The VA Loma Linda Healthcare System mismanaged more than $1 million in patient transportation funding over a three-year period by colluding with ambulance companies through informal “handshake” agreements and unauthorized contracts, according to a confidential federal report.
The blistering fact-finding report, issued in October 2022 and recently obtained by the Southern California News Group, implicates employees who arranged for ambulances, wheelchair vans, air ambulances and other specialized modes of transportation for patients in the VA Loma Linda system.
Investigators said employees assigned to the Veterans Transportation Services and the Transfer Center circumvented the government’s official procurement protocols, possibly for personal gain. Evidence indicates they purportedly approved vendor invoices without review, processed unauthorized payments and entered into improper agreements.
Testimony and documents “clearly support the existence of inappropriate relationships between VA staff in the past and currently with irresponsible billing/payment oversight, inappropriate information sharing, potential kick-backs to VA employees from vendors, illegal contractual relationships, and potential disallowed staff/vendor relationships,” states the report, which covered a period from October 2019 to May 2022.
One key manager, in fact, told investigators he needed training because he didn’t know what he was doing in his job.
The three-member fact-finding team from the Veterans Administration spent 35 days reviewing evidence from employees in VA Loma Linda’s Beneficiary Travel Department and examining 33 exhibits containing more than 300 pages of documents, all of which were acquired by SCNG.
Among deficiencies uncovered by the fact-finders is a March 30, 2021, policy signed by VA Loma Linda Medical Director Karandeep Sraon granting authority to Transfer Center staff to approve inter-facility care transportation.
The policy violates a VA directive making the mobility manager responsible for all beneficiary travel programs at medical facilities. “Transfer Center staff has been operating outside of VA policy” by disregarding budgetary considerations, patient eligibility and mobility management requirements, the report says.
Sraon did not respond to a request for comment.
The fact-finders recommended that their investigation be turned over to the VA’s Office of Inspector of General, which is charged with investigating and auditing waste, fraud and abuse.
The OIG declined to comment, saying it does not discuss pending or ongoing investigations, while the VA said it would cooperate with a probe.
“Whenever there are allegations of wrongdoing at VA, we thoroughly investigate and address those allegations to ensure that we are creating a safe, welcoming, and caring environment for Veterans and VA employees alike,” said VA press secretary Terrence Hayes. “That’s the standard to which we hold ourselves accountable, and we will never settle for anything less.”
Employees pressured
VA Loma Linda employees say they pushed back on executive staff pressure to sign a $1 million “ratification,” which would signal their approval for the unauthorized ambulance payments. “We are the ones that reported the waste, fraud, and abuse and they want us to get in trouble for it,” said one worker, who asked not to be identified because they fear retaliation
“It’s not right,” said another employee who also requested anonymity. “It’s a disservice to veterans and taxpayers. The money that is saved (from unauthorized payments) could go back to the VA for the treatment of veterans.”
The unauthorized payments first came to light In April 2022, when an employee notified VA Loma Linda Associate Director Deesha Brown of irregularities in the transportation program and raised concern that requirements were being bypassed to reduce bed occupancy and improve wait-time metrics at the Jerry L. Pettis Memorial Veterans Hospital.
Brown, who convened the fact-finding team and is currently on assignment with VA’s Desert Pacific Healthcare Network in Long Beach, declined to comment because the investigation has been referred to OIG’s Criminal Division.
Unauthorized payments identified
When transportation expenses jumped from $400,000 in August 2022 to $600,000 a month later, additional funding was requested, according to the fact-finding report.
Louis Garcia, who at the time was the mobility manager, was questioned by a VA Loma Linda official about a series of funding increases. He responded that the Fiscal Department typically provided funding as needed whenever it was requested.
Garcia, now a patient advocate at VA Loma Linda, was unable to provide the official with audits for ambulance service invoices, saying no one had been doing that, the report says. Additionally, he pretended he didn’t know what he was doing and said he needed training.
An invoice review identified 21 ambulance companies that provided services to VA Loma Linda, with Stockton-based Journey Transport receiving most of the fee-for-service trips, according to the fact-finders.
It was determined that Journey — which has a contract to transport wheelchair-bound patients — submitted unitemized invoices as well as those with extra charges outside of its contract parameters. Garcia, the report states, dutifully paid Journey $170,000 to $180,000 every two weeks without reviewing the invoices for compliance or patient eligibility.
Journey’s contract calls for it to transport patients within a 20-mile radius of the Jerry L. Pettis Memorial Veterans Hospital, while VA Loma Linda ambulances are responsible for patients outside of that area.
In one instance, Garcia established an unauthorized agreement with Journey to pick up two dialysis patients who could call the ambulance company as needed, resulting in $129,755 in overpayments from VA Loma Linda, which should have been responsible for the transportation, according to the report.
The fact-finders also obtained a $159,973 invoice from Journey for monthly transports in October 2022 that belonged to the Sacramento Veterans Affairs Medical Center, but was billed to VA Loma Linda and paid by Garcia without review.
According to the report, Journey billed VA Loma Linda $1.1 million over four months, while only $500,565 in charges were identified as payable. Additionally, Journey failed to submit reports of driver discipline, training and ambulance accidents to VA Loma Linda’s mobility manager as required, the fact-finder said.
