Transcripts For CSPAN3 Hearing On Veterans Health Care Services Outside VA System 20240622

Shameful. Thank you, dr. Head. Let me just say also that the retaliation isnt limited to employees of the v. A. But also patients who step forward. And in colorado we had a case last year where a patient gave a statement to an Investigative Reporter and called the v. A. And talked to the Public Affairs individual for that particular visit and the Public Affairs person said you dont want to talk to this person. He is a patient undergoing psychiatric care. I sent a letter to the secretary of Veterans Affairs and never gotten a response to this date. Our thanks to the witnesses. You are now excused. Today we have had a chance to hear about problems that exist within the department of Veterans Affairs. With regards to whistleblower retaliation. With the testimony provided and the questions asked today i am dismayed at the failure of the department to adequately protect conscientious employees who seek to improve Services Provided to our veterans. As such this hearing was necessary to accomplish, number one, to allow v. A. Highlight what efforts its made to improve whistleblower protection practices and processes. And two, address improvements that have not been made, or where insufficient attempts give way to continued retaliation experienced by whistleblower and three assess next steps taken by both the v. A. And by this committee to ensure that those employees who seek to correct problems within the department are adequately protected. I ask unanimous consent that all members have five days to extend remarks and include extraainus material. Without objection, so ordered. I would like to once again thank all of our witnesses and audience members for joining us at todays hearings. With that, this hearing is adjourned. An aarp report said half of retirees must work or want to continue to work into their retirement. Coming up at 4 30 on cspan, there is a hearing for a need for Older Workers an lgts way employers are taking to improve that. And also more coming up at 5 45 p. M. Today. We hear are from visitic leaders every other weekend on cspan and cspan 3. And with congress on the summer recess the cities tour is on cspan each day at 6 00 p. M. Eastern. More on colorado springs, colorado, with a look at the citys literary life. Now a hearing on the procurement of nonv. A. Health Care Services for former soldiers who usually receive medical care from the department of veteran affairs including Specialty Services that v. A. Patients may rarely use. V. A. Executives for external care of federal over sight official and an army veteran that experienced trouble with contracted care testify before a house committee. Good afternoon. This hearing will come to order. I want to welcome everybody to todays hearing titled circumvention of contracts in the provision of nonv. A. Health care. This hearing is the second in a series of hearings examining illegal v. A. Procurement practices resulting in massive waste of limited taxpayer resources and serious jeopardy to the quality of healthcare received by our nations veterans. In previous hearings on may 14th, 2015, we focused on the mismanagement and misuse of purchase cards and voidance of contract requirements and spending limitations and warrant authority. V. A. Senior procurement executive mr. Jan frye testified these unauthorized commitments were the billions of dollars. Mr. Frye has indicated similar levels of mismanagement and abuse in the procurement of nonv. A. Health Care Services by vha. By far, the most prevalent method by which veterans receive nonv. A. Care is through the individual authorization, socalled fee basis process. Under title 38 of the code of federal regulations, section 17. 52, v. A. Is authorized to obtain nonv. A. Medical services when demand is infrequent and the needed health care is not available inhouse or through an existing contract. Unfortunately, v. A. Uses this process even when the requirements are not at issue. Moreover, v. A. Admits that the execution of these authorizations does not comply with the contract requirements of the federal Acquisition Regulation or f. A. R. Veterans federal acquisition far. The f. A. R. And the v. A. R. In the fee base authorization process the v. A. Has illegally obligated billions of dollars. He will explain that v. A. Incurred billions in improper payments, that represent material weaknesses in v. A. Internal audit controls. Significantly in 2009 and 2010 the oig reports on Serious Problems with the accuracy and efficiency of claims paid through the fee base program. They reported that the v. A. Medical centers made hundreds of Million Dollars of improper payments, including duplicate payments and incorrect amounts. Most troubling is that vha has not established prevention or detection controls because it didnt consider the program to be at significant risk. Oig estimated that v. A. Could be paying as much as 380 million annually for fraudulent claims and in may 2014, contrary to the v. A. Assertion that previous illegal purchases can be ratified. Oig reported that v. A. Further violated the law by institutionally ratifying illegal purchases and avoiding important checks and balances. Today gao director of health care Randall Williamson will testify about the continuing limitations and oversight of Health Care Service contracts and will focus particularly on the inadequate management of clinitians who provoid Service Provide services under contract with v. A. Facilities. Well also hear from the veteran Christopher Labonte whose horrific experience with v. A. Represents a case study in the risk associated with noncompetitive contracts, with affiliates and the importance of Quality Control and oversight of contract performance standards. As i said in the purchase card hearing, violations of procurement laws are not mere technicalities. It is not just a matter of paying a little more for needed supplies and services as some apologize for v. A. Have asserted. Among other things, without competition, businesses may be awarded based on business may be awarded based on cronyism and the director of business to favored vendors, including those who may who may be employees or former v. A. Officials. Without contracts, Patient Safety provisions are not legal requirements. The v. A. Mismanagement of the fee basis program is not a justification to expense with far or var requirements. If the atom bomb can be built, surely v. A. Can deliver patient care under them as well. With that, i now yield to Ranking Member custer for any opening remarks she may have. Thank you, mr. Chairman. This afternoons hearing is a followup to the hearing two weeks ago and today our focus will be on the legal basis underlying v. A. s purchase of nonv. A. Health care and the practice of v. A. In obtaining this care. At the end of the day, we can all agree we want to see our veterans receive the healthcare they need at precisely the moment they need it but i want to make clear that neither i nor my colleagues view this laudable intent as a blanket rational for not following laws, regulation or proper procedure. V. A. Acquisition regulations exist for a reason. They exist to ensure that there is proper competition when appropriate, and that the best practice and price possible is obtained when the government purchases goods and services. For the v. A. , the law protect veterans and save taxpayer dollars and ensure our veterans receive the highest possible quality of care. V. A. States in its testimony it has had a 30 year practice of using individual authorizations without applying federal acquisition processes and procedures. At the same time it seems the v. A. Has taken the position that individual authorizations are indeed contracts and should be viewed as such even when acknowledging that v. A. Officials appear to have acted in a manner inconsistent with procurement law. Now v. A. Is arguing that it needs new statutory authority, quote, to revote what has emerged as serious legal questions to its purchased care authorities. This new authority would exempt v. A. From procurement regulations and requirements and allow the v. A. To continue with the same practices that it has been following for the past 30 years. I, personally, am not convinced this is the best solution given the lack of oversight in this area. In fact, i would argue it is not that the legal questions have arisen over the v. A. Purchase care program but for too long the v. A. Has operated a program where the legal basis has been challenged and yet v. A. Has never changed course or modified its procedures. The v. A. Authority to purchase care without having a contract in place is predicated on individual authorizations being used, quote, when demand is only for infrequent use, period, closed quote. Im interested