▶ 0:28:19Good afternoon. Thank you to our witnesses for being here today. Without objection, the chair may declare recess at any time. I'd also like to welcome the members present from the subcommittee on technology modernization. I think they're on their way. And the other members who have sponsored bills on today's agenda who will be joining us today who are hopefully on their way as well. Today's hearing is about coordinating with other individuals who also care deeply about how veterans are treated and who represent organizations with expertise on the proposed legislation on the agenda.
▶ 0:28:47This afternoon, we will use the feedback and ideas they share with us to make informed policy decisions to improve the delivery of services at the VA. We have nine important legislative proposals to consider here today. It is important to note that not all of the proposals will move forward in the legislative process.
▶ 0:29:04The valuable insight provided by these members, stakeholders, and agencies is fundamental to the work of the During today's legislative hearing, we will examine a variety of bills, including bills that impact the VA's systems and technology acquisition, pay, and accountability. The agenda includes HR 984, sponsored by Representative Van Orton, which would direct the VA secretary to cancel agreements with debt collectors to collect debt from veterans. of the VA determines the debt was due to an error.
▶ 0:29:33The Veterans Scam and Fraud Evasion Act of 2025, sponsored by Representative Calbertt, would codify an office of the VA that is needed to fight against scammers targeting HR 3185, the Personal Integrity and Veteran Affairs Act of 2025, sponsored by Representative Franklin, would provide oversight bodies with the tools to complete their investigations into misconduct and improve the federal workforce by requiring the VA to make note in their personal file if they resign under investigation.
▶ 0:30:02The bill sponsored by Representative Gray, which would prohibit the VA from collecting co-pays after two years if the delay in collection is due to a VA failure in timely processing. HR 3482, the Veterans Community Care Scheduling Improvement Act, sponsored by Representative Barrett, would establish a program from VA employees to directly schedule health care appointments for veterans receiving community care.
▶ 0:30:24In HR 3455, the Veteran Affairs Distributed Ledger Distributed Ledger Innovation Act of 2025, sponsored by Representative Mace, would direct the VA to conduct a study on the use of distributed ledger technology to modernize the claims process. HR 3483 forcing real accountability for unlawful distributions or the fraud act of 2025 sponsored by Representative Barrett would direct the VA to implement an information technology system to detect fraud waste and abuse and payment processing for community care payment submissions.
▶ 0:30:55A discussion draft of legislation to improve the VA EHRM program. And lastly, my legislation HR 3494, the VA hospital inventory management system authorization act, which would authorize the VA to purchase or develop a modernized inventory management system for hospitals.
▶ 0:31:12Inventory modernization is an important step forward to more effectively manage the crucial medical equipment and other assets providers need to deliver first class healthc care to our nation's I'm eager to hear more from our members and witnesses about these bills, and I want to thank our witnesses again for being here today. I look forward to our discussion. I now recognize ranking member Ramirez for her opening remarks. Thank you, Chair Kiggins. I want to first uh start by thanking our witnesses that are here today, Dr. Phillips, Miss Duke, Miss Waters, and Miss McDonald.
▶ 0:31:42Thank you for being with us today. When I first joined this committee a couple years ago, I hoped to find common ground with my conservative my more conservative colleagues because we were united by a shared belief that it's our responsibility to serve those who sacrifice so much for our country, our diverse veterans. So, I have to admit that I continue to be disappointed as I witness the erosion of the spirit of bipartisanship in our committee.
▶ 0:32:08While I'm committed to work on today's bills on advancement and modernization of the VA, I can't help but point out that contrary to the traditions of this committee, we're discussing eight Republican le bills and only one Democratic le bill. In the past, for every two bills from the majority, we considered a bill from the minority.
▶ 0:32:30So, you can understand my disappointment that while we're in fact going to discuss modernization of the VA, we omitted and disregarded Democratic legislation on the subject that could bring even a greater level of transparency and accountability to the Let me give you a couple examples. Congressman Kennedy's VA funding and workforce protection act, which would reinstate veterans who've been illegally terminated from the VA and exempt them from the hiring freezes, or Dr.
