Department of
 

Veterans Affairs
 

Review of
 

Alleged Mismanagement
 

of Non-VA Fee Care Funds
 

at the Phoenix VA Health
 

Care System
 

OFFICE OF AUDITS AND EVALUATIONS

November 8, 2011 

11-02280-23 
ACRONYMS AND ABBREVIATIONS
 

CPRS Computerized Patient Record System 

HCS Health Care System 

LTAH Long Term Acute Hospital 

OIG Office of Inspector General 

VHA Veterans Health Administration 

VISN Veterans Integrated Service Network 

To Report Suspected Wrongdoing in VA Programs and Operations:
 

Telephone: 1-800-488-8244
 

E-Mail: vaoighotline@va.gov
 

(Hotline Information: http://www.va.gov/oig/contacts/hotline.asp)
 
Report Highlights: Review of Alleged 

Mismanagement of Non-VA Fee Care 

Funds at the Phoenix VA Health Care 

System 

Why We Did This Review 

The Office of Inspector General received an 

allegation of mismanagement of non-VA fee 

care funds at the Phoenix VA Health Care 

System (HCS). This review assessed the 

allegation that mismanagement of the 

Non-VA Fee Care Program at the Phoenix 

HCS resulted in a $12 million budget 

shortfall at the end of FY 2010. 

Since 2009, we have reported that the 

Veterans Health Administration faced 

significant challenges to address serious 

nationwide weaknesses in this program’s 

controls. We also reported that this program 

needed immediate management attention 

given the magnitude of the payment errors. 

What We Found 

We substantiated that the Phoenix HCS 

experienced a budget shortfall and 

mismanaged fee care funds in FY 2010. We 

determined the shortfall to be $11.4 million, 

20 percent of the FY 2010 Non-VA Fee 

Care Program funds. The shortfall occurred 

because the HCS lacked effective preauthorization procedures for Long Term 

Acute Hospital fee care. Additionally, HCS 

staff did not monitor inpatient fee care 

patients to determine if the patients could 

receive services in a VA facility. 

Authorization procedures were so weak that 

the HCS processed about $56 million of fee 

claims during FY 2010 without adequate 

review. Further, the HCS did not have 

adequate procedures to obligate sufficient 

funds to ensure it could pay its commitments 

for these services. However, since the 

discovery of the budget shortfall, the HCS 

has initiated several corrective actions to 

reduce the risk of future shortfalls and 

strengthen the management of their Non-VA 

Fee Care Program. 

What We Recommended 

We recommended that the Interim Director 

of the Phoenix VA Health Care System 

establish monitoring procedures to ensure 

that the official designated to pre-authorize 

fee care thoroughly reviews fee care 

requests, clinical staff conduct necessary 

utilization and concurrent reviews, and fee 

staff obligate sufficient funds for approved 

fee care. 

Director’s Comments 

The Phoenix HCS Interim Medical Center 

Director agreed with our finding and 

recommendations and plans to complete all 

corrective actions by December 2011. We 

consider these planned actions acceptable, and 

we will follow up on their implementation. 

BELINDA J. FINN
 

Assistant Inspector General
 

for Audits and Evaluations
 

i 
TABLE OF CONTENTS
 

Introduction......................................................................................................................................1
 

Results and Recommendations ........................................................................................................2
 

Finding Phoenix VA Health Care System Had a Budget Shortfall of $11.4 Million
 

in FY 2010 ..........................................................................................................2
 

Appendix A Scope and Methodology..................................................................................... 7
 

Appendix B Phoenix VA Health Care System Interim Director Comments ......................... 8
 

Appendix C OIG Contact and Staff Acknowledgments....................................................... 11
 

Appendix D Report Distribution .......................................................................................... 12
 

ii 
Review of Alleged Mismanagement of Non-VA Fee Care Funds 

at the Phoenix VA Health Care System 

Objective 

Hotline 

Complaint 

Phoenix VA 

Health Care 

System 

Description of 

the Non-VA 

Fee Care 

Program 

Prior OIG 

Audits 

INTRODUCTION 

This review assessed an allegation submitted to the Office of Inspector 

General (OIG) that the Phoenix Health Care System (HCS) had a budget 

shortfall due to the mismanagement of their Non-VA Fee Care Program. 