in finding out how much of the 7 billion expenditure for nonv. A. Care in fy 2014 has been obligated under this authority as compared to situations where contracts are in place. As we examine the authority for the Purchase Care Program and whether this authority must be modified. We must first get to the bottom of how this program has been operated over the last number of years. This is critical that we understand how the v. A. Legal interpretation were changed and communicated and enforced. It is hard to expect accountability where there are no clear signs pointing out the way. The testimony of mr. Frye and the litigants in the litigation makes it unlikely that over the last years clear policies and procedures were in play. The gao testimony points out, quote, significant monitoring and oversight of the nonv. A. Medical program. Perhaps to you time to stop applying quick band aids and resolve right now to fix what is wrong. It took years for v. A. To get into this problem and it will take time to fix it. But the first step in addressing the problem is to acknowledge these problems and quickly and forth rightly come up with a concrete plan to fix them. I would like to thank mr. Labonte before us today to relate his story which is absolutely hor ebdous. He reminds us that the bottom line is the quality of care for our veterans. This quality can certainly be impacted by lack of accountability and process when it comes to making sure that all relevant laws, regulations and policies are followed. And with that, mr. Chair, i yield back the balance of my time. Thank you, Ranking Member custer. I ask that all members waive their opening remarks as per this committees custom. With that, we have the first and only panel at the witness table. On the panel we have mr. Edward murray, acting assistant secretary for management and interim chief Financial Officer of v. A. Office of management. Mr. Greg giddens, principal executive director of the v. A. Acquisitions, logistics and construction. Mr. Norbert doyle, chief logistic officer of the Veterans Health administration. Miss phillipa anderson, assistant general counsel for the government contracts of the v. A. Office of general counsel. And mr. Jan frye, Deputy Assistant secretary for the office of acquisitions and logistics. Mr. Randall williamson, director of gao health care team. And mr. Christopher labonte, the United States army veteran. I ask the witnesses to please stand and raise your right hand. Do you solemnly swear under penalty of perjury that the testimony you are about to provide is the truth, the whole truth and nothing but the truth. I do. Thank you. Please be seated. Mr. Murray, you are now recognized for five minutes. Good afternoon, chairman coffman, Ranking Member custer and members of the community. Thank you for talking about the care of veterans by contracting with community providers. Mr. Chairman the subject of this involves complex procurement process and legal interpretations and the processing of hundreds of thousands of purchase care transactions per year. I know we will be discussing these areas in detail. And that the committees oversight is important. It is depending on a mix of inhouse and Community Care and with the care in the community continuing to grow to ensure veterans get the care they need in a timely way as close to home as possible. So while the discussion here may be technical, were discussing transactions that represent the purchase of health care for a veteran who needs it. When purchasing care in the community, v. A. Depends on both federal acquisition based con tracks and nonfar compliance and referred to as individual authorizations. These are used because a provider may have a relatively small number of veterans referred by v. A. As part of their total patient mix. For those providers many t may not make sense to enter into a far based contract provider care. This is especially true in rural areas. Although the agreements are not far compliance, v. A. Makes sure the carob tabed by a carob ta carob tained protect taxpayer dollars. The v. A. Community care has risen dramatically. In fiscal year 2006 it was roughly 200 billion and we estimate 10. 4 billion. And over that time it has not been applied and have been marked by conflicted interpret algss. With the determination by the department of justice that individual authorizations are contracts and therefore must be far compliance, the v. A. Began reviewing the internal processes working to improve immigration, transparency and over sight of all purchase care. We have recognized these problems and propose a solution. Last year an informal discussions with community staff, v. A. Noted issues that need to be addressed by statute. In februarys budget submission, we noted that the department would be putting forward a legislative proposal. On may 1st we provided a proposal for comprehensive reform and specific requirements for nonfar based agreements. The legislation would authorize the secretary into veteran care agreements when farbased contracts are not practical. With payment rates tied to medicare rates. Similar to Community Care throughout the veterans choice program. The legislation recognized that far based contract should be used when they can but must use farbased agreements. They review all agreements of a certain side and evaluate whether far based con tracks are more appropriate. The legislation finds protection for veterans and taxpayers. Mr. Chairman we look forward to answering the committees questions. Thank you mr. Murray. Mr. Frye, you are now recognized for five minutes. Chairman kaufman, Ranking Member custer and members of the subcommittee, thank you for allowing me to testify today. You just heard about the illegal purchases of billion dollars of dollars in nonv. A. Care over multiple years. If you are not confused, im surprised. I would be completely confused if i were not familiar with the fakes. We do not intend to admit our failures and stewardship of public funds. Mr. Murray stated there was and is and confusion and conflicting interpretations. As v. A. Senior leaders weve had many years to correct these deficiencies. And there are incorrect conflicting interpretations of law. In 2012 a v. A. Official informed me trouble was looming as they were violating the law with regard to the purchase of nonv. A. Care. I asked for legal documents. He declined to reveal anything. On october 12th i began a interview into this ordeal. I addressed the polite to hope to receive Additional Information from him. He declined to respond. On december 3rd, i sent a note to the boston general counsel requesting a opinion on whether these were considered far based contracts. I received no response. I followed up again on december 31st and again on january 15th, 2013. Nearly three months after i requested the initial opinion, the office of general counsel provided me a legal opinion dated september 10th, 2009. This opinion declared procurement of nonv. A. Fee based care to be farbased. There is no confusion in this legal opinion despite of what you heard to the contrary. Neither my predecessors or others have approved anything except by far based executives. I had never seen this prn and why there was reluctant to provide it to me. That is an enigma. Mr. Murray and myself testified under oath to this subcommittee stating fee based care was not far based. If this existed in 2009 why was it kept from us in preparation for the hearing. Given the resal sit rant i submitted a hotline complaint to the Inspector General. They refused my submission, questioning my motive for submitting the complaint. I persevered and they subsequently accepted it. Im unaware of they investigated. I requested for help from the office of general counsel in conducting ratification for violations of federal law. I received no assistance from either office. Secretary shinseki as made was made aware of the actions. I was not invited to the meeting. I write a letter to representative issa outlining these illegal matters and others. My letter never made it to him. Two senior officials, one from the House Oversight and vha kept chairman issa and others unaware of the violation of federal laws. In april 2014 the v. A. Senior assessment voted to disclose ongoing discussions with mine as the lone opposing vote. In that same meaning there was a sponsored motion which passed which raised the v. A. Material weakness from 400 million to 1 billion. I believe this is an effort to avoid reporting to the public through the insurance process. From july to november of 2014 we collaboratively zreled a developed a method to acquire health care. It was rejected in november 2014. The illegal active continues unabated. This past friday deputy secretary gibson made my disclosure and other a personal action. His actions in an open and oneonone