A House panel on Monday heard testimony about the Department of Veterans Affairs’ scheduling scandal, hours after the VA released the troubling results of an audit showing the depth of the problems.

The hearing, held by the House Veterans Affairs Committee, focused largely on a string of official watchdog reports that warned of the VA’s inappropriate scheduling practices long before they grew into a national scandal.

Witnesses included representatives from the VA inspector general’s office, the VA itself and the Government Accountability Office, Congress’s nonpartisan investigative arm. Below are five issues that cropped up repeatedly during the hearing:

Assistant Deputy Veterans Affairs Undersecretary for Health for Administrative Operations Philip Matkovsky, Acting VA Inspector General Richard Griffin and Assistant VA Inspector General for Audits and Evaluations Linda Halliday testified Monday. (Chip Somodevilla/Getty Images).

VA leadership problems

According to Monday’s report, 13 percent of VA schedulers said they were instructed to falsify request dates to make wait times appear shorter, and employees at 24 sites reported that they felt “threatened or coerced” to enter incorrect information into the scheduling system.

VA health official Philip Matkovsky acknowledged that management problems contributed to the VA’s cover-up culture. “We know there is an integrity issue here among some of our leaders,” he said. “We can and will address this issue.”

Acting VA Inspector General Richard Griffin said the VA needs to hold its senior leaders accountable in order to finally stop the scheduling manipulation.

“Once someone loses his job or gets criminally charged for doing this, it will no longer be a game, and that will be the shot heard around the system,” he said.

Criminal investigations

Some lawmakers have called for an investigation to determine whether the scheduling scandal involved fraud. Griffin said his office is looking for evidence of criminal violations and coordinating with the Justice Department “when sufficient credible evidence is identified.”

Griffin said falsifying records for financial gain could constitute fraud, and he suggested that talking to front-line schedulers could help root out who ordered such actions.

“I suspect if people do start getting charged, maybe that middle-level person will say, ‘Wait a minute, I’m not going to take a fall here for somebody higher up the food chain than me who directed that we do this,” he said. 

Whistleblower protections

The Office of Special Counsel, a federal prosecutorial and investigative agency the protects government employees from retaliation, said last week that it is investigating allegations of retaliation against 37 VA whistleblowers, including some who tried to report actions related to the agency’s recent scheduling scandal.

Matkovsky said the VA must not tolerate reprisals against whistleblowers.

“We need our staff at all levels, but most importantly at the point of care,” he said. “We need them to tell us how to improve our system to be able to deliver care better for veterans, and they just feel safe to identify problems, and they must feel empowered to find solutions.”

IT problems

The VA has complained about archaic scheduling technology for years, and the department did so again on Monday. Matkovsky said the department’s appointment bookers are working with “completely outdated technology.”

Rep. Jeff Miller (R-Fla.), who chairs the committee, rattled off a long list of projects Congress has already funded in recent years to update the VA’s scheduling system. He said the allocations amounted to at least $2.4 billion.

“”Why are we still using outdated scheduling software and programs?” Miller asked.

Griffin said the funding from Congress has yielded poor results. “A lot of money has been wasted — millions of dollars have been wasted on contractors trying to create a better system for capturing this data, and over the past 15 years going back to 2000, it hasn’t had any success.”

Matkovsky acknowledged that leadership and culture problems contributed to the scheduling problems more than technology issues. “We have found in some of our networks where staff are using the same outmoded technology as other staff, using the same policy, they can schedule with integrity,” he said.

Private care is not a perfect solution

The VA plans to expand its use of non-VA health clinics to help meet the demand for care. But GAO health care director Debra Draper said new challenges can arise with that option, explaining that veterans have died before receiving care through a non-VA providers.

Draper said one patient was diagnosed with two aneurysms in September 2013 and died in February 2014 without a needed surgical procedure after a non-VA clinic lost the veteran’s information and it had to be resubmitted.

“While non-VA care may expand capacity, there are also some potential pitfalls,” Draper said. She added that the need for prior approvals can delay treatment and that the VA does not track wait times for non-VA care.

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