On March 28, 2011, the OIG received an allegation that the Phoenix HCS 

mismanaged their Non-VA Fee Care Program, which resulted in a 

$12 million budget shortfall at the end of FY 2010. The allegation pointed to 

a sharp increase in the use of Long Term Acute Hospital (LTAH) fee care 

due to a lack of pre-authorization procedures and alleged that the Phoenix 

HCS did not have adequate procedures in place to properly record 

obligations for fee care during FY 2010. 

The Phoenix HCS is part of Veterans Integrated Service Network (VISN) 18 

and consists of a tertiary hospital located in Phoenix, AZ, and seven 

community based outpatient clinics. The Phoenix HCS provides medical 

services to about 81,000 unique veterans annually and had a total budget of 

about $438 million in FY 2010, of which the facility budgeted $56 million 

(13 percent) for their Non-VA Fee Care Program. 

The purpose of the Non-VA Fee Care Program is to assist veterans who 

cannot easily receive care at a VA medical facility. This program pays the 

medical care costs of eligible veterans who receive care from non-VA 

providers when VA is unable to provide specific treatments or provide 

treatment economically because of the veteran’s geographical inaccessibility. 

Fee care may include dental services, outpatient care, inpatient care, 

emergency care, and medical transportation. Pre-authorization is required 

for non-emergency inpatient and outpatient care. 

The OIG issued Audit of Veterans Health Administration’s Non-VA 

Outpatient Fee Care Program (Report No. 08-02901-185, August 3, 2009) 

and Alleged Mismanagement of the Fee Basis Program VA Connecticut 

Healthcare System West Haven, Connecticut (Report No. 09-01219-141, 

June 3, 2009). OIG concluded in both of these reports that controls over 

pre-authorizing fee care services needed improvement. We also reported that 

the magnitude of the fee care program’s payment errors indicated the 

Veterans Health Administration (VHA) faces significant challenges in 

addressing the healthcare and financial vulnerabilities associated with this 

program. 

VA Office of Inspector General 1 
Review of Alleged Mismanagement of Non-VA Fee Care Funds 

at the Phoenix VA Health Care System 

Finding 

Pre-Authorization 

Procedures 

Ineffective 

RESULTS AND RECOMMENDATIONS 

Phoenix VA Health Care System Had a Budget Shortfall 

of $11.4 Million in FY 2010 

We substantiated the allegation that the Phoenix HCS had a budget shortfall 

at the end of FY 2010. We determined the shortfall to be $11.4 million 

(20 percent of the FY 2010 Non-VA Fee Care Program funds) rather than the 

alleged $12 million. We found that the HCS did not have effective preauthorization procedures for fee care and did not conduct utilization and 

concurrent reviews of patients receiving LTAH fee care. Additionally, the 

HCS did not ensure sufficient funds were obligated to pay fee care claims. 

These problems occurred because HCS management did not have sufficient 

procedural and monitoring controls to ensure that: (1) the official designated 

to pre-authorize fee care thoroughly reviewed requests, (2) clinical staff 

conducted necessary utilization and concurrent reviews, and (3) fee staff 

obligated sufficient funds for fee care. As a result, the Phoenix HCS had to 

obtain additional funds from the National Fee Program and VISN 18 and 

cancel equipment purchases to cover the $11.4 million shortfall. 

The Phoenix HCS did not have effective pre-authorization procedures over 

the $4.5 million they spent for LTAH fee care during FY 2010. Since the 

medical records of the veterans who received the LTAH care did not justify 

the use of this care, we attributed $4.5 million (39 percent) of the 

$11.4 million shortfall to uncontrolled and unsupported spending for LTAH 

care. VHA policy requires that the facility Chief of Staff or their formal 

designees pre-authorize non-VA fee care prior to a veteran receiving medical 

services. This is to ensure the request is appropriate and that medical facility 

management is aware of how they are utilizing fee services. 