meeting were clearly meant to intimidate me and cast a chill over me and others who might attempt to report violations in the future. I will allow you and the court of Public Opinion to decide for yourselves if what i briefly described constitutes corruption, dereliction and malfeasance. Improper payments continue. Veterans receive Health Care Without protection of mandatory terms of condition and no one is liable. I believe these are two relevant questions. How can we hold employees accountable as Senior Leaders selectively pick and choose the laws we want to observe for the sake of convenience. When will the Senior Leaders be held accountable. There were more than a dozen Senior Leaders in the july 11th, 2014, meepting. It was positively leader. Not one voted to protect government resources. We have lost our way. Senior leaders are required to obey and enforce federal laws. Our actions or inactions do not show anything ive experienced in 40 years as a public service. Mr. Chairman this concludes my statement. Im prepared to answer all of the questions the subcommittee may have for me. Thank you mr. Frye. Mr. Williamson, you you are now recognized for five minutes. Thank you chairman and Ranking Member custer and members of the subcommittee. Im pleased to be here today to discuss our work on the v. A. Programs for delivering care through nonv. A. Providers. They treat veterans using a fee for Service Arrangement or a prearranged Provider Network. Nonv. A. Providers render care in v. A. Facilities under a contracting arrangement or affiliation agreement with University Medical schools. In fiscal year 2013, v. A. Spent almost 5 billion for nonv. A. Provider medical care for more than 1 million veterans. As more veterans seek care outside of the vi system, it is important to ensure the care is of the highest quality and reliable, accessible and efficienty. Three recent reports identified numerous weaknesses in the management of the nonv. A. Medical care program and todayly focus on the issue the v. A. Needs to resolve this area. They do not collect wait times therefore v. A. Can not assure that veterans are receiving access to medical care that is comparable to veterans receiving care at v. A. Mcs. Also they do not have Automatic Systems for all services and charges tied to a episode of care during a Veterans Office visit or inpatient stay. As a result. The v. A. Does not know how much it is paying for episodes of care from nonv. A. Providers and cannot ensure they are appropriately billing the v. A. For veterans care. In october of 2013 we reported on weaknesses in the v. A. Process forecontracting with nonv. A. Providers to provide care at v. A. Facilities and specialties that are difficult to recute and supplement clinitians in high volume areas or fill critical staffing vacancies. We found that contracting representatives at v. A. Mcs that monitor contracts for goods and Services Including clinical contracts had heavy work loads and lacked training on how to gage and post award monitoring of clinical contractors which compromised diligent oversight of nonv. A. Providers. Robust oversight is essential to ensure nonv. A. Providers deliver high quality care and fulfill the responsibilities of their contracts. Finally in march 2014, we reported serious weaknesses in the way v. A. Was add mibsterring and over seeing the program for reimbursing nonv. A. Providers for veterans. In processing and reimbursing claims for nonv. A. Providers we found patterns of v. A. Nonpliens with the own processing requirements atributed to oversight at the local and National Levels therefore some veterans were likely billed for care that v. A. Should have paid for and many were not informed that v. A. Had rejected their claims for reimbursement from nonv. A. Providers. As a result, many may have been denied appeal rights. While v. A. Has made rog res inx addressing recommendations made on three reports, only one third of them have been fully implemented. Moving forward, as new components are added to the nonv. A. Medicare, or 3 and provisions of the choice act, it is anticipated that the numbers seeking medical care through nonv. A. Providers will continue to grow. It is vital that the v. A. Establish robust oversight and accountability in the nonv. A. Medical care program such that relevant staff at every level understand the importance of and are held accountable for ensuring that veterans receive high quality accessible and Cost Effective care for nonproviders. This concludes my opening remarks. Thank you mr. Williamson. Mr. Labonte, first of all, thank you so much for your service to the United States army, and you are now recognized for five minutes. Thank you for giving me the opportunity to speak to this community today. I crister labonte had jaw sergeant the atlanta v. A. Medical center. There have been numerous unethical issues ive had to face. Ive explained in detail. I was coerced in a highly Invasive Surgery performed by a student with no background or qualifications to be present in the room let alone in the residency program. I have submitted evidence to prove this statement and the evidence in my written statement. The atlanta v. A. Has been negligent and complicit for allowing nonqualified personnel and the worse healthcare ive experienced. Ive submitted an in dex of medical evidence and my written statement proving the willness negligence from the doctors and krir corruption. On the day of my surgery they changed my contract to allow a student from kuwait to perform the surgery. I have no recollection of this as medication was already implemented. Months down the line, he cut a nerve. As a result this surgery, i have [ inaudible ] from damage to multiple damage to my cranial nerve. Known as suicide disease is described as one of the most medical conditions known to man. The v. A. Surgical report admitted to damaging and cutting this nerve during the surgery. According to Ibrahim Muhammed ram han, he has deep views. At the time he was attending the university of kuwait. There is no secret that they want to harm u. S. Soldiers. My question is why was allowed to operate on combat vets that he would have difficulty treating. The Veterans Affairs should be sensitive to the needs for veterans to feel comfortable and safe with doctors. The v. A. Medical centers should be more sensitive to this than any others in the country. I should have the choice of who should be involved in my care, especially performing a highly dangerous Surgical Care that required me to be unconscious. I wake up every day in chronic pain. If you can imagine the worst tooth pain, that is how all of the teeth on the right side of my mouth. I have to take muscle relaxers three times a day and narcotics for the nerve pain and i had to have Anxiety Campaign to keep facial muscles from tensing and cause facial pain and migraines. The feel like someone is kicking me in the skull. I struggle with facial deformity and i cannot chew. According to the nonv. A. Doctors i need continued medical care for my mouth and jaw but ill have to wear oral prosthetics in the mouth for the rest of my life and need surgery and will need medication for the rest of my life. One is profit, two, hospital reputation, three protecting bureaucrats. Four, cutting doctors and five cutting costs and six veteran health care. I refer to it as death care as health is barely taken into account. From my experience the Atlanta Medical Center motto should be read, deny, and hope you die. Thank you mr. Labonte. Written statement of those who vuft provided oral testimony will be entered into the hearing record. Well proceed to questioning. Mr. Labonte, how long have you been waiting for v. A. And or emory to address the situation created by the surgery . Since august 16th, 2013. So two years. Two years in august. According to the white paper it was recommended that the v. A. Conduct a cost benefit analysis of contracting out the processing of claims as with other pair models like tricare, medicare, medicaid, blue cross, blue shield, et cetera and their applicability for v. A. What was the rest of the cost benefit analysis . Thank you for your question. Im not aware of that being conducted. But i believe ill ask my vha contractor head of contracts aware of that analysis. Sir, im not aware of that analysis. Mr. Frye, any comment . Im not aware i cant give you an answer on that. Okay. Mr. Frye, v. A. Secretary mcdonald was publicly critical of you after the last hearing conduct by this subcommittee on may 14, 2014. The secretary is this 2015 . Yes, sir. Im sorry, may 14, 2015. The secretary stated he was aware of the problems and characterized your memo as just showing what he, marining mr. Frye, needs to improve, unquote. He further stated it is your quote, responsibility to fix it, unquote. What is your response