▶ 0:32:57Conway's VA data act, which addresses serious privacy concerns veterans have shared with us and would prevent DOGE from accessing um veterans personal information from the VA systems. And I hope I have the chance to discuss the bills that I plan to introduce over the next few months, which would include a bill to restore collective bargaining rights for VA employees and a bill that will bring muchneeded transparency to VAS rel VA's relationship with special government employees.
▶ 0:33:25While I'm disappointed the ratio of Republican to Democratic bills that is so low in this hearing, I am proud of the single Democratic le bill on today's agenda, Congressman Gray's Strive Act. The bill would prohibit the VA from collecting co-pays from veterans in specific situations when the build care is more than two years old or the debt incurred by the veteran is due to the department's fault and exceeds $2,000.
▶ 0:33:53This bill would protect veterans by ensuring that they're not on the hook for surprise medical bills due to dysfunction or error in VA systems. It's common sense step to shield veterans from avoidable financial burdens. Today, we will also be considering bills on modernization efforts within the department and that is a timely and crucial conversation. But if I'm being honest with you, from my perspective, we can't successfully realize modernization without the infrastructure needed to actually support it and implement it.
▶ 0:34:24For example, Secretary Collins has announced his plans to accelerate the electronic health record modernization, we call her the EHRM program, to 13 sites next year and 26 the following year. At the same time, there's a doubling of the sites. There's a reduction in the EHRM integration office staff about 10% of whom took the deferred resignation program.
▶ 0:34:48Chair Kigan's HR 3494 seeks to initiate a pilot program to test adequacy of a centralized supply chain solution at one VA medical center. But the VA has tried four previous times to realize a supply chain solution without identifying what critical infrastructure was needed for previous pilots to succeed. And I got to tell you, I'm concerned we're bound to repeat the same mistake from the past.
▶ 0:35:14Congressman Franklin's Personnel Integrity in Veteran Affairs Act would require investigative bodies like the Office of Inspector General and the Office of Accountability and Whistleblower Protection to continue investigating employees even after they've left the department. While no investigation should conclude with a proper res without a proper resolution, the legislation doesn't acknowledge that limited resources could impede these investigations.
▶ 0:35:41As we consider modernization, I just want to echo my colleagues on the technology modernization subcommittee who have pointed out that we must pursue a balance of investments in technology with equivalent investments in staffing and resources when we're rolling out these modern solutions. Because without investing in all of these three areas, modernization, staffing, and resources, VA will not be able to implement the modernizations our veterans desperately need.
▶ 0:36:10But this administration is doing the opposite, openly undermining the VA, proposing major reorganization, and engaged in reductions in force. Their efforts weaken the very internal infrastructure of the VA that the modernization depends on. It's almost as if privatization is the endgame.
▶ 0:36:31Deconstruct infrastructure, create new systems and protocols that rely on infrastructure, then complain that there's no infrastructure to support the changes, and then have a seemingly novel idea outsource the service. So, as we consider today's legislation, we need to keep in mind that we cannot have honest discussions about modernization without getting honest about the internal infrastructure needed to provide our veterans with the quality, comprehensive, and accessible services.
▶ 0:36:59Chair Kiggins, I hope we can make the changes needed before we advance these bills to the full committee. And with that, I yield back. Thank you, Ranking Member Ramirez. Before hearing their testimony, I will introduce the witnesses on today's first panel. Representing the Department of Veteran Affairs, we have Miss Sherry Waters, acting DCIO and executive director of the Health Portfolio portfolio product delivery services in the office of information and technology.
▶ 0:37:25Miss Waters is accompanied by Miss Laura Duke, the chief financial officer at the Veteran Health Administration, and Dr. Tony Phillips, chief nurse informatics officer of the electronic health record management information officer office. Also for on our first panel representing the office of the inspector general, Dr. Jennifer McDonald, director of the community care division, office of audits and evaluations, and office of the Inspector General. We'll now swear in our witnesses. If you could please stand and raise your right hand.
▶ 0:37:56Do you solemnly swear that the testimony you are about to provide is the truth, the whole truth, and nothing but the Thank you. You may be seated. Let the record reflect that all witnesses answered in the affirmative. Miss Waters, we will start with you. You are now recognized for five minutes to provide your testimony on behalf of the Department of Veteran Affairs.