Part of the pre-authorization process is a requirement to conduct utilization 

reviews to evaluate the medical necessity, efficiency, or appropriateness of 

services and treatment plans for patients receiving inpatient fee care. A 

utilization review is an assessment of requests for fee care by nursing staff to 

ensure the requests are medically necessary and a VA facility cannot 

reasonably provide the care. 

The Phoenix HCS sent 31 veterans to two non-VA long-term acute care 

providers for ventilator weaning during FY 2010. The medical records of the 

31 veterans did not adequately justify the HCS’s extended use of LTAH fee 

care. For example, the documentation for 6 (19 percent) of the 31 requests 

were for long-term care, such as a skilled nursing facility, rather than for the 

much more intensive and expensive long-term acute care. However, there 

VA Office of Inspector General 2 
Review of Alleged Mismanagement of Non-VA Fee Care Funds 

at the Phoenix VA Health Care System 

Concurrent 

Reviews Not 

Conducted 

were no requests for clarification from the pre-authorizing official, such as 

asking requesting physicians about the medical necessity or requesting a 

utilization review to determine whether VHA could provide the services. 

The Phoenix HCS did not have effective pre-authorization procedures for 

LTAH fee care because the Chief of Staff delegated the responsibility for 

reviewing and pre-authorizing virtually all of the fee care claims (budgeted at 

approximately $56 million) to one physician in FY 2010. The physician told 

us that he pre-authorized hundreds of requests per week while also 

performing other clinical responsibilities. 

He acknowledged routinely approving requests for LTAH care with no 

substantive questions or requests for additional information. In addition, the 

HCS did not have a utilization review team to ensure the HCS evaluated the 

medical necessity, efficiency, or appropriateness of services and treatment 

plans for patients receiving LTAH fee care. Authorization procedures were 

ineffective because HCS management did not adequately monitor the 

delegated physician to ensure the HCS only authorized appropriate fee care 

requests. 

Opportunities for processing improper payments increase significantly in the 

absence of effective controls. The mismanagement of fee authorization 

procedures at the Phoenix HCS introduces risks to the Non-VA Fee Care 

Program, such as authorizing: 

 Diagnostic tests or procedures that are not medically necessary. 

 Services that are available at a VA medical facility. 

 Unnecessary and often excessive numbers of therapy treatments. 

Since October 2010, Phoenix HCS management has recognized these risks 

and has established a utilization review team. In January 2011, HCS 

management also delegated the responsibility for overseeing the 

pre-authorization of fee care to a different physician solely dedicated to 

managing the pre-authorization process. 

The Phoenix HCS did not conduct concurrent reviews for patients sent to the 

two LTAH fee care providers for ventilator weaning. VHA requires a 

concurrent review, which is an assessment that determines medical necessity 

or appropriateness of services during a patient’s hospital stay or course of 

treatment. This review assesses the need for continued inpatient care for 

hospitalized patients and includes continued-stay authorization and discharge 

review. 

The Phoenix HCS paid for over 30 consecutive days of long-term acute care 

for 15 (48 percent) of 31 of these patients. The longest stay was 162 days 

VA Office of Inspector General 3 
Review of Alleged Mismanagement of Non-VA Fee Care Funds 

at the Phoenix VA Health Care System 

Inadequate 

Funds 

Obligated 

(over 5 months). The Chief of Staff and Chief of Intensive Care told us that 

30 days was a reasonable limit to attempt ventilator weaning. If the veteran 

had not weaned in that time, then the HCS needed to re-evaluate the 

appropriateness of continued weaning and consider alternative medical 

options. Timely concurrent reviews would have assessed the need for 

continued ventilator weaning or a different course of treatment, thus reducing 

the cost of fee care. 

