Review of VA’s Compliance With the Improper Payments Elimination and Recovery Act for FY 2016
We conducted this review to determine whether VA complied with the Improper Payments Elimination and Recovery Act (IPERA) for FY 2016. VA reported improper payment estimates totaling approximately $5.5 billion in its FY 2016 Agency Financial Report (AFR). As allowed by Office of Management and Budget (OMB) guidance, VA reported improper payment data based on the previous fiscal year activity. VA did not comply with two of six requirements that constitute compliance according to OMB. VA did not:
• Report a gross improper payment rate of less than 10 percent for each program and activity for which an improper payment estimate was published in the FY 2016 AFR. Two VA programs—VA Community Care and Purchased Long Term Services and Support—exceeded 10 percent.
• Meet annual reduction targets for the following six programs—VA Community Care, Purchased Long Term Services and Support, Beneficiary Travel, Civilian Health and Medical Program of the Department of Veterans Affairs, State Home Per Diem Grants, and Supplies and Materials.
VA met four of the six IPERA requirements for FY 2016 by publishing the AFR, performing risk assessments, publishing improper payment estimates, and providing information on corrective action plans. Although VA published improper payment estimates as required, we determined estimates for the Supplies and Materials Program and the Post 9/11 G.I. Bill Program were not reliable because of weaknesses in sample evaluation procedures. We also noted further improvements VA could make in estimating improper payments for two programs and in reducing improper payments for another program that resulted from a program design issue. We recommended the Acting Under Secretary for Health take steps to reduce improper payment rates and achieve reduction targets. We recommended the Acting Under Secretary for Health, the Acting Assistant Secretary for Management and Acting Chief Financial Officer, and the Principal Executive Director, Office of Acquisition, Logistics, and Construction, take steps to improve improper payment estimates. We recommended the Acting Under Secretary for Benefits improve the improper payment estimate for one program and continue to address the issue of prohibited concurrent payments of certain program benefits and military reserve pay. VA management concurred with our recommendations and provided plans for corrective action. We consider the planned actions responsive.
All other inquiries can be directed to vaoig.reportsstaff@va.gov.This service is provided to you at no charge by Veterans Affairs Office of Inspector General (OIG).-------
U.S. Department of Veterans Affairs CMV - Research Update for Monday, 15 May 2017 - U.S. Department of Veterans Affairs in Washington, D.C., United States
Dear Veteran/Supporter,
The Center for Minority Veterans (CMV) is sharing information about recently published research related to minority Veterans on a monthly basis. You can access additional minority Veteran research information on the CMV Research webpage. PubMed.gov is a resource that comprises more than 26 million citations for biomedical literature from MEDLINE, life science journals, and online books. Citations may include links to full-text content from PubMed Central and publisher websites. Please contact your local library to obtain the full-text of any of these references.
Thank you for your service and support,
Barbara Ward
Director, Center for Minority Veterans
Racial Differences in Mental Health Recovery among Veterans with Serious Mental Illness
All MK, Hack SM, Brown CH, Medoff D, Fang L, Klingaman EA, Park SG, Dixon LB, Kreyenbuhl JA. Racial Differences in Mental Health Recovery among Veterans with Serious Mental Illness. J Racial Ethn Health Disparities. 2017 Apr 14. doi: 10.1007/s40615-017-0363-z. [Epub ahead of print] PMID: 28411327
Keep updated & let us know how we're doing.
VA does not endorse and is not responsible for the content of any external web site links. These sites are provided for informational purposes only.
If you are in crisis and need immediate help, please call 1-800-273-8255 and (PRESS 1) or visit http://www.veteranscrisisline.net/.
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Wilmoth's careers in academia, military were dual but never dueling for Monday, 15 May 2017 - Military Health System in Washington, D.C., United States
Wilmoth's careers in academia, military were dual but never duelingPeggy Wilmoth enjoyed a long military career where she reached the rank of major general and deputy surgeon general for the U.S. Army Reserve, the first nurse and woman in this role.
