2 Investigates: Veterans, health care providers outline problems with VA program for outside providers

ATLANTA — Veterans and health care providers are sounding off on a VA program designed to connect veterans with outside health care providers, complaining the authorization and payment process has led to veterans missing out on critical care. The Atlanta Veterans Administration Medical Center is now pointing to new leadership and plans to mitigate the issues that are also outlined in recent federal reports.

Valerie Rachel owns and operates Simplicity Healthcare in Riverdale. The home health care service is responsible for the in-home care of dozens of veterans, including a 91-year-old whose family recently moved him from metro Atlanta to Chicago.

That’s because he’d gone months without services. Rachel said it was tied to expired authorizations she couldn’t clear through the VA’s Community Care program. In other words, benefits the veterans are due are not being processed, causing lapses in services.

“(At) any moment, it can happen,” Rachel told Channel 2 investigative reporter Nicole Carr. " At any moment, because each month, we have to send them a list of our veterans that are … their authorizations are going to expire.”

The VA’s Community Care program gives veterans across the nation, including thousands here in Georgia, a way to connect with licensed health care providers outside of the VA system for both clinical and in-home care. The payment for those providers comes directly through the VA by way of a new private payment vendor: Optum. Optum is a part of United Healthcare Group.

But since the transition to Optum’s electronic processing system last fall, Rachel said she’s unable to track authorizations the way she did prior to September. Rachel said the VA has continually allowed veteran authorizations to expire in recent months, citing administrative and technical delays through Optum’s online system.

It has become a race against the clock to provide care to veterans before their benefits expire. No authorization, which is also needed for government audits, means no payment and no way for Rachel to send her nursing staff into the veterans’ homes. Veterans like the 91-year-old client whose family just relocated him.

Delays have caused breaks in service for up to half a dozen veterans at one time or for Simplicity to render services without payment. All this happens while Rachel said she continues to get the runaround from the Atlanta VAMC.

“We was brought up in that generation where you don’t stop until you get what you need,” Rachel said when asked why she continues to work through the program. “Yes, it is tiring. And it’s hurtful. It is very hurtful emotionally; it’s breaking me down. But I have to keep going.”

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Donna Bell is one of the veterans who described problems linked to the Community Care program with Carr. Bell, an Air Force veteran, has been fighting the system for the past six months to raise awareness about her own mental health clinician.

“He’s not been paid since September 2020,” Bell said. “And that’s that.”

Bell said she is grateful for her Tucker-based doctor because he has not discontinued her care. She said he’s connected to her through the Community Care program but, like Rachel, has struggled to process authorizations for Bell’s care since the VA transitioned to Optum.

“He has continued to give me treatment because he knows I need it. But it’s just a difficult process for any physician or therapist to go through because they’re not versed in this (new authorization process),” Bell said.

Rachel said nothing appears clear through the system, as it did prior to the transition.

“If it (authorization) is in a pending status, if it was denied ... if it was denied, why it was denied ... those systems are no longer in place,” Rachel said.

“So you can’t see anything?” Carr asked of the electronic portal.

“We can’t see anything,” Rachel said. “We can’t see anything. So it’s a combination, the new system and just leadership is not familiar (with it).”

“I think it’s a lack of training with the new system that was put in place in September, along with new management and leadership, the changes and with the new system,” Rachel added. “No one has had a chance to adapt or learn.”

In its latest statement to Channel 2, the Atlanta VA Medical Center acknowledged challenges with the Community Care program, particularly as it relates to the veteran authorization processing. In a statement, the VAMC stated new leadership is mitigating the problems but did not specify how. It also indicated Bell’s doctor’s issue may be outside of its control.

“The Atlanta VA Health Care System has taken actions to improve community care including installing a new community care leadership team in October of 2020. One of the initiatives of the new leadership team has been a collaborative effort with community health nursing to develop an improved process for tracking home health referrals to ensure no authorizations inadvertently expire,” the statement read.

“Outside of emergencies, Veterans must have an authorization before receiving care from a community provider. Care can only be authorized with providers who are credentialed in the Community Care Network, which in our region is Optum (part of UnitedHealth Group). Unfortunately, VA is unable to pay for non-emergency care that was not pre-authorized. Information for community providers who wish to join the Community Care Network of Providers can visit the website https://provider.vacommunitycare.com or call 888-901-6613 for more information.”

The Atlanta VAMC also moved to immediately address issues tied to veterans whose names were provided by Channel 2.

Recent problems with community care

The problems veterans like Bell and providers like Rachel describe are well-known to the Government Accountability Office. By the time Rachel had filed a complaint with Congressman David Scott’s office late last year, the GAO released a study on worsening delays in its Community Care program, tying them to the VA appointment system and surging request for care during the pandemic and the Optum transition.

In another Channel 2 investigation last fall, whistleblowers from the Atlanta VAMC shared documentation showing more than 5,000 referrals that were outstanding for more than 30 days, and hundreds more that had been sitting for months.

Those whistleblowers suspected the delays were tied to Optum’s new system and a lack of training with the private vendor for the Atlanta VAMC’s community care workers.

“In order for it to be fixed, it starts from the top,” one whistleblower said, wishing to remain anonymous.

In response to that report, the VA stated it’d revamped leadership and increased staffing. At the same time, it points to providers’ “fundamental misunderstanding of how the medical appointment scheduling and referral process works. Preventive care is routinely and appropriately scheduled three to six months – or even longer – in advance.”

“They are therapists and doctors. They’re not computer programmers,” said Bell. “They don’t know how to manipulate the system or, and they don’t get any guidance.”