The Department of Veterans Affairs warned its health clinics as early as 2010 to stop manipulating scheduling records to hide treatment delays, but the practice continued for years, according to whistleblowers.

A top VA health official issued a memo to the department’s health clinics four years ago listing 17 inappropriate schemes the department had documented at its medical centers. He noted that the techniques were used “to improve scores on assorted access measures.”

Members of Congress on both sides of the aisle are now calling for Veterans Affairs Secretary Eric Shinseki's resignation. PostTV explains the timeline of the VA health-care scandal. (Pamela Kirkland/The Washington Post)


The official cautioned the VA clinics that “these practices will not be tolerated,” but they continued to use them at least until 2013. An email from that year, first reported by CBS News, shows that a top nurse at a Cheyenne, Wyo. health clinic instructed employees on methods for “gaming the system.”

Below is an explanation of five cover-up techniques that stand out in the 2010 VA memo. The rest you’ll have to read for yourselves in the document.

* Unofficial log books: Schedulers used these instead of the department’s electronic database to avoid documenting appointment delays that exceeded the department’s goals. Whistleblowers allege that a Phoenix VA clinic used a “secret waiting list,” which may refer to this scheme.

* Rebooking: Schedulers would go back into the scheduling system and change falsified appointment-request dates to give the impression that patients always saw their doctors within 14 to 30 days of asking for appointments, regardless of when they actually called about openings. This appears to be the technique used at the Cheyenne clinic.

* You were supposed to show up early: Clinics would cancel appointments if patients failed to show up 15 minutes early or if they did not respond to reminders. The memo said this scheme inappropriately eliminates the patient from the Missed Opportunity measure and is misleading to patients who will show up for their appointments.”

* Faking patient cancellations: Schedulers would book patients for visits within the 30-day window but then rebook the appointment for another date. They would enter “cancelled by patient” instead of “canceled by clinic” to give the impression that the patient had caused the extended delay.

* Call again later: Patients were told to call back in a month if appointments were not available within 30 days. VA policy requires schedulers to book the earliest appointment available if the patients can accept it, regardless of whether the wait would exceed the department’s goals.

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The House Veterans' Affairs Committee on Thursday voted to subpoena top VA officials to testify on May 30 after a tense discussion of the issues facing the department. (Sarah Parnass/The Washington Post)