Peggy Wilmoth was a young nurse working with severely disfigured cancer patients when she had an aha moment about a missing aspect of their care. It led to her passion for health policy and a prestigious academic career in psychosexual oncology, or how surgery, chemotherapy, radiation, and immunotherapy impact body image, sexuality, and fertility.
The same Peggy Wilmoth had a master’s degree in nursing and a 4-month-old baby when she fulfilled a childhood dream and joined the Army Reserve. It led to her storied military career where she reached the rank of major general and deputy surgeon general for the U.S. Army Reserve, the first nurse and woman in this role.
Of the more than 135,000 people serving in the Military Health System, Wilmoth stood out by juggling careers in academia and the military for more than 35 years before retiring from the Army May 1.
“If you cut me, I bleed green,” Wilmoth said. “I’ll miss it, but it’s time for me to move aside and let someone else move up.”
Wilmoth grew up in Columbus, Ohio, listening to her neighbor tell stories about serving as an Army nurse in the South Pacific during World War II. Wilmoth’s own family’s military service reaches back to the Revolutionary War.
Wilmoth wanted to join the ROTC program at the University of Maryland, Baltimore, where she earned bachelor’s and master’s degrees. But women weren’t allowed in ROTC when she started her undergraduate program. She joined the Army Reserve in 1981 while a nursing instructor at the University of Delaware.
Wilmoth combined reserve duty in the Army Nurse Corps with academic appointments at Central Missouri State University, University of Kansas, University of North Carolina at Charlotte, and Georgia State University. There, she was dean and professor of the nursing and health professions school. She also has had more than 60 psychosexual oncology academic papers published on topics such as comparing the effects of lumpectomy vs. mastectomy on sexual behaviors; and strategies to help nurses become comfortable with psychosexual assessments of patients. “We’re not providing holistic care if we omit discussions and education about the effects of treatment on this part of life,” Wilmoth said.
Wilmoth’s military accomplishments include being the first woman and first nurse at the general officer rank to command an Army medical brigade, the 332nd in Nashville, Tennessee. With opportunities came challenges, however. They included physicians who weren’t supportive of nurses assuming leadership roles in the military, and women who were wary of other women in uniform achieving success.
“Women need to learn how to support one another, to lead without undermining each other, to be happy when other women succeed,” she said. “These are important aspects of leadership development that we need to talk about more.”
She also thinks it’s important to share lessons from her own career. In late March she told attendees at this year’s Female Physician Leadership Course in Falls Church, Virginia, about being a “happy camper” colonel serving as commander of the 312th Field Hospital in Greensboro, North Carolina. At that point a one-star asked her to be his chief of staff at the 81st Regional Support Group at Fort Jackson, South Carolina.
“It was a non-medical position in a non-medical command,” she recalled. “And my first thought was, why would I want to leave my command early to be his chief of staff? It took him several phone calls to convince me that when someone opens a door for you, you need to walk through it.”
For Wilmoth, the point of the story for attendees of the leadership course was, “Had I said no, the door would have been slammed shut, and I wouldn’t be standing here today.”
The infant of 4 months at the beginning of Wilmoth’s military career is now a staff sergeant in the Army Reserve. Wilmoth also has a younger son who works in the film industry. As for her own plans post-MHS, Wilmoth is exploring options in and out of academia. She won’t leave the military behind for good, though.
“I’m a soldier for life, so I’ll be helping the Army from a different vantage point,” she said. “And hopefully, I’ve done my part to pave the way for those who are coming behind me.”
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Immunization Healthcare Branch nurse practitioner Ann Morse (left) speaks to Sailors about immunizations at a health fair. The Health Fair was part of a long-range plan to improve the overall health and wellness of Sailors.(U.S. Navy photo by Lt. j.g. Mckensey Smith)Immunization Healthcare nurses have all bases coveredFrom the bedside to the battlefield to the classroom and beyond, nurses have always had a prominent role in the history of military medicine.
Nurses of the Defense Health Agency’s Immunization Healthcare Branch (IHB) carry on the nursing mission through education, policy development, adverse event management, research, and training.