The average cost paid for LTAH care by the HCS during FY 2010 exceeded 

$2,600 per day. The Phoenix HCS did not conduct these reviews because the 

HCS management did not commit the attention and resources needed to 

provide the staffing necessary to have a concurrent review team. Since 

October 2010, Phoenix HCS management has recognized the need to 

monitor these veterans and has developed a utilization review team. 

The Phoenix HCS did not obligate sufficient funds for fee care. We 

attributed the remaining $6.9 million (61 percent) of the $11.4 million 

budget shortfall to fee staff obligating insufficient funds to pay for fee care 

services provided during FY 2010. VHA policy requires VA medical staff to 

submit requests for non-emergency fee care to the health care facility chief 

of staff or their formal designees for pre-authorization of fee care. 

VA medical staff initiate their requests for fee care by entering the request in 

the Computerized Patient Record System (CPRS) and then sending it to the 

official designated to pre-authorize the type of fee care requested. CPRS 

notifies the fee staff when the fee care is pre-authorized. The fee staff enter 

the request into the fee payment system and obligate sufficient funds to pay 

for the specified care.1 The medical facility then provides an approval letter 

to the patient to obtain the approved care from a non-VA provider. 

The Phoenix HCS fee staff frequently paid claims for non-emergency fee 

care that was not pre-authorized. This occurred because HCS lacked 

adequate fee authorization processing controls. Although VA medical staff 

initiated their requests for fee care by entering the request in CPRS, they did 

not send it to the designated pre-authorization official. Instead, medical staff 

provided a copy of the request for fee care directly to veterans. The veterans 

presented the hardcopy fee request to their non-VA providers as 

authorization of care. Since the requested care was not pre-authorized, the 

fee staff were unaware of the care and did not obligate funds to cover costs 

of care. Later when fee staff received the invoice, they entered the request 

into the fee payment system and paid the invoice. 

1 VA pays Medicare rates for most inpatient and outpatient medical services. The Centers 

for Medicare and Medicaid services publishes these rates annually and were available to fee 

staff to create appropriate obligation amounts. 

VA Office of Inspector General 4 
Review of Alleged Mismanagement of Non-VA Fee Care Funds 

at the Phoenix VA Health Care System 

Effects of 

Shortfall 

Conclusion 

Recommendations 

The fee staff did not obligate sufficient funds for all types of approved 

inpatient and outpatient fee care. For example, during FY 2010, fee staff 

obligated $200 for six physical therapy sessions, but the cost of the six 

sessions was about $1,000. They also obligated $300 for a routine magnetic 

resonance imaging procedure, but the cost of the service was about $800. 

This occurred because the fee staff did not take the time to calculate an 

estimated cost based upon appropriate pricing rates. The fee staff also did 

not obligate additional funds to cover higher than expected LTAH costs 

because HCS medical staff did not adequately monitor the patients’ length of 

stay and inform the fee staff when a patient stayed longer than expected. 

Due to the FY 2010 budget shortfall, the Phoenix HCS improved the controls 

over the fee authorization process in FY 2011. HCS management provided 

training to the HCS physicians regarding the importance of ensuring fee care 

is pre-authorized. They also added a statement to the fee request so that if 

the request is printed, it states that the request is not an authorization for 

payment. HCS fee management has also instituted a review process to 

update fee obligation amounts to reflect the expected payment amounts more 

accurately. 

The Phoenix HCS made up the $11.4 million shortfall by obtaining $2.3 

million in special funding from the National Fee Program, acquiring $5.3 

million in supplemental funding from VISN 18, and canceling $3.8 million 

in equipment and other purchases. In addition, to emphasize the seriousness 

of the shortfall, the VISN reduced the Phoenix HCS’s FY 2011 budget by 

$2 million. 