to secretary mcdonalds statement. Well, i think all of us make comments sometimes and then wish we could retract them. Im not sure mr. Mcdonald read my 35 page statement to him at that point. Since that time, mr. Secretary mcdonald came to see me last week and he expressed appreciation for me raising these issues. In answer to your question specifically, i dont run contracting. Im responsible for overall policy in the v. A. And i have one of six heads of contracts who does report to me but i do not run contracting for v. A. I think anyone who reads the document that i provided to the secretary will see that i have struggled in trying to right the ship and i certainly was asking for assistance from he and the deputy secretary given that i have been unable to, on my own, to fix what was wrong. So again, i make comments sometimes that i wish i could withdraw and perhaps he does as well, but i sincerely believe at this point that the secretary appreciates and probably is more angry than i am at seeing this waste given that hes trying to move us forward and every time we move forward one step in this malfeasance, we move backward 12. I hope youre right, that he is upset. Mr. Williamson, your testimony states v. A. Didnt collect data on wait times from nonv. A. Providers, leaving the department unable to analyze Critical Data and did not provide critical oversight and monitoring of related claims or even the performance of the Services Provided. Gao made 22 recommendations to address v. A. Shortfalls but how is the Department Addressing them at this time. On all 22 . I could provide a little bit of that for the record but i will say that they have made progress. It is not like they are ignoring. They are meeting with us and making progress. But to consider a recommendation closed from our perspective we need rigorous documentation and the v. A. Has not provided the documentation as of now on many of those. Thank you, mr. Williams. Ranking member custer. Thank you, mr. Chairman. I have a question at the top just to get to the bottom of the issue as to what legal authorities provide the basis for the purchase of nonv. A. Care and so im asking our representatives from the v. A. To provide the following documents. The 2008 guidance from the chief acquisition officer and office of general counsel that nonv. A. Care was not governed by f. A. R. I think that was the original 2008. And then the may 2013 white paper provided to secretary shinseki on nonv. A. Care authority options. And then finally, and i dont have a date for this, i think it is 2014, the department of justice ruling referenced that the v. A. Must consider all feebased care actions as being farbased. So i want to im interested in going back but i also want to try to go forward where we go from here. I think whenever were talking about health care, talking about a triangle of access, quality and cost and it seems part of the problem in terms of Public Policy Going Forward is the sheer scope of this problem. Because part of what the choice act entails is to bring in private Sector Network coordination through triwest and health care net. Essentially that is what we are talking about here. I mean, it is massive in scope to have individual contracts and my district is a rural district in new hampshire, i know about these contracts, i know about these authorizations. Could you comment and well start with mr. Murray, but i would be interested mr. Williamson, with your knowledge of reviewing this, even if it is an opinion at this point. Do you think we can get out of this moreas by simply changing the rules of contracting or do you think we should try to bring in the authorizations and even the farbased contracts into these private Sector Networks and ill set it up to mr. Murray, if you would. So the choice act does have triwest and health net as the two we call them third party administrators. And as you know, we have not got off to the start the quickest start with those programs as we would like. Rest assured that all leadership, the deputy secretary, are doing our utmost to exercise those programs to the maximum ability to get care to the veterans that earn it and need it and deserve it. The Model Looks Like it i go to the access meetings every morning. Many of the members of this committee have been invited to the morning access meetings. Well believe it will be a effective model for providing care in the community to our veterans. Can you envision a time in the future when the networks will be sufficiently extensive where you would have dealt with the cost issue whether it is medicare reimbursement rates, whether you would have the quality issue addressed view o ago via the over sight by the third party administrators, can you envision where we dont need to have these oneoff individual contracts. Ill defer that question in a moment to the acquisition folks and the vha gentleman here norb doyle. But it is about signing up, building the network. Having the right type of providers in the network and in certain geographical areas of the country, and we see these in the morning through dep sac and the Senior Health administration to make sure you have the right Clinical Care and the right physicians. Is there an attempt to get the physicians youre dealing with through individual authorizations, is there an attempt to get those physicians into these networks . Absolutely. Absolutely. So Health Administration leadership, if dr. Tushman was here, he could tell you about the options they are exercising, reaching out to the current Provider Network to encourage them to sign up for choice through triwest or health net. So this is all hands on deck. Everybody is moving forward full board to do that. Well have to come back with mr. Williamson when we have another round. My time is up. Thank you. Dr. Benishek. You are identified for five minutes. Thank you mr. Coffman. Thank you for being here this afternoon. I think that to me, when ive learned from this, it is not as easy to get health care in the private sector for the v. A. As one might think. I think the tricare model is interesting. But they pay tricare, the medicare rate and tricare pays less than the medicare rate. In my district nobody wants to sign up for any of this stuff because it doesnt pay very well. And it has been problematic, some of the choice offered choice but there are no providers to do choice because they are getting paid less than medicare rates because they pay tri west, but tri west doesnt pay the people providing the care those rates. And to get the numbers, it is tough for me to figure that out. My concern more is about this for today, a little bit, is about this apparently legal illegal activity that is happening. Im just wondering, let me ask mr. Doyle, were you aware that some of these things were illegal, mr. Doyle . I mean that is what mr. Frye seems to be telling us. That all of the these purchases are illegal and then there is a legal opinion this is not the way it should be done from a long time ago, when you didnt know that was the case. You are sort of in charge of procurement of outside care, right . Yes, sir. As the chief procurement officer for v. A. , we do do contracts for nonv. A. Care. So is your opinion different, this is not illegal, what is going on. Im not a loyal or a judge and i refer to my Legal Counsel and i dont believe they would say it is illegal what we are doing. So there is a difference between what you believe and mr. Frye believes. Is that right . Is there a basic difference here or am i talking about two different things. I think counsel will tell you these arentel legal, they are improper. It is illegal to go through a stop sign but improper to spend billion dollars outside of the law. It makes no sense. This is the same argument that counsel used years ago when there was an argument in these chambers about the buying of pharmaceutical without contracts. And at that time, the deputy secretary was here at the table and he, in his oral statement, was about to make the statement that it was improper and not illegal. And this body absolutely confirmed that it was illegal. If were going to a court of law, the supreme court, i would love to have the argument made that these are improper, not illegal. But this is the court of Public Opinion, the court of Public Opinion, not a court of law. Let me isnt it fee for Service Providing different than contract. Im a prior physician. I worked at the v. A. For 20 years and i was a fee for Service Physician so i didnt have a contract. I agreed to a fee and frankly i wanted to do a contract but it was so difficult to get the contract, it would take months or more than a year to get the contract negotiated and completed so that they couldnt get it done so they actually prefer to do it fee for service because they could get that done right away and i dont know exactly what the details were but im sorry to hear you werent on contract. It sounds like an unfamiliar contract. Im not familiar with what they did to bring you on. If they were required to have a contract. They were required to have a contract. Let me go to a different thing. There labonte, let me ask you a question about your care. You say that you you dont think you signed a consent form before you had narcotics or some sedatives. I signed a consent form after i was administered anesthetic to calm me down before the surgery. It was on a pad. Apparently i scribbled on a digital pad under anesthesia to give the resident the primary surgeon slot instead of martin b. Steed, the surgeon that was supposed to conduct the surgery. It seems unusual. It is highly unusual where i come from, nobody is allowed to sign a consent after theyve had any drugs. So that is usually witnessed by somebody. I imagine you have the documents. Are you doing a lawsuit in reference to all of this. It is pending. And what is unusual is that heron is the only resident in the entire program with a bachelors degree instead of a doctorat and i find that unusual too. There are a lot of things unusual about the v. A. Medical center. Well i think that needs more work than we have here today. Im out of time. Thank you. Thank you doctor, mr. York you are recognized for five minutes. Thank you, mr. Chairman. Miss anderson, ill ask you, but mr. Frye summarized what he thought your response would be to the question. Was this or was this not legal . And not to put too fine a point, these were not illegal actions or illegal activities. Yes, they were not f. A. R. Client and im speaking as a lawyer, an illegal action or illegal activity, it is not enforceable. These commitments are enforceable. In fact, the federal Acquisition Regulations acknowledge understand that that there are times when officials not authorized to commit the government, they do commit the government and there is a formal ratification process. The courts an the boards have recognized that when the government makes a commitment, pays for fees for services, that the government can hide behind the fact that you didnt follow the f. A. R. The government received the benefit. And there is a legal theory for recovery on that. So i i respectfully disagree with mr. Frys position that these are illegal contracts. It sounds like i may or may not be following the distinction, but it sounds like this is a an obligation by which the v. A. Is legal by bound to fulfill. Did someone at the v. A. Did anything illegal in committed the v. A. To this obligation . If were addressing merely the fact that a person not committed perform, enter into a contract, the answer is, there was no illegal activity. Okay. And then so for mr. Murray, to followup, if this was not illegal, was this improper . Thank you for your question. Its proper is an interesting question, because if you establish the obligation, the provider provided the service, the provider billed correctly, and the provider was paid, one would argue that it was proper but not far compliant. Should the obligation have been entered into in the first place . Was that proper . It so thank you again for your question. So was it proper . If it was so proper . Im struggling with the word proper. Id like to address that. Yes. And this is going afield on the appropriation the appropriation area. So, the just if if funds are available, one, we have the authority to contract. Done improperly, but we do have the authority to contract for these services. Funds are available, then they are proper. The payments are proper. From an appropriations, and authorities. So let me ask this followup question, mr. Murray. Have these actions, obligations, been ratified . In other words, has this been blessed bit va . Im trying were all concerned about what happened here and want to know the basic question of whether youre concerned and this think was appropriate or not. So, as we know, the office of Inspector General recently reviewed unauthorized commitments in the purchase card program. For those that were identified to the oig, we did 100 review of that sample and we referred those to the head of contracting activity for ratification review and ratification if appropriate. So thats where those are. Now, those were, with respect to purchase Card Transactions above the micro purchase threshold. So if they were identified as being, we didnt have the authority, the va Acquisition Regulations, which says you can go to 10k, right . Mr. Frye will tell you about that. If they were above the 10,000 authorization for fee care and they were nonfar based, one could logically say they probably require ratification. And if they require ratification, one could make an argument that they perhaps were not proper. Okay. Ill allow a colleague to pursue this because if they choose, because im out of time. And for the record will ask mr. Williamson what is noble about the cost of purchasing this care without contract, 7 billion, do we know it, or is it noble . But i realize i dont have time now. Well ask this question for the record. I yield back to the chair. Thank you, mr. Orourke. Miss walorski, five minutes. Thank you, mr. Chairman. I am aiming this in the direction of mr. Murray and mr. Doyle, im not sure which. Theres a business in my district that supplies specialized shoes, diabetic shoes and custom inserts to the vets through the va. However, the business didnt have a contract. In november of 2014, 11 notified them that the custom orthotic appliance and related Service Released a request for proposals. The business filled out the paperwork. They were denied for not meeting the minimal technical requirement of having a certified podiatrist but pedorthist on staff. Who sets the requirements for the contracts . And my second question is, since this business did not have a contracted, how do you think the va was paying them for the Services Provided . Well doesnt matter. Ill take that. Okay. One, ill need to explore more the specifics of this case, but the requirements, if it was done by visna 11, done by the local Contracting Office that supports visen 11 and they work for me and my organization. They probably worked closely with the prosthetic folks in that visen or at that Medical Center to develop the requirements. It is not set by the central office, i dont believe, in this particular case. Now, i dont know about the contract situation, or not, but it is possible they were being bought under the micro purchase threshold, 3,000, by the local prosthetic folks with the government purchase card. And i get my followup question to that, the owner did say they would receive a purchase order that would have a credit card number on it and Expiration Date and couldnt purchase more than one set of shoes or inserts per time. My question is when talking about this particular organization serviced about 200 veterans in my district, and now can no longer do that. There really is no competitor, and when businesses that are highly specialized at service veterans, get stuck in this p3x cycle in between va between theyre not setting rules. Theyre responding to an organization saying, yes, well join with you in partnership to provide some specialized care. You know, its harmful to the folks on the other end of this trying to comply, getting an rfp in the mail saying, now you have to sign up for this. Theyd been providing this for a couple years already and then they get thrown out because they didnt have a minimum certification, but it was okay and it was fine as long as they were being paid through the credit card number and the purchase order. Dont you see inequity with that even wh youre trying to keep Service Providers even available . They have no idea what youre doing and whats complicit and not complicit. I understand. Sounds like if they were doing repetitive orders with a purchase card, that is a split requirement. If its a split requirement that goes above the microthreshold of 3,000 in this case, there should be a farbased contract in place. You can check this out for me if i give you the info, the personal info happy to do so, yes. I appreciate it. I yield back, mr. Chairman, thanks. Thank you. Ms. Rice, you are recognized for five minutes. Thank you, mr. Chairman. I feel like i missed something here. Im just trying to figure out why and maybe, mr. Murray, you can answer this question. Why is there such a reluctance to apply far regulations when youre talking about nonva care . If you can give that answer succinctly, because i have a lot of other questions. I dont sense theres a reluctance at, you know, the Leadership Levels. In fact, all the Leadership Levels i see, pc3, choice, provider agreements, seem to be the preferred approach for providing care in the community. That specific if you