▶ 0:38:19Good afternoon, Chairwoman Kiggins, Chairman Barrett, Ranking Member Ramirez, Ranking Member Bodzinski, and members of the subcommittees. Thank you for inviting us here today to present our views on several bills that would affect the Department of Veterans Affairs programs and services. Joining me today are Miss Laura Duke, Chief Financial Officer for VHA, and Dr.
▶ 0:38:44Tony Phillips, chief nurse informatics officer for the EHRM implementation While VA's views on all the bills are detailed in my written testimony, including areas of concern and support, I would like to highlight some of the bills in my opening remarks.
▶ 0:39:05First, VA supports, subject to amendments and availability of appropriations, the Forcing Real Accountability for Unlawful Distributions Fraud Act of 2025. BA strongly supports using the franchise fund and we estimate that the savings from preventing overpayments will more than cover the technologies and services to fully recover all the costs.
▶ 0:39:34However, as written, we believe the bill would not cover those claims at highest risk for fraud or overpayment. VA would welcome the opportunity to discuss several technical improvements to the bill that could provide VA enhanced authority to combat fraud, waste, and VA supports the intent of the Veterans Community Care Scheduling Improvement Act, subject to amendments and availability of appropriations.
▶ 0:40:04VA fully agrees that it can and should improve the patient scheduling However, we are concerned that specific legislation on this topic could constrain our ability to address veterans needs and emerging issues. This bill seems to duplicate some of the work previously done as part of VA's 2022 integrated product team as well as other efforts including those to implement the Cleveland Dole Act.
▶ 0:40:35VA is already working to develop a selfservice scheduling platform and does not require additional authorities. Rather, the challenges facing VA are both technical and process-based and VA recommends a human centeredbased design study that would address both technical and non-technical elements of the issue.
▶ 0:40:58VA also welcomes the effort to modernize VA's current inventory management systems and improve overall efficiency and supply chain management. We therefore support the VA Hospital Inventory Management System Authorization Act subject to some amendments and the availability of Lastly, BA also supports the intent of modernizing VA's electronic health record system subject to amendments
▶ 0:41:28and the availability of appropriations. Regarding section three, VA acknowledges the importance of the EHRM as a critical priority for VA, but also believe there's an opportunity for VA and the committee to collaborate to address technical concerns in the section.
▶ 0:41:47Likewise, VA looks forward to working with the committee to address technical concerns in sections four, six, and VA agrees with the intent of section five to protect veterans personal and protected information and welcomes the opportunity to work with the committee to ensure this section effectively addresses that concern.
▶ 0:42:09VA further agrees with the importance of reporting requirements contained in sections 8 through 16 and welcomes the opportunity to work with the committee to ensure that VA can develop the information and address the committee's Chairwoman Kiggins, Chairman Barrett, this concludes my statement. We appreciate the congressional intent embodied in the bills on today's agenda and welcome the opportunity to work closely with Congress on these important issues.
▶ 0:42:39My colleagues and I are prepared to respond to any questions that you or other members of the subcommittees may Thank you, Miss Waters. The written statement of Miss Waters will be entered into the hearing record. Dr. McDonald, you are now recognized for five minutes to provide your testimony on behalf of the VA Office of the Inspector General. Chairwoman Kiggins, Ranking Member Ramirez, and members of the subcommittees.
▶ 0:43:04Thank you for the opportunity to testify on independent oversight conducted by the OIG on BHA's pause of its program integrity tool, which relates to HR 3483. Our testimony on this tool was requested by the subcommittee because the fraud act of 2025 requires VA to analyze community care claims using an IT system to detect overp payments and other fraud, waste, and abuse.
▶ 0:43:29This is something that the program integrity tool did previously in a limited The program integrity tool is a repository that consolidates data for multiple VA community care programs after a claim has been paid by VA. For revenue operations, VHA uses data from the tool to determine if veterans or their private insurance companies should be built for care that is not service connected.
▶ 0:43:51To support VHA's fraud and waste detection and mitigation efforts, data from the tool can be used to identify duplicate claim payments or indicators of potential fraud, such as payments to the same provider in different locations on the same day. VA paused operations of the program integrity tool in February 2023 after becoming aware of ongoing issues with its database logic and unreliable data.