Garcia and Journey officials did not respond to repeated requests for comment.
The “inappropriate relationship” may have benefited Garcia and provided Journey with “insider information,” the report states without elaboration. An employee reported to fact-finders that Garcia, who in 2022 received an $81,000 salary, showed off photos of his expensive cars, including a BMW, Mercedes and two Chevy Impalas.
Meanwhile, the Transfer Center, without approval from VA Loma Linda’s mobility management staff, initiated payments to ambulance companies totaling $250,000 to $300,000 per month, the fact-finders said. A subsequent audit revealed that of 68 payments from October 2021 to April 2022, only nine met eligibility, authorization and emergency care requirements, according to the report.
The fact-finders also found that VA Loma Linda patients contacted ambulance companies directly to schedule rides with the “knowledge and support” of Transfer Center staff. When Transfer Center employees were informed that was not allowed and had to be discontinued, they responded with hostility because it eliminated an “easy fix” for quick scheduling, the report states.
“Unethical behavior” rampant
The report states that “unethical behavior” is not limited to Transfer Center staff, noting that employees in various VA Loma Linda departments have increasingly complained about the Mobility Management Department for attempting to enforce patient transportation rules.
Fact-finders noted VA Loma Linda Flow Management Chief Mike Reynaga also established unauthorized agreements with several companies, including Symbiosis, Cavalry Ambulance, Premier Ambulance and American Medical Response.
“Symbiosis has worked with the VA Loma Linda’s Veterans Transportation System since 2012, and in all that time, we have always followed the VA’s directions on billing, provided consistently outstanding and reliable service, and we have not raised our rates,” said Chief Operating Officer Jared Horricks.
Cavalry Ambulance denied any wrongdoing. American Medical Response said in an email it doesn’t have an agreement with VA Loma Linda and has provided only a handful of transports. Premier Ambulance did not respond to requests for comment.
Throughout 2022 and as recently as July, ambulance companies sent a barrage of emails and texts to VA Loma Linda pleading for payment of outstanding invoices, but the mobility management staff refused to budge, contending that many of the charges were unapproved.
“I looked up today how many payments have been made since I saw you guys three weeks ago and it’s only $14,000,” Calvary Ambulance Vice President Debbie Ruiz said in a text to a VA Loma Linda employee. “We normally get $250,000 worth of payments a month so now I am getting super, super concerned.”
Dawn Downs, chief nursing officer for Symbiosis, said in a March 14, 2023, email to Brown that VA Loma Linda’s denial of many of the company’s invoices was inexplicable.
“Our services have been timely paid for by the Loma Linda VA since 2011, so it’s hardly a handshake deal,” Downs wrote. “How can Loma Linda VA personnel request a transport for a veteran and then deny payment? This seems blatantly unfair and wrong.”
Ruiz defended Calvary Ambulance, saying the company had provided service for VA Loma Linda for more than 20 years on an as-needed basis. “It was their own practice to not contract with ambulance providers,” she said. “We did ask for an agreement for service in writing to document our services at the VA for our National Accreditation process.”
Growing problem
Darin Selnick, a senior adviser to Virginia-based Concerned Veterans for America, said “handshake” agreements and unauthorized contracts are a growing problem.
“Part of the problem is the culture due to employees not being held accountable,” he said. “This is not just a one-off by one VA medical center, but a substantial growing issue across the Veterans Health Administration hospital system. At VA, especially with a lot of management, if you go along then you are rewarded; if you object or are a whistleblower, then you are punished and get fired.
“Congress needs to hold VA senior management accountable, and VA senior management needs to hold employees accountable.”
The VA improperly spent or lost about $3.5 billion in fiscal 2022 across seven programs it is mandated to track, according to an OIG report released in June. Of that amount, about $1.4 billion is a monetary loss and the remaining $2.1 billion is considered either a nonmonetary loss that cannot be recovered or an unknown payment, the OIG said.
Whistleblower investigation ongoing
Revelations of the fact-finding investigation come as the House Committee on Veterans’ Affairs continues to investigate widespread whistleblower complaints alleging retaliation, harassment and a toxic work environment at VA Loma Linda.
The catalyst for the probe is a VA Loma Linda employee identified by sources as grounds department supervisor Martin Robles, found to have frequently used racial slurs, required workers to buy him food and drive him to and from work, and then punished those who refused his demands with bad assignments, according to a 2021 federal investigation that recommended he be fired.
However, instead of being terminated, Robles was inexplicably promoted and remains employed at VA Loma Linda. He also was the focus of two other VA Loma Linda investigations in 2020 and 2022 that substantiated allegations he fostered a hostile work environment. Details of those investigations have not been released.
House Committee on Veterans’ Affairs Chairman Rep. Mike Bost, R-Illinois, and Rep. Jay Obernolte, R-Hesperia, are sponsoring a bill to restore the VA’s ability to quickly fire problematic employees. They also have demanded that the federal government turn over unredacted copies of all investigations conducted this year involving high-ranking VA Loma Linda officials.
“It appears that failures in senior leadership are directly impacting the delivery of care and services to our veterans,” said a statement from Bost, who met with VA Loma Linda whistleblowers last month. “Anyone with a shred of judgment would agree that’s wrong.”