want to delve into this, i think that chief acquisition officer, head of contracting activity for the Health Administration might have some sense for why this is true or could be true in the field. All right. One of the things that we try to address and try to do it with the legislation request that came in was to recognize that there are some venders that may shy away from doing business with the government. Were not known as being the most streamlined and the most easiest to deal with. Vendors have to deal with brad street numbers, have to do this, apply for federal contract wage statutes. Theres a lot of additional activity to do business with the government. We tried to recognize with the legislation, theres an order of precedence. We want to start, deliver and provide care in our va Medical Centers. Next is with contracts. Next with agreements. Our last preference would be what has been termed the individual authorizations. So we want to the have that as really kind of the backstop, as we go through this priority, this hierarchy of providing care, we see that as the really our least preferred option, but one that we dont want to take away from approximately 400,000 veterans that are being served by some of those small providers mr. Giddens, its become a 7 billion backstop. Right . I dont know all seven of that. All seven, i believe, is for overall fee and some happened through far and nonfar. I dont have the breakout. The problem is that theres no comprehensive auditing that has been done. I guess, mr. Williamson, if you could i mean, what what i see a pattern of is either gao or Inspector General saying, heres a problem, heres how you fix it. And an intentional or negligent failure on the part of the va to take recommendations and actually implement them. So, can you just tell us what youve recommended the va do and where they are still lacking . Well, of course, as you know, we put va on our high risk list very recently, and part of the justification for that was that they are not implementing many of the recommendations. In fact, over 100 recommendations weve made that va has not implemented just in the Health Care Area alone. So so there are 22 recommendations, and i dont want to use all your time up, but let me give you a couple examples. One is, we recommended that va keep track of wait times for for veterans that went to nonva providers. They have not yet done that. Weve talked to them about it. They still havent done that. Whats the reason for them not having done it . We dont really know. When you ask them, you tell them, how i think what theyre looking at they want to close a case from the time the veteran starts the process of getting an appointment till the time the claims paid. They want to do that in 90 days, and they are tracking that. But for some reason theyre reluctant to track the 30 days. Why . Good question. I dont know theyve given us a great answer on that. What would be a good answer . Is there a good answer . They probably dont have the systems to do it. It takes a lot of work. It does. It does take some good data. But thats not a good reason necessarily for not doing it. Mr. Williamson, so youve laid out a blueprint for how the va can improve, whether its tracking wait times, doing better audits to see where these multibillion dollar expenditures are going. And i guess what i and maybe there isnt an answer to this. That it seems to me that you have not been able to get any satisfactory answers as to why youre recommendations have not been implemented, and maybe youre not the right person to answer this, but i dont know if anyone at the va, i havent heard mr. Murray give any explanation has to why, so well, i think part of it is that it always comes back to the same issues no matter what youre what program youre reviewing in va. The data is often insufficient. The Automated Systems they have in many cases cannot produce the kinds of things they need. And it comes down to a lack of oversight. Both at the local level and at the headquarters level. And time and time again, the claims processing problems we found on the Emergency Care for for nonservice connected veterans, same thing. The problem is that you there will be no overall cultural shift at the va unless there is meaningful oversight, whether youre talking about this issue or about how whistleblowers are treated or anything else. And thats really at the heart of the problem, isnt it . Comes down to accountability, and its not there. Thank you, mr. Williamson. I yield back, mr. Chair. Thank you, ms. Rice. Mr. Lamborn, youre recognized for five minutes. Thank you, mr. Chairman, and i appreciate your leadership in pursuing yet another scandal, basically. Here it is june 1st. Its another month and we have another scandal. And it seems like the whole year has been like this. And i, for one, am getting sick and tired of it. Mr. Williamson, id like to ask you for some background in this whole issue. Whether we call the contracts illegal or just improper or noncompliant, what can go wrong when the va doesnt follow the proper procedures as regards these contracts . Mr. Williamson . Youre talking to me . Yeah. Oh, okay. I thought you said mr. Giddens. From a gao perspective. You know, im not a lawyer or a procurement expert either, and im in listening to whats what ive heard today from the va witnesses, im a bit confused because in one hand, you know, there are they say theres no impetus or no reluctance to go to a farbased kind of process for purchased care for va nonproviders. And i think there obviously is or otherwise mr. Frye would not have had the difficulty hes had. I think i would i would want to know, i would want to know what a farbase system would mean to accessible care for veterans because the end game here is still providing high quality, accessible and Cost Effective care for veterans. And so if a remedy to solve the problem, if a farbased if its determined that a farbased system should be used here, the remedy should i want want to know how long will it take in this process for a person to for a contract to be executed and what the process means. And i would want to know how it affects the accessibility to care for veterans. Also, one thing we havent mentioned yet is the whole idea of what it would mean for the acquisition workforce. When we did our clinical contract care work, we found that the Contracting Officers and the Contracting Officer representatives who do most of the legwork for the Contracting Officers are already stressed in terms of workload. If you increase that workload, you double it, tenfold, whatever it would mean to get a farbased system, then, you know, what would it mean in terms of the budget for hiring new people and so on . I just dont know what a farbased system would do in terms of accessibility and the workforce, and thats what thats what we need to know. Well, its interesting, the gao has identified six categories of problems that can arise when proper oversight is not provided by the va. The type of provider care, credentialing and privileging, clinical practice standards, medical record documentation, business process, and maybe the most important to me, access to care. So, let me turn now to mr. Frye. Would you agree that those six areas are called into question when proper procedures are not followed . Well, yeah, absolutely. And in addition to that, when federal contracts are required and you dont use them, there are terms and conditions that are completely missing from the contract. By federal statute, youre required to have terms and conditions. These include the termination for convenience, termination for default, the disputes clause, fair and reasonable price determination. Just a whole host of issues, not not and probably even more important in terms of health care, the safety and efficacy terms and conditions that are required to be followed by the specific contractors. Without those contracts without a contract, without those terms and conditions, the contractor is free to do what he or she wants. Well, and thats thats my concern. And, ms. Anderson, in regards to your statement earlier, i have to agree with you. The government is obligated to pay for services that are rendered even if the Proper Foundation wasnt you know, the procedures werent followed in soliciting those services. Thank you for the opportunity to respond to that. We were comparing a farbased contract and what it what it will take to become far compliant. And then to mr. Williamsons point, to what end . Will that result in Immediate Care to the veterans . And i i i chaired a work group in july of 2014. And that work group was responsible, tasked with identifying measures and how do we become far client . We quickly we realized after threehour sessions over four months, threehour weekly sessions over four months, that there are