Local Veterans Affairs employees were told to falsify appointment dates to "game" the system, a VA audit has found, raising fresh questions about officials' denials that staffers schemed to hide delays in responding to veterans.
At the Philadelphia Veterans Affairs Medical Center, nearly a third of schedulers interviewed by auditors this spring said they had been instructed not to enter the actual appointment dates veterans had requested, but instead log different dates.
Similar manipulations were encouraged at the clinic in Horsham, auditors found. They called it an attempt to skirt the system.
The disclosures outraged members of Congress, leading some to call for firings or criminal charges.
"I'm hopping mad," said Rep. Patrick Meehan (R., Pa.). "Because I sat directly across from the director at both Horsham and at the Philadelphia hospital and specifically asked about this issue, and they lied to my face."
The auditors' findings, released to legislators, answer the long-standing question of why 112 VA facilities nationwide, including the University City hospital and the Horsham clinic, were flagged last month for added scrutiny.
Jennifer Askey, a Philadelphia VA spokeswoman, said Wednesday the facility continues to "act with integrity and reaffirm our values." She declined to elaborate until the review is completed.
Askey has previously said auditors' concerns might have stemmed from incorrect bookkeeping at the clinic, which serves about 10,000 veterans, and the hospital, the regional hub for more than 57,000 veterans from Southeastern Pennsylvania and South Jersey.
The findings appear to compound the problems facing the city's VA system, now assailed on both the health and benefits sides. The VA benefits facility in Germantown is under review after investigators found staff there had changed dates on old claims from veterans or their family members, making them appear new.
The VA ordered an audit of its health system in April after reports surfaced that schedulers - unable to meet tight deadlines for appointments - were keeping secret wait lists or entering desired dates other than the ones requested by veterans, a practice that makes the delay appear shorter.
The review found rampant manipulation by employees, but site-specific details only emerged this week.
In Danville, Ill., for instance, schedulers said they feared retaliation if they didn't follow supervisors' instructions to change dates. In Kenosha, Wis., new patient requests were tracked in a spreadsheet separate from the VA's records system, according to the auditors. And in Harlingen, Texas, staffers told veterans whom they could not quickly accommodate to call back after several days.
In Philadelphia, more than three-quarters of the staff interviewed on May 12 said the electronic waiting list was not used correctly, the report said. Half also said their work was never checked by a supervisor, according to the audit.
At first, no schedulers acknowledged keeping alternative waiting lists. But when asked a second time, some - about 6 percent - conceded that they had.
Similar site-specific data was not provided for Horsham, which auditors visited May 16. The audit team wrote that staff there "were encouraged to inaccurately enter ... [the desired dates] in an attempt to game [the] system."
Staff at each of the 10 hospitals in the same VA service network as Philadelphia reported tracking appointments somewhere other than the official list, including 16 percent of schedulers in Wilmington; 10 percent in Coatesville; 32 percent in Pittsburgh; and 12 percent in Lebanon, Pa.
Spokespersons in Coatesville and Pittsburgh said their own reviews found no unofficial waiting lists.
The VA has urged caution in interpreting the findings, as the agency deployed 400 staffers to complete the nationwide interviews over five days.
The initial report, though, was enough to spur an FBI investigation into whether administrators orchestrated the data manipulation to inflate performance numbers, which were tied to bonuses.
On Tuesday, the VA moved to fire six employees, including the directors, at sites in Cheyenne, Wyo., and Fort Collins, Colo.
Meehan on Wednesday said he was considering filing a complaint with the VA's central office about Philadelphia VA director Daniel Hendee, who he said lied to him during several meetings.
In June, Meehan met with Hendee and other VA officials in Horsham, then stood before a crowd of cameras and veterans and said the concerns seemed to be a misunderstanding.
On Wednesday, he said the VA crisis cannot be solved without honest leadership.
"I do believe that there is a need for complete accountability," he said. "And compete accountability should very well include somebody losing their position over this kind of misrepresentation."
Rep. Robert Brady (D., Pa.) said the local findings seemed "to be the worst kind of criminal behavior, and the perpetrators should be punished to the full extent of the law."
Rep. Mike Fitzpatrick (R., Pa.) called it "troubling" that concerns uncovered months ago in other VA facilities have been found to be "commonplace in the backyard" of his district.
Sen. Robert P. Casey (D., Pa.) said he recently met with newly appointed VA Secretary Robert McDonald and pressed for action to address concerns in Philadelphia and statewide.
On Wednesday, the House approved a $17 billion spending bill to help the VA hire more doctors and lease space for 27 new medical facilities, an attempt to address the underlying shortages that officials say led to the crisis.
The bill also would allow veterans who have to wait more than 30 days for an appointment or who live more than 40 miles from a VA facility to receive care from a non-VA provider.
The VA Office of Inspector General is conducting the investigation into the 112 sites flagged in the VA audit and has not provided details or said when it will be complete.