Internal VA documents show the depth of fraudulent scheduling, manipulation of data and in some cases intimidation of staff to hide delays in medical care to veterans in the 6-million patient national system.
Auditors found at least one appointment scheduler at 109 VA medical centers who said wait times for veterans had been falsified, according to a USA TODAY analysis of internal VA survey data made public Tuesday. To keep evidence of delayed care out of the VA's official electronic tracking system, secret lists were maintained at 110 facilities, the analysis shows.
Workers at the Department of Veterans Affairs outpatient clinic in Wilmington, N.C., told auditors they "were fearful of retaliation" if they did not manipulate appointment data.
At the Edward Hines Jr. VA hospital in Hines, Ill., near Chicago, "staff felt they would be subject to disciplinary action" if appointment records were not changed, one report shows.
Managers instructed or "encouraged" schedulers to falsify appointment data at such VA medical facilities as those in Leeds, Mass.; Jacksonville, N.C.; Virginia Beach and Cleveland, according to the documents.
The audit by the VA's Veterans Health Administration was ordered earlier this year by then-VA Secretary Eric Shinseki. The results were provided to President Obama on May 30, the day Shinseki resigned.
The Senate on Tuesday confirmed Obama's nomination of former Procter & Gamble CEO Robert McDonald as Shinseki's successor. McDonald, 61, of Cincinnati, was approved on a 97-0 vote to replace Acting VA Secretary Sloan Gibson, who took over after Shinseki resigned.
Auditors interviewed more than 3,200 employees at more than 700 clinics and hospitals to gather their findings.
A broader investigation underway by the VA Inspector General and the Justice Department is scheduled to be completed next month. Gibson has testified in Congress that "several supervisors" are being investigated in connection with potential criminal charges.
The VA issued a statement late Tuesday saying it is seeking disciplinary action against six employees working at a hospital in Cheyenne, Wyo., and at an outpatient clinic in Fort Collins, Colo., for manipulating appointment data.
One of the six is a regional director; others include the director of the Cheyenne hospital and the chief of staff there. The VA said it is seeking to have two of the six fired. The agency said it found evidence that supervisors personally manipulated data, instructed subordinates to do so and withheld accurate information from higher officials.
Internal investigations found that clinic or hospital chiefs may have manipulated appointment data in order to look better on performance evaluations upon which their bonuses were based.
"As these new details make painfully obvious ...some VA executives are so driven in their quest for performance bonuses, promotions and power that they are willing to lie, cheat and put the health of the veterans they were hired to serve at risk," said Rep. Jeff Miller, R-Fla., chairman of the House Committee on Veterans' Affairs.
The internal audit made public Tuesday shows that schedulers who said they did not manipulate data worked at medical centers that reported the longest wait times, according to official VA data.
On the other hand, high rates of data manipulation were found at medical centers that had officially reported some of the best wait-time records.
Schedulers at VA medical centers in Montgomery, Ala., Clarksburg, W.Va., and White City, Ore., said they were instructed how to falsify appointment data.
Investigating auditors complained that during an interview with a scheduler at a VA hospital in Hudson Valley, N.Y., someone in the room was coaching the employee on how to answer the auditor's questions.
One auditor visiting an VA outpatient clinic in Horsham, Pa., near Philadelphia, wrote: "staff were encouraged to inaccurately enter ... (dates) in an attempt to game the system."
About a VA clinic in Rochester, Minn., another auditor wrote: "staff encouraged and felt pressure to manipulate... (appointment data) in order to meet performance measure."
Secret lists of veterans whose care was delayed were kept by VA hospitals or clinics in places such as Richmond, Va., Washington, D.C., and Lebanon, Pa. who they could not provide medical.
Republican and Democratic leaders of Congress have reached an agreement that will provide $10 billion in emergency funding to the VA to allow veterans to seek private care rather than face long wait times at Veterans Affairs medical facilities.
Contributing: Cogan Schneier, Rachel Chason, Allison Wrabel, Paul Overberg, Jodi Upton and Mark Hannan