lots of hurdles to overcome. Not the least of which, labor issues, consultation with labor, hiring, hiring a work a Contracting Officer, workforce, estimate 600. Then its how immediate can we really give the care at that point . Still, we need to go through the hurdles. So, we quickly realized that we need to really begin aggressively pursuing legislation. And in aggressively pursuing legislation, we we working with working with the department of labor, working with omb, working with the department of justice, we maam weve embed in the legislation protections, credentialing, quality of care okay, maam. Youre getting into another issue that is a very important issue. The proposal of legislation. My time is way over. I wanted to make the point. No ones arguing that the government should not pay these contracts. Im concerned what gao and mr. Frye has identified as what can go wrong when the procedures not followed. Mr. Chairman, thank you for your indulgence. I yield back. Thank you, mr. Lamborn. Mr. Walz, youre now recognized for five minutes. Thank you, mr. Chairman, and first of all, mr. Labonte, my deepest apologies for you and what i understand, and you understand, much more clearly is that veterans care is a zero sum proposition. If one veteran doesnt receive the care theyre entitled to and the best quality then its a failure. So your situation is unacceptable. The thing i encourage you on and as i looked into this, the tort issue. Thats your recourse on this and they will always try throw barriers up, both in the private sector and in the public. But there are a lot of good folks out there that can help with that, so i would hope you could pursue that. Well, the efficacy of the tort program is that the va essentially investigates themselves. I mean, their attorney acts as their investigator which is trust me, people win these, and what im saying is, if this was wrong, there are people out there to assist you. There are veteran attorneys that are veterans themselves, that their job is to try and help make this right. Yes, but the va has a sixmonth to head start to coach witnesses where youre not allowed to file i agree. Its never easy. As youre sitting here listening to this, the issue for you is, is that all the rest of this is kind of irrelevant. The issue is what happened to you, and i would just say from your perspective, theres two things happening here. Were kind of at the 40,000foot reform discussion here. My advice to you is, is that go down that road, pursue that hard, where you can get redress thats what im doing now and witnessing that that program is ineffective as far as va investigating themselves. The va attorney sends the information that i send the attorney investigator to the actual hospital Risk Management coordinator, who then tells the privacy officer which records they need to keep or manipulate or lose, and then tells the Department Head how to coach their residents specifically to the legal matter. So i would say to that recourse is ineffective and designed to protect the hospitals reputation rather than actually help the veteran. I wouldnt disagree with you, i would just my theres folks out there to advocate for you. Stick with it. Veteran service organizations, others, so stick with it. Thank you. Im going to move back to this again, our 40,000 foot, and i appreciate you all being here. And im going to my colleague from new york, ms. Rice, was hitting on this, mr. Williamson. Ive seen this before. J. O. Puts out 22 recommendations. What exactly is the weight of a gao recommendation . Exactly what does that do . Well, you are, because the congress is we report to the congress and the congress provides the leverage we need. And its forums like this that we have that bring those things to light. Exactly. This is why and, again, mr. Murray, i could go down and ask why some of these but i dont think it was necessarily even a rhetorical question. I do think youre the wrong person to answer this. Were in this needs to be fixed and somebody needs to deal with this, but this is a much broader issue. Its a reform issue. The va being all things for all people and not to antagonize my chairman, this is the va trying to build hospitals, this is the va trying to do everything for everybody. And ive been saying we need to have that discussion to figure out how do we best leverage both the private sector, the public sector, our promises to our veterans, get quality care and do it in the most costeffective manner. So were here, i would ar gushgs dealing with a very important issue. Its very granular. Were discussing inappropriate versus illegal. They do matter. But the bigger issue here is that if i would ask the questions and again, i dont think theyre fair to you, mr. Murray is what is the va doing, how can we fix the contracting and we can get back into it, mr. Frye pointing out where those holes are in there, this is probably not the forum for that. So, i appreciate you all being here. I dont question that were all trying to get to the same point, but you heard mr. Labonte, this is what happens when you break faith. He doesnt believe anybodys going to get good care. We can tell him countless stories of the highest Quality Health care delivered in the country by a va hospital, and it will be irrelevant to him. And i think thats a noble goal for us to continue to strive for, but i dont think were going to get there in the current system. I feel like im quite confident your 22 remss will be recommended in two years from now and well still be trying to implement them. Thats a horrible condemnation on the entire process. They have implemented seven of them, so yeah. Well, it is, its not because the motive is not to provide quality care. I think it goes back to the institutional design and some of the issues on culture were trying to get to. And i think that level over the top of this is going to make answering many of these questions very difficult. So, i thank you, chairman are for your time. Well, again, mr. Labonte, i certainly apologize for your situation. And i think you personalize the problems in this contracting process. Im stunned by the kind of bureaucratic incompetence, the corruption, the lack of leadership demonstrated here today, where what ive heard is, yeah, we had these rules, but theyre really not important. The kind of lawlessness that exists in this department is just extraordinary. Mr. Frye, how do you what you heard here today was essentially, oh, splitting hairs. Oh, its really kind of not improper. Oh, its really not illegal, but we dont follow the law here. Because were somehow above the law. I mean, mr. Frye, could you comment on what youve heard today . Thats exactly right. Lets talk about those, those purchases above 10,000. They are using the same methodology from 1 that is used from 1 to 10,000 above 10,000. That authority has never existed. Every purchase, every acquisition of health care above 10,000 must have a farbased contract in place, it must be signed by a duly appointed Contracting Officer, and i will take issue with ms. Anderson. We cant pay that unless its been ratified by a Contracting Officer. Ratification is a requirement where a Contracting Officer must do an investigation. We cant liquidate that obligation willynilly, but we are. Were going ahead without doing ratifications and liquidating the obligation. Those are improper payments, by the way. Our own regulations and the gao red book and other statutes state that we will not pay unauthorized commitments until theyre ratified. Weve done it wholesale. To my knowledge, not a single one of these requirements above 10,000 has ever been ratified, and we bought billions of dollars worth of health care. If that isnt illegal, i dont know what is, but i guess we can parse words here. And, mr. Frye, is there anybody else in Senior Leadership besides yourself that actually cares about getting this right . It doesnt appear. That theres anyone outside my organization that cares. I come to work every day and i watch this malfeasance. I watch this malpractice. You know, it theyve made a mockery of the federal acquisition system. The f. A. R. Has the same force and effect as the law. We all know that. Those who were trained in its use and certainly the attorneys know that. And were just ignoring it. This isnt done in any other government agency. If you were to bring other government agencies, senior procurement executives or chief acquisition officers, you wouldnt get this same story. This is just another example of us trying to blow smoke up your sleeve. Is secretary mcdonald a placeholder . I dont sense hes working to make a difference here. Does he care . I hope secretary mcdonald cares. Again, i think secretary mcdonald dislikes these scandals, this malfeasance more than anybody else, because hes got a very short window here to move