
warrant authority;
Frequency of key recommendations: Overarching themes (39 percent of all
key recommendations): 9.
Total key recommendations;
Key types of recommendations: [Empty];
Frequency of key recommendations: 214.
Source: GAO analysis of VA IG reports.
[End of table]
With respect to the pre-award phase, we identified two types of key
recommendations. The first is that pre-award audits should be done for
all noncompetitive contracts with estimated values of $500,000 or more.
The IG found 22 occasions where contracting officers had awarded this
type of contract without requesting the required audits. These
practices were not consistent with VHA Directive 99-056, which expired
in 2004, and are not consistent with VA Directive 1663, which was
issued in August 2006. These directives require that a pre-award audit
be done by the IG's Contract Review and Evaluation Division on all
contract proposals valued at $500,000 or more that were awarded on a
sole-source basis. According to IG CAP reports, historically pre-award
audits have resulted in contract prices significantly lower than what
had been proposed.[Footnote 8]
The second type of key recommendation in the pre-award area concerned
the failure to obtain required legal and technical reviews--which help
ensure that contracts meet all relevant requirements. The IG found
several situations in which contracting officers failed to obtain such
reviews in the pre-award phase, and made 20 related recommendations.
The VAAR requires legal and technical reviews by the VA Office of
Acquisition and Materiel Management for contracts for the acquisition
of health care resources with an estimated value of $1.5 million or
more. Such reviews are also required for sole-source solicitations of
$500,000 or more for the acquisition of health care resources, in
addition to an IG pre-award audit.
For the contract award phase, there were also two key types of
recommendations. The first relates to preparing price analyses and
documenting the rationale for contract pricing. To help ensure that
prices are fair and reasonable, the FAR requires that contracting
officers prepare price negotiation memoranda (PNM) and conduct cost or
price analyses for negotiated procurement contracts. The FAR also
requires that the contracting officers document any significant
differences between a contractor's and a contracting officer's
positions. Despite this requirement, 31 IG recommendations addressed
situations in which contracting officers had failed to prepare price
analyses or document the rationale for awarding contracts in price
negotiation memoranda.
The second key type of recommendation for the contract award phase was
related to background investigations once a contractor is selected
prior to contract performance. VA policy requires contracting officers
to initiate background investigations of contract personnel with access
to VA computer systems and sensitive information. The IG made 12
recommendations related to contracting officers not initiating such
investigations prior to contract performance.
For the post-award phase, we identified two key types of
recommendations concerning the FAR requirement that contracting
officers protect the government's interests. In several reviews, the IG
determined that a number of sites under review had not:
* verified and certified the accuracy of invoices prior to payment, or:
* reviewed all invoices to identify and collect actual overpayments.
As a consequence, the IG made 29 recommendations concerning invoices
that had not been certified for accuracy, resulting in inaccurate
payments for services rendered. Such practices are in conflict with
provisions of the Contracting Officer's Technical Representative (COTR)
Handbook, which recommend the review of contractor invoices to ensure
that the services provided were authorized and amounts billed complied
with contract terms. Seventeen other recommendations addressed
situations in which invoices had been improperly certified and
contractors overpaid after the contracts had expired, and called for
identification and collection of actual overpayments.
In addition to recurring themes related to the phases of the
procurement process, there were two overarching themes of human capital
and management issues among key IG recommendations. The human capital
issues include two key types of recommendations. First, VHA needs to
upgrade the skills of contracting officers and COTRs through more
effective training. Although VHA policy requires that COTRs receive
initial training and 40 hours of continuing education in acquisition
subjects every 2 years, the IG's review of training records found that
many COTRs had received neither. As a consequence, during the last 3
fiscal years, the IG made 34 recommendations calling for initial and
annual refresher training on roles and responsibilities for both
contracting officers and COTRs.
Another key type of recommendation addressing the human capital theme
involved findings by the IG of numerous instances in which the files
contained no documentation that officially assigned employees as COTRs.
VA policy requires that a COTR be assigned in writing to monitor
contract performance to ensure that services are provided consistent
with contract terms. That documentation should be maintained in the
contract file. COTRs may not redelegate their authority, and if they
can no longer perform their duties, the contracting officer should
appoint new COTRs. The IG made 11 recommendations that COTR
designations be in writing and that the appointments be current and
appropriate.
The recurring management theme we identified includes two key types of
recommendations. The first is to ensure that VHA is in compliance with
the FAR, VAAR, and VA policy. In particular this key recommendation
focuses on improving oversight of contracting through thorough and
complete contract file reviews and by ensuring that contracting
officers and COTRs perform duties as required. The IG made 29
recommendations to ensure all such requirements would be met, with the
intention of protecting VA's interest and minimizing risk to the
contracting process.