We substantiated that the Phoenix HCS experienced a budget shortfall of 

$11.4 million and mismanaged fee care funds in FY 2010. Program 

management was ineffective because the HCS processed FY 2010 claims, 

budgeted at about $56 million, without adequate review. The Phoenix HCS 

has substantially changed the control environment we audited. Its corrective 

actions, if implemented consistently and successfully, should improve the 

management of the Non-VA Fee Care Program. However, it will take HCS 

management’s time and attention to monitor properly these corrective actions 

to ensure the actions become a permanent part of the management of this 

program. 

1. We recommended that the Interim Director of the Phoenix VA Health 

Care System establish monitoring procedures to ensure that the delegated 

approving officials pre-authorize only fee care requests that are medically 

necessary or for services that a VA facility cannot provide. 

2. We recommended that the Interim Director of the Phoenix VA Health 

Care System establish monitoring procedures to ensure that the utilization 

VA Office of Inspector General 5 
Review of Alleged Mismanagement of Non-VA Fee Care Funds 

at the Phoenix VA Health Care System 

Management 

Comments 

and OIG 

Response 

review team reviews fee care requests to determine that requests are 

medically necessary or for services that a VA facility cannot provide. 

3. We recommended that the Interim Director of the Phoenix VA Health 

Care System establish monitoring procedures to ensure that the concurrent 

review team ensures that hospitalized veterans need continued inpatient fee 

care. 

4. We recommended that the Interim Director of the Phoenix VA Health 

Care System establish monitoring procedures to ensure that fee staff obligate 

sufficient funds to pay for approved fee care. 

The Phoenix HCS Interim Medical Center Director agreed with our finding 

and recommendations and provided responsive implementation plans to 

address our recommendations. The Phoenix HCS has designated a full-time 

Utilization Management Physician as the approving authority for fee consults 

and designated a utilization review team to review all fee consults and 

conduct concurrent reviews for all veterans while receiving inpatient fee care. 

The utilization review staff will review a minimum of 30 fee consults 

monthly to ensure that all authorized fee care requests are medically 

necessary or for services that a VA facility cannot provide. The HCS Office 

of Compliance will report the results of quarterly audits of this monitor to 

senior leadership quarterly. 

In addition, the Phoenix HCS is establishing a process to appropriately 

estimate and track the funds needed to pay for requested services. The 

Manager Fee Basis will audit at least 30 newly created fee basis items 

monthly and the Office of Compliance will audit fee basis obligations 

quarterly. The HCS plans to complete all corrective actions by 

December 2011. 

The implementation plan is acceptable, and we will follow up on the planned 

actions until they are completed. Appendix B contains the full text of the 

Interim Medical Center Director’s comments. 

VA Office of Inspector General 6 
Review of Alleged Mismanagement of Non-VA Fee Care Funds 

at the Phoenix VA Health Care System 

Appendix A Scope and Methodology 

We conducted site visits to the Phoenix HCS and reviewed all 31 claims the 

facility paid to LTAHs between October 1, 2009, and September 30, 2010. 

We reviewed the medical facility’s fee authorization, utilization review, and 

budget processes. In addition, we interviewed the complainant, the HCS 

Interim Director, the Chief of Staff, and clinical and administrative staff. We 

also assessed the results of a financial review performed by 

VISN 18 officials and the preliminary results of an Administrative 

Investigation Board review of the facility, which included issues related to 

the Non-VA Fee Care Program. 

Reliability of 

ComputerProcessed Data 

We used computer-processed data obtained from the Veterans Health 

Information Systems and Technology Architecture to determine fee billing 

and payment information during the period October 1, 2009, through 

September 30, 2010. To test the reliability of this data, we compared 

relevant computer-processed data with hardcopy documents, such as claims 

and medical records. We found no significant discrepancies and concluded 

the billing and payment data was sufficiently reliable for the review 

objective. 

Government 

Inspection and 

Evaluation 

Standards 

We conducted our work from March 2011 through September 2011. Our 

assessment of internal controls focused on those controls relating to our 

review objective. We conducted this review in accordance with the Council 

of Inspectors General on Integrity and Efficiency’s Quality Standards for 

Inspection and Evaluation. We planned and performed the review to obtain 

sufficient, appropriate evidence to provide a reasonable basis for our finding 

and conclusions based on our review objective. We believe that the evidence 

obtained provides a reasonable basis for our finding and conclusions based 

on our review objectives. 