“Our primary role is being patient advocates,” said Tara Reavey, a registered nurse and chief of Program and Policy Management for IHB. “No matter where you are, your heart always goes back to the patients and the staffers who are pounding the pavement, and making sure they’re taken care of.”
Since IHB serves a global population, much of its work with health care providers or patients is done through telehealth service or electronically. A nurse or nurse practitioner is on call 24/7 to field clinical questions through the Immunization Healthcare Support Center.
With the Centers for Disease Control and Prevention, the IHB utilizes a Collaborative Adverse Events Reporting System (CAERS) to perform a clinical review of all military-related Vaccine Adverse Event Reports (VAERS) for the assessment of medical interventions, outcomes, and potential for IHB intervention.
“Our goal is to ensure clinicians and patients have access to 24/7 assistance with immunization questions and adverse event management,” said Catherine Skerrett, a nurse practitioner at IHB’s San Antonio Regional Vaccine Safety Hub.
Ann Morse, a nurse practitioner in Portsmouth, Virginia, and part of IHB’s National Capital Region hub, works with the Atlantic Fleet, Military Sealift Command, and Navy Medicine East, among others. She provides training and consultation with a wide range of patients, providers and families mostly through the Immunization Healthcare Support Center and HELP (Health Experts onLine Portal), a telemedicine portal run by Naval Medical Center Portsmouth medical staff and serving all of the Services within NAVMED EAST.
“We love taking care of patients,” Morse said. “We love alleviating concerns and answering questions, no matter who it is.”
Tom Rampy, an RN at IHB’s San Antonio hub who teaches at the Medical Education Training Campus, echoed that notion, saying he owes his students “the knowledge that they can reach back to IHB with any concerns or issues.” Rampy primarily works with the Navy Preventive Medicine Technician Course and teaches a two-day course each quarter centered on the Eight Standards for Military Immunization.
A lot of work is being done to address vaccine hesitancy, said Laurie Housel, a nurse practitioner at IHB's Fort Bragg, North Carolina hub. That includes outreach through events like a new parent support group, outreach lectures, and the development of a toolkit for health care providers to provide counseling to vaccine-hesitant parents before their babies are born.
"There's a lot of misinformation out there,” Housel said, “and it can be very difficult for families because they hear conflicting things. We understand that."
Suzy Walker, an RN and Immunization Healthcare Specialist, IHB’s “boots on the ground” providing direct support to MTFs, works with the Navy accession site at Great Lakes, Illinois, and Soldier Readiness Programs at Fort Leonard Wood, Missouri, where she provides immunization training and consultation, and assistance with procuring sometimes large amounts of vaccines. Walker spent 27 of her 30 years in the Air National Guard working around immunizations, which she says gives her a kinship with the providers in the clinics she visits.
“You can’t tell me anything that would shock me,” Walker said. “Having seen so much in my career helps me relate better to the people going through it now. It feels great seeing when everything clicks and everyone understands the full scope of what they’re doing.”
The research component of nursing also plays a big part in the IHB mission, as "better understanding leads to better outcomes," said Connie Lohsl, RN with IHB's Vaccine Safety and Evaluation Section. That includes clinical and epidemiologic studies to improve safety, effectiveness, and acceptability of vaccines.
Among the research projects currently ongoing is looking at whether physical exercise is more effective at relieving post-immunization injection-site pain than ibuprofen, and testing to help identify sensitivities to vaccine components.
IHB nurses and nurse practitioners also help conduct in person Standards for Quality Immunization Practice and Immunization Program Leaders courses. The courses, developed by RN Dana Donaldson and the IHB Curriculum and Content Development Office, are geared toward health care providers directly involved in immunization activities, to provide the best experience possible to each patient.
“When you’re educating health care professionals, you’re still giving back to those patients,” said Donaldson, who put herself through nursing school as the single parent of two young children. “If you always err on the side of patient safety – imagine the person you’re caring for is the person you love most in the world – you will always succeed no matter what.”
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