Second, the FAR and VAAR authorize limiting contracting officer
authority to contract value thresholds as established in their
warrants; these thresholds are established to ensure that the officers
only engage in procurements commensurate with their level of education,
experience, and training. The IG made nine recommendations to ensure
that contracting officers not award contracts in excess of their
established authority.
VA Data Show That IG Recommendations Implemented:
According to VA data, all of the key acquisition-related
recommendations we identified in recent VA IG reports have been
implemented at the facilities for which the recommendations were made.
In general, managers of the VHA facilities that were reviewed as part
of the IG's Combined Assessment Program had taken at least some action
in response to the IG's recommendations before the review had been
completed, or in some cases had prepared plans for taking action, as
detailed in the IG reports. The facility's action plan for addressing
each recommendation is outlined in the CAP report along with the
organization responsible for executing the action plan as well as the
date by which the remedy is to be implemented.
Separate VA IG and VHA databases confirm that the key acquisition-
related recommendations have been implemented.[Footnote 9] In addition,
VA has developed a buying guide to help VA improve its contracting for
health care services.[Footnote 10] According to VA officials, VA has
also taken other steps to improve the acquisition process such as
developing standard operating procedures for procurement and
contracting. However, this does not mean that all contracting issues
have necessarily been resolved agencywide. Our analysis of the key
recommendations we identified shows that the IG made the same or
similar recommendations at many VA facilities. Moreover, the IG's
report on recurring and systemic issues identified during CAP reviews
at VA facilities acknowledged that while facility managers have
provided acceptable implementation plans and taken corrective actions
in response to specific CAP review recommendations, there is a need to
institute comprehensive and rigorous oversight to realize continuing
improvements. The frequency with which certain deficiencies were
identified during the CAP reviews suggests there may be systemic
issues.
VA IG's Office of Audit is now concentrating more on broader audits
encompassing more than one program site to take a more agencywide
approach at addressing deficiencies.[Footnote 11] For example, the IG
has done a review on VA disbursement agreements for senior medical
residents at four VA medical centers and another review on certain VA
acquisitions for other government agencies.[Footnote 12] These reviews
involved multiple medical centers and facilities and the
recommendations were implemented at the Veterans Integrated Service
Network (VISN) level or agencywide. In addition, the IG conducted a
local review with potential agencywide implications based on its review
of mismanagement of federal funds at the VA Boston Healthcare
System.[Footnote 13] The recommendations resulted in procedural changes
concerning contract administration that were implemented VISN-wide,
which affected several facilities.
The IG is currently working on three other broader audits---VA
purchases made on behalf of the Department of Defense, acquisition and
management of surgical device implants, and VHA durable medical
equipment. According to the IG, these broader audits will enhance the
IG's efforts to provide effective oversight and address the complexity
and scope of VA's diverse mission and help address issues agencywide.
Agency Comments:
VA reviewed a draft of this report and sent us comments by e-mail. VA
stated that it agreed with the facts presented in the draft.
We will send a copy of this report to the Secretary of Veterans
Affairs, appropriate congressional committees, and other interested
parties. We will also make copies of this report available to others on
request. In addition, this report will be available on GAO's Web site
at [hyperlink, http://www.gao.gov]. If you or your staff have any
questions, please contact Laurie Ekstrand at (202) 512-7114 or
ekstrandl@gao.gov or William T. Woods at (202) 512-4841 or
woodsw@gao.gov. Contact points for our Offices of Congressional
Relations and Public Affairs may be found on the last page of this
report. Key contributors to this report were James Musselwhite,
Assistant Director; Myra Watts Butler; Leanna Parkey; and Robert
Swierczek.
Signed by:
Laurie E. Ekstrand:
Director, Health Care:
and:
William T. Woods:
Director, Acquisition and Sourcing Management:
[End of section]
Related GAO Products:
Federal Contracting: Use of Contractor Performance Information. GAO-07-
1111T. Washington, D.C.: July 18, 2007.
Contract Management: Further Action Needed to Improve Veterans Affairs
Acquisition Function. GAO-06-144. Washington, D.C.: October 19, 2005.
Guidance: Framework for Assessing the Acquisition Function at Federal
Agencies. GAO-05-218G. Washington, D.C.: September 27, 2005.
Contract Management: Opportunities Continue for GSA to Improve Pricing
of Multiple Award Schedules Contracts. GAO-05-911T. Washington, D.C.:
July 26, 2005.
Contract Management: Opportunities to Improve Surveillance on
Department of Defense Service Contracts. GAO-05-274. Washington, D.C.:
March 17, 2005.
Contract Management: Opportunities to Improve Pricing of GSA Multiple
Award Schedules Contracts. GAO-05-229. Washington, D.C.: February 11,
2005.
Contract Management: Further Efforts Needed to Sustain VA's Progress in
Purchasing Medical Products and Services. GAO-04-718. Washington, D.C.:
June 22, 2004.
Contract Management: Civilian Agency Compliance with Revised Task And
Delivery Order Regulations. GAO-03-983. Washington, D.C.: August 29,
2003.
Acquisition Workforce: Agencies Need to Better Define and Track the
Training of Their Employees. GAO-02-737. Washington, D.C.: July 29,
2002.
Contract Management: Service Contracting Trends and Challenges. GAO-01-
1074R. Washington, D.C.: August 22, 2001.
[End of section]
Footnotes:
[1] The Veterans' Health Care Eligibility Reform Act of 1996 simplified
eligibility standards for veterans in need of hospital and outpatient
care and made available services that previously had not been made
available to veterans without service-connected disabilities or low
incomes. See Pub. L. No. 104-262, §§ 101, 104, 110 Stat. 3177, 3178-81,
and 3182-84.
[2] Department of Veterans Affairs, Office of Inspector General, Review
of Recurring and Systemic Issues Identified During Combined Assessment
Program Reviews at VA Facilities, Report No. 06-03441-227 (Washington,
D.C.: Sept. 25, 2006).
[3] Department of Veterans Affairs, Office of Inspector General, Issues
at VA Medical Center Bay Pines, Florida and Procurement and Deployment
of the Core Financial and Logistics System (CoreFLS), Report No. 04-
01371-177 (Washington, D.C.: Aug. 11, 2004); Evaluation of VHA Sole-
Source Contracts with Medical Schools and Other Affiliated
Institutions, Report No. 05-01318-85 (Washington, D.C.: Feb. 16, 2005).
[4] See list of related GAO products at the end of this report.
[5] Pub. L. No. 95-452, 92 Stat. 1101 (codified as amended at 5 U.S.C.
app. 3, §§ 1-12).
[6] There were also 196 non-key recommendations, which focused mainly
on documentation issues.
[7] Human capital permeates virtually every effort within an agency,
including successfully acquiring goods and services and executing and
monitoring contracts. Management of the acquisition function is
generally dictated by regulations, policies, and processes that focus
on assuring that agencywide objectives are achieved.
[8] For example, see discussion of a summary of historical results of
such IG audits in Department of Veterans Affairs, Office of Inspector
General, Combined Assessment Program Review of the Ralph H. Johnson VA
Medical Center Charleston, South Carolina, Report No. 05-00048-84
(Washington, D.C.: Feb. 14, 2005). In addition, our work at the General
Services Administration has shown that pre-award audits there similarly
result in lower prices. See GAO, Contract Management: Opportunities to
Improve Pricing of GSA Multiple Award Schedules Contracts, GAO-05-229
(Washington, D.C.: Feb. 11, 2005).
[9] We found one instance where the IG and VHA do not agree on whether
a recommendation should remain open or be closed, but we consider this
disagreement to be outside the scope of our review because it does not
address how VHA goes about awarding and administering service
contracts. Specifically, in its report, Audit of VA Acquisition
Practices for the National Vietnam Veterans Longitudinal Study, Rep.
No. 04-02330-212 (Sept. 30, 2005), the IG identified a number of
deficiencies concerning the award of a contract, which was subsequently
terminated, for a legally mandated study. Although the IG recommended
that VA use proper contracting procedures to expeditiously complete the
study, VA officials have decided to attempt to satisfy the mandate
through other means. In our view, the decision on how best to meet the
mandate is a management issue, not an acquisition issue.
[10] Department of Veterans Affairs Directive 1663, Health Care
Resources Contracting--Buying, Title 38 U.S.C. 8153, August 10, 2006.
[11] The IG Office of Health Inspections and the IG Office of
Investigations plan to continue CAP reviews to identify specific
facility deficiencies that need to be addressed.
[12] Department of Veterans Affairs, Office of Inspector General, Audit
of VA Disbursement Agreements for Senior Residents, Report No. 05-
01234-25 (Washington, D.C.: Nov. 15, 2006). Department of Veterans
Affairs, Office of Inspector General, Audit of VA Acquisitions for
Other Government Agencies, Report No. 04-03178-139 (Washington, D.C.:
May 5, 2006).
[13] Department of Veterans Affairs, Office of Inspector General, Audit
of Alleged Mismanagement of Government Funds at the VA Boston
Healthcare System, Report No. 06-00931-139 (Washington, D.C.: May 31,
2007).
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