VA Office of Inspector General 7 
Review of Alleged Mismanagement of Non-VA Fee Care Funds 

at the Phoenix VA Health Care System 

Appendix B Phoenix VA Health Care System Interim Director 

Comments 

Department of Memorandum Veterans Affairs 

Date: October 11, 2011 

Interim Medical Center Director, Phoenix VA Health Care System (644/00) From: 

Subj:	 Response to Draft Report: Review of Allegation of Mismanagement on Non-VA Care Funds at 

Phoenix VA Health Care System (Project No. 2011-02280-R8-0151) 

Director, Seattle Audit Operations Division (52SE) To: 

Thru: Director, VA Central Office (10N)
 

VISN 18 Network Director (10N18)
 

1.	 The following response is provided regarding the Office of the Inspector General’s draft report of 

allegations regarding mismanagement of Non-VA Care Funds. 

a.	 Recommendation 1. We recommend that the Interim Director of the Phoenix VA Health Care 

System establish monitoring procedures to ensure that the delegated approving officials preauthorize only fee care requests that are medically necessary or for services that a VA facility 

cannot provide. 

Concur	 Target Completion Date: December 1, 2011 

Action Taken: The Phoenix VA Health Care System (PVAHCS) has substantially changed the 

control environment for the fee care program. Corrective actions have been implemented to 

improve the management of the fee care program. The Phoenix VA HCS has established a 

clinical authorization process to carry out provisions of M-1, Part 1 Chapter 18, Change 3, July 20, 

1995. The Chief of Staff has designated a full-time Utilization Management Physician as well as 

specialty care Service Chiefs as the approving authority for the clinical review of fee consults. A 

utilization review team has been designated for the administrative review of all fee consults. 

Delegation of Authority letters are in place. All fee consults are reviewed based on the guidance 

from the national fee office and Title 38 part 17: emergency request, administrative eligibility, 

consult accuracy, hierarchy of care, justification of service and service connection status. 

Utilization review staff will implement a monitor to review a minimum of 30 fee consults submitted 

each month to ensure that only fee care requests that are medically necessary for services that a 

VA facility cannot provide are pre-authorized. The Phoenix VA Health Care System Office of 

Compliance will perform quarterly audits of this monitor which will be reported to senior 

leadership. 

b.	 Recommendation 2. We recommend that the Interim Director of the Phoenix VA Health Care 

System establish monitoring procedures to ensure that the utilization review team reviews fee 

care requests to determine that requests are medically necessary or for services that a VA facility 

cannot provide. 

VA Office of Inspector General 8 
Review of Alleged Mismanagement of Non-VA Fee Care Funds 

at the Phoenix VA Health Care System 

Concur	 Target Completion Date: December 1, 2011 

Action Taken: The Phoenix VA Health Care System utilization review staff will implement a 

monitor to review a minimum of 30 of fee consults submitted each month to ensure that fee care 

requests are reviewed to determine that requests are medically necessary or for services that a 

VA facility cannot provide. The Phoenix VA Health Care System Office of Compliance will 

perform quarterly audits of this monitor which will be reported to senior leadership. 

c.	 Recommendation 3. We recommend that the Interim Director of the Phoenix VA Health Care 

System establish monitoring procedures to ensure that the concurrent review team ensures that 

hospitalized veterans need continued inpatient fee care. 