▶ 0:44:14The pause was intended to allow VHA time to evaluate the tools processes, data, and its underlying IT system to determine the causes of any data errors and identify improvement opportunities. In July 2024, we issued a management advisory memorandum to VA leaders highlighting the major impacts of the tools pause on VHA's revenue collection processes and on identifying fraud, waste, and abuse related to community care claims.
▶ 0:44:41In response to this work, VA officials stated that they had resumed using data from the program integrity tool for revenue collection for claims, but were still considering the path forward for the tools oversight functions, including audit and compliance efforts. While the tool was offline, VHA had limited ability to collect revenue of more than $660 million from veterans co-ayments or from private health insurers. This may negatively affect veterans because they could receive co-ayments for bills that are well over a year old.
▶ 0:45:11The pause also affects the resources needed to address a significant billing backlog. BHA staff have been reviewing tens of millions of community care claims to determine which were billable for veteran co-ayments or to private insurers. The HA will need to make certain that revenue operations staff has sufficient resources and processes to timely review and build the full backlog of community care claims. Currently, the program integrity tool is still not being fully used for the prevention, detection, and mitigation of fraud, waste, and abuse for paid community care claims.
▶ 0:45:41It is vital that the Office of Integrity and Compliance also have the needed resources to perform timely fraud, waste, and abuse examinations of community care claims to ensure the proper use of taxpayer In addition to the fraud act, many of the other bills under consideration require VA to develop or improve its IT systems. IT modernization has consistently been a major major management challenge for VA. Our work has identified extensive breakdowns with upgrading or replacing key systems as well as significant cost overruns.
▶ 0:46:12The OIG remains vigilant in overseeing all significant IT initiatives to identify all risk to veterans, their families, and survivors. To do this, IG staff monitor programs and operations for breakdowns and processes, for non-compliance with mandates, for failures to provide timely and quality health care, and for deficiencies in the delivery of benefits and services to veterans.
▶ 0:46:36We will continue to advance accountability by conducting effective oversight into how VA plans, implements, and remediates identified weaknesses in its system modernization efforts. This concludes my statement and I am happy to answer any questions you may have. Thank you Dr. McDonald. This the written statement of Dr. McDonald will be entered into the hearing record.
▶ 0:46:58We will now turn to questions and I yield myself five minutes and the chair just reminds our witnesses to speak directly into the microphones when answering your questions so we can hear or listening members can hear. Miss Waters, how would a modern inventory system at the VA hospitals help improve the VA oversight of its uh of its of its inventory Um, thank you very much for that question.
▶ 0:47:25So we believe that the modern inventory system will help us with oversight of having access to view all inventory across the entire enterprise in a single unified view and help make sure that we are in front of any challenges with inventory and supplies and most efficiently using resources across the VA.
▶ 0:47:52How big of a problem is it right now that you don't have this oversight in Um, so as I think you're well aware, we do have multiple inventory systems in place at this time. Um, we do have three systems that are running, one of which has many instances and so that does lead to disparity and difficulty with collection of information.
▶ 0:48:17It is important to note that replacing the system is part of our supply chain modernization and it is an effort that is underway at the VA at this time and we're fully confident that we can implement this system for inventory and asset management across the enterprise. Great. Thank you. And then again, Miss Waters, what standards will the VA use to implement this advanced technology if it becomes available for hospitals? You talked about there's different systems right now. Will they be integrated into one? And will there be other changes?
▶ 0:48:47Correct. So we will have at the end of this initiative, we will have a single system that is providing asset and inventory management across the enterprise. Um we've built a dynamic set of requirements to define what needs to be contained in that system and we're currently working on uh procurement processes to move forward with that process. Great. and who would be trained on how to use this new system if it were to be implemented?
▶ 0:49:16So, anyone that would be required to use the system will receive the needed training. Um, obviously part of our goal is to make the system designed in a real human centric way so that the ease of use minimizes training needs etc. But anyone that needs to interact with the system will receive appropriate training. Great. That that's great to hear.