the va forward. And, again, he moves us two steps forward and we move 12 steps backwards every time one of these scandals arises. Thank you. Ranking member kuster, youre recognized for five minutes. Thank you. Mr. Frye, let me just follow up on this. If every single one of these contracts was f. A. R. Qualified or whatever the verb would be, what would the Time Commitment and cost to the va be for that process . Thank you for asking that question. So, from 1 to 10,000, we have a nonf. A. R. Compliant, however it is f. A. R. Based, system in place. Its like falling off a rock. Its nonfar compliant. The appropriate terms and conditions are in that contract. It is simply a process where authorized personnel, not Contracting Officers, sign this documented, and theyre on their way to the doctors. Its not hard at all. And its been this way for years. Now, we all recognize, including counsel, that it is not compliant with the f. A. R. , and so a year ago in july, we began a fourmonth effort to bring it in compliance, but in november, after all that effort, Veterans Health administration sum marrily rejected it. It didnt go far enough for them, even though it was f. A. R. Compliant, so thats my concern, is that weve heard from my colleague, ms. Walorski that a company that had been providing services was obviously somebody drew attention to that. They didnt have a contract. They tried to go through a contract, but, in fact, the process was so burdensome, what ended up happening was that the veterans didnt get the podiatry they needed because that company was disqualified. There was no other company available. So i want to try to understand how do we get from here i recognize the problem. I agree with you, weve got a problem. How do we get from here to veterans all across the country getting timely care in a costefficient, highquality manner . Sure. And i i realize there are issues sometimes with veterans getting care. No matter what system we have. Whether its in the va hospital but would you agree theres an added cost for all of this administrative procedure on top . I mean, im not im not condoning it. Im just asking you. I have no idea if theres an added cost but i tell you this, there is a requirement talked about 600 additional people . Under the act to do it. I understand the requirement. Im not asking you about the requirement. Thats up to us. Right. What im asking you is, what is the cost to the system for each one of these authorizations to be compliant . Youre asking the wrong person. Youd have to ask the Program Officials. Theres the ones that make do you agree that theres a cost . Theres potential delay, theres administrative procedure that has to go on, there are individuals that have to be involved. Do you agree i agree theres a cost using any system. Federal acquisition or any other system. By the way, im ambivalent if the federal Acquisition Regulation wasnt used. Thats fine. But we have to have a system. We cant just spend money like drunken sailors willynilly. If were going to have a nonf. A. R. System, lets put a nonf. A. R. System in place. Lets go through the rulemaking process at omb. Promulgate the rules and lets comply with the rules. Simple as that. What do you think is the correct dollar amount that we would have the balance of being able to supervise contracts, but not have every last paper clip be covered by this contractual obligation . Again, i have no idea. Im not a Program Official but i can tell you, this we have f. A. R. Based contracts in place, pc3, which you may be familiar w is a f. A. R. Based contract. It provides Specialty Care and it goes up into the hundreds of thousands of dollars and veterans are getting care every day using pc3. And do all providers in the pc3 network have a f. A. R. Based contract . Have a what contract . A f. A. R. Approved contract . If theyre in even in a rural area like im in . No. There are some rural areas, for instance, theres another f. A. R. Based contract which youre familiar with called arch. Im not that familiar with it, because im not a Program Official. But i know it exists, because of care thats required out in rural areas. So well, my time is nearly up, but i think what im interested Going Forward is, lets separate out the ones that are possible. Id like to hear more about the pc3 f. A. R. Based contracts and then not chase every last one down a rabbit hole with 600 new employees, but lets try to use a Public Private arrangement, because i know its expensive. Ive been in health care the past 25 years. Its expensive to supervise these contracts. Were going to have to get to the bottom of it. So, thank you. Mr. Lamborn, youre now recognized five minutes. Thank you, mr. Chairman. Mr. Murray, i have a question or two for you. I want to ask you about the proposed legislation that the va has come up with, and i think ms. Anderson made reference to it. Basically to let va off the hook saying you dont have to follow f. A. R. Anymore for these kinds of contracts. It really bothers me, because one of the potential abuses that can happen when f. A. R. Or something the equivalent of f. A. R. Is not followed, is there is the potential for cronyism or higher prices. Its sort of like soul sourcing of contracts, and the taxpayer isnt given the benefit of competing bids and that kind of thing. So, would you agree with me that the legislation or i wont put it that way. Are you concerned that the legislation va is proposing could allow for those problems to arise . I am. And im concerned about that sort of thing, fraud, cronyism, paying more than you should across programs, whether its travel or conference spending, or whether its payroll. Got a Major Initiative to make sure we you know, payrolls where it needs to be in terms of controls. So, absolutely, which is why its so important that the controls that we suggested, and perhaps more are required, am this legislation be implemented. You know, reviews, the control that im intrigued with is that we review these individual authorizations to see if they pass a threshold, 1 million annually. If so, we start thinking right away, maybe this needs to be f. A. R. Based. Were doing a lot of this, for instance. The specific language that concerns me in the proposed bill says, quote, that health care can be awarded, quote, without regard to any law that would otherwise require the use of competitive procedures for furnishing of care and services, unquote. So, to me that opens the door for potential cronyism. Mr. Frye, would you like to comment on that, that same question . Well, that piece disturbs me as well, but i think in the background there may be some Additional Information. Counsel, down at the end of the table, was involved in putting that together. But certainly, again, if you give us legislation that allows us to do something besides the f. A. R. , im ambivalent, but weve got to develop those rules, go through the rulemaking process, put those rules in place, and then we have to enforce the rules and hold people accountable. We dont hold people accountable for anything right now. You know, we come down here. I read the newspapers every day. Chairman miller says, you know, why arent things working . Why arent why dont we follow the rules . Its because no ones held accountable. No one. No one has been held accountable at all for these violations of federal regulations and law in the course of events with this these obligations for feebasis care. And i suspect no one will ever be held accountable. There are hundreds of thousands of these transactions that should have been ratified. There are billions of dollars that have been spent, and well just sweep it under the carpet. Well, im truly concerned about that, mr. Chairman. I appreciate your leadership on this issue and i yield back. Thank you. Mr. Orourke, youre recognized for five minutes. Oh. Ms. Rice, youre recognized five minutes. Thank you, mr. Chairman. Mr. Williamson, i want to follow up on ms. Kusters line of questioning in terms of the vas position that was stated previously, that following f. A. R. Would impact a large number of veterans by compromising immediate access to care in our community providers. Now, forgive me if this was already spoken about, but do you share that . I share its very much of a concern. Again, unless i know more about how a f. A. R. Based system would work for purchased care for nonva providers and i know how long that takes to execute these contracts, i cant give you an answer. If i had that, i would but my concern is that its going to take a longer period of time to do, and in the meantime, that veteran the access that that veteran has to that nonva provider is going to be degraded. So, we have to figure out a way to either not have f. A. R. Apply, right, and implement your recommendations it wasnt our recommendation on that particular aspect