Concur	 Target Completion Date: December 1, 2011 

Action Taken: The Phoenix VA Health Care System will establish a process for utilization review 

nurses to conduct continued stay concurrent reviews on 100% of veterans who are hospitalized 

under fee care to evaluate and ensure the clinical necessity of continued inpatient fee care 

utilizing InterQual criteria. Veterans who are identified as no longer meeting the intensity of 

service to justify continued hospitalization and are beyond the point of stability will be placed on a 

variance list. After identifying the variances, the utilization review nurses will notify the 

designated physician advisor or hospitalist on call of each instance to facilitate and expedite 

discharge or transfer of these veterans from inpatient fee care. The utilization review nurses 

identifying the variances will note the status on the authorization. The Phoenix VA Health Care 

System utilization review staff will implement a monitor to review a minimum of 30 fee veterans 

hospitalized under fee care each month to ensure that hospitalized veterans need continued 

inpatient fee care. The Phoenix VA Health Care System Office of Compliance will perform an 

annual audit of this monitor. 

d.	 Recommendation 4. We recommend that the Interim Director of the Phoenix VA Health Care 

System establish monitoring procedures to ensure that fee staff obligate sufficient funds to pay for 

approved fee care. 

Concur	 Target Completion Date: December 1, 2011 

Action Taken: The Phoenix VA Health Care System is establishing a process wherein the 

Manager Fee Basis will ensure all authorized consultations for Fee Basis care is entered into the 

Fee Basis Claims System (FBCS) software and appropriate funds are obligated to each Fee 

Basis Authorization. The Fee Basis staff will utilize the reporting features of the Computerized 

Patient Record System (CPRS) to ensure all approved consults are identified and a matching Fee 

Basis Authorization is created for each authorized episode of care. All new Fee Basis 

Authorizations will record the consultation number. This process will ensure the creation of the 

authorization based on the consultation, the recording of the appropriate estimated obligated 

amount for the services requested, and the ability to track the expenditures of the estimated 

obligated amount. The tracking of these expenditures will allow for increasing/decreasing of 

funds, as required. The Manager Fee Basis will conduct an audit of at least 30 newly created Fee 

Basis Authorization cases on a monthly basis to ensure Fee Basis Authorizations are created and 

funded appropriately. This audit will be accomplished by utilizing the reporting capabilities of 

FBCS and VISTA. The Phoenix VA Health Care System Office of Compliance will perform 

quarterly audits of this monitor which will be reported to senior leadership. 

VA Office of Inspector General 9 
Review of Alleged Mismanagement of Non-VA Fee Care Funds 

at the Phoenix VA Health Care System 

2. Please contact Kathy Sloan, Executive Assistant to the Director, PVAHCS at 602-277-5551, ext 2658, 

if you have any questions 

JAMES L. ROBBINS, M.D. 

Interim Medical Center Director 

SUSAN P. BOWERS 

Network Director, VISN 18 

VA Office of Inspector General 10 
Review of Alleged Mismanagement of Non-VA Fee Care Funds 

at the Phoenix VA Health Care System 

Appendix C OIG Contact and Staff Acknowledgments
 

OIG Contact	 For more information about this report, please 

contact the Office of Inspector General at 

(202) 461-4720. 

Acknowledgments Gary Abe, Director 

Barry Johnson 

VA Office of Inspector General 11 
Review of Alleged Mismanagement of Non-VA Fee Care Funds 

at the Phoenix VA Health Care System 

Appendix D Report Distribution 

VA Distribution 

Office of the Secretary 

Veterans Health Administration 

Office of General Counsel 

Director, VA Southwest Health Care Network (10N18) 

Director, Phoenix VA Health Care System (644/00) 

Non-VA Distribution 

House Committee on Veterans’ Affairs 

House Appropriations Subcommittee on Military Construction, Veterans 

Affairs, and Related Agencies 

House Committee on Oversight and Government Reform 

Senate Committee on Veterans’ Affairs 

Senate Appropriations Subcommittee on Military Construction, Veterans 

Affairs, and Related Agencies 

Senate Committee on Homeland Security and Governmental Affairs 

National Veterans Service Organizations 

Government Accountability Office 

Office of Management and Budget 

This report will be available in the near future on the OIG’s Web site at 

http://www.va.gov/oig/publications/reports-list.asp. This report will remain 

on the OIG Web site for at least 2 fiscal years. 

VA Office of Inspector General 12