▶ 0:49:40And also, we've we've had conversations just with different veterans, uh, especially ones who are older adults who are often victims of scammers and are targeted by scammers through phone calls, emails, texts, and letters in the mail. And, and, uh, one of the bills addresses this type of fraud and the new information technology system. And how would this type of system help our older veterans protect themselves from fraud?
▶ 0:50:04Um, so that is obviously related to the be safe bill that's proposed and we fully support any efforts to help protect the veterans from being succumb to scams of any um sort.
▶ 0:50:20It is important to note that VA has had a Vsafe officer in place since 2023 and therefore we recommend that the bill clearly establish that Vsafe officer position in the veterans experience office to ensure that incumbent can do everything they can to help these So how does VFE currently collaborate with other efforts within the federal government to prevent fraud and scams?
▶ 0:50:48So, unfortunately, that's not a subject I have detailed information on, but I'm happy to take that question for the record and get additional information. Just curious if it will work with other existing systems to provide the best uh just protection for our veterans. And last question from Miss Waters. You know, we've been pushing for good leadership and improved processes at the VA since I've been on this subcommittee. So, how is the VA making sure these performance plans keep political appointees accountable? Um so thank you for that question.
▶ 0:51:18Obviously one of the focuses that we have overall is accountability in the organization and so I know that there have been changes that have been put into place for performance plans. Um and we are always focused on accountability. Great. And then one last question for Dr. McDonald.
▶ 0:51:40Are you aware of investigations conducted by OIG where an individual retired, resigned, or transferred to another federal agency while under investigation by the VA? Um, in terms of that being related to HR 3185, I think that some of my OIG colleagues are working with your subcommittee staff on our knowledge around and our views related to that bill. So, I would rather have them speak on that because I'm not me specifically I'm not knowledgeable about that.
▶ 0:52:08So, um, I think we should let them discuss that with your staff. That that's that's fine. Oh, and real quick, in accordance with committee rule 5E, I ask unanimous consent that Representative Barrett from Michigan be permitted to participate in today's subcommittee subcommittee hearing. Without objection, so ordered. And just one last question. From an oversight perspective, would it be beneficial for a federal agency to know if an applicant has been under prior investigation at a separate federal agency? Dr. McDonald.
▶ 0:52:39From an oversight perspective, any information we have would be helpful to our ongoing audits. Um, generally our audits are related to programmatic oversight more than specific Great. Thank you. And and I will now uh yield five minutes to the ranking member for her questions. Thank you, Chairman.
▶ 0:52:59As I mentioned earlier, our agenda today contained several bills which would authorize the VA to move forward with modernization efforts like the VA scheduling, supply chain management, and fraud, waste, and abuse detection. Modernization of the systems is absolutely critical. However, doing so without compromising the continuum of care for veterans requires thorough and careful investigation of the root problems and the potential implementation challenges. So, Dr. Dr.
▶ 0:53:28McDonald, how important is adequate staffing, clear internal processes, and assessments of previous failures when the VA moves to implement technologies like the electronic health record and the centralized supply chain solution? Sure. So, our work in different areas has found that resources, clear processes, and assessments of both failures and successes is important in implementing any updated technology.
▶ 0:53:53Um, for an example, as you mentioned in your opening statement, VA has started and stopped multiple times modernization efforts for its supply chain and inventory management because the department had not fully assessed its needs. Um, as another example, our work in EHRM has identified that a lack of a full deployment schedule and full cost estimates upfront resulted in implementation delays and challenges.
▶ 0:54:17So our perspective is that in general VA needs to make sure they assess full needs upfront, develop processes and guidance, provide training, and then also assess the effectiveness of any modernization efforts after they're implemented. Thank you, Miss McDonald. I agree with that. I appreciate that. Dr. Phillips and Miss Waters, can you commit to providing the committee with data regarding the number of staff that touch the modernization efforts we're discussing today?
▶ 0:54:42for example, EHRM, supply chain scheduling and fraud and waste and abuse monitoring who have taken the DRP who've resigned or otherwise left the VA since January 20th, 2025. Uh, yes, ranking member, we commit to taking that question for the record and providing that information. Thank you so much. And I know that I asked that also of Dr. Phillips, just for the record.
▶ 0:55:08Yes, we can take that back and we're working with our leadership on that and certainly um we will provide that information. Thank you, Dr. Phillips. It is critical our committee has updated numbers regarding the staffing of the service lines before deploying new systems. So, I appreciate that. Miss Waters, I want to come back to you. Has the VA performed an assessment of previous failures of the supply chain modernization program like DIM the DIMs and the latest solicitation last year to ensure future efforts will not be subject to the same pitfalls?
▶ 0:55:40Um, thank you for that question. We actually have performed an assessment of uh previous challenges that have happened and as we've briefed the subcommittee on previously one of the things that we're doing in the supply chain modernization effort at this point is doing a very disciplined incremental approach to ensure that we don't suffer to the large program failures that have been seen in the past.
▶ 0:56:08So can you commit to providing some more of that more more of that information to our committee before you move forward with the supply chain modernization program? Yes, we can do that. Thank you. Uh and let me ask you one last follow-up question here. Do you feel that you have addressed the challenges that if we had moved forward with this pilot to restart the effort of HR 3494 and what it calls for that it would be resolved?
▶ 0:56:32Um, so I do think again we're approaching it in a very disciplined incremental fashion to ensure uh that we don't have those challenges. Got it. And I know I only have a minute, so let me try to move through my questions quicker. Your testimony highlights challenges the VA may face in implementing Rep. Franklin's personnel integrity bill due to new programs being implemented by OPM. How would Secretary Khan's impending reorganization plans impact the modernization efforts envisioned in these bills today?
▶ 0:57:03Um, so I can't speak directly to that question on the plans. Um, as you know, the secretary has been very clear that he's working on a plan and that he will come back and brief once the plan has been Okay. Thank you, Miss Waters. And that's actually what I'm concerned about. we're waiting for these plans and what this reorganization will do and the impact while we're talking about um implementing modernization. I just want for the record that uh this is very clear.
▶ 0:57:32This is not directed at anyone in particular here, but I would be remiss if I did not share my concerns with HR 3185, the personnel integrity and veteran affairs act. I hope you can work with Rep. Kiggins and and Rep. Franklin to help make this bill better. And I would also like to ask the VA, will you commit to providing technical assistance on these bills before our markup June Would you commit to provide technical assistance? So, thank you for that question. We absolutely will commit to working and collaborating with the committee. Thank you.
▶ 0:58:02With that, I yield back. Chairman, the chair now recognizes Mr. Barrett for five minutes. Thank you, Madam Chair. Appreciate it. and uh thank you for your um uh willingness to allow me to uh participate in today's hearing and to panelist thank you.
▶ 0:58:16I wanted to speak with you about um a bill that I introduced the fraud act which is uh before us today um which would require the VA to acquire an IT system to improve the department's ability to detect uh fraud or waste or overcharging or over billing in the community care program or in um care that is done outside the VA. Um, wanted to start with uh, Miss Duke for a moment.
▶ 0:58:41Um, VA's testimony on the fraud act stated that the savings generated from preventing overpayments would quote more than pay for the technology and services end quote. I was very excited to see that. I think we should get like a refund for introducing the bill. Um, but uh, with that being the case, can you explain how the VA came to that conclusion? Is it a little bit of perhaps self-awareness about the the process right now and how you kind of reached that conclusion?
▶ 0:59:05So I I believe that that's based on um comparing our experience to private sector um standards of recruitment. Um because we would intend to pursue such a system through our revolving funds, the idea would be that the revenue generated would ultimately pay for the investment. Okay. Um no, that's uh that's very encouraging and I appreciate that.
▶ 0:59:29Um, I also know that um the bill does not include any uh authorities for monetary penalties or or fines or or things of that sort in a in a penalized fashion against providers who submit fraudulent claims. Is that an an authority that the VA would like but doesn't have presently? I I guess it was my thought in in drafting the bill the way we did that that would fall under more of a like enforcement agency and less on the VA.
▶ 0:59:56So I would the challenge is that a lot of times we are not well equipped to identify the intent that is necessary to constitute fraud. Okay. What such a system would do is help us identify where there are overp payments to focus recruitment attempts. I think we would defer to um the department of justice or others to investigate fraud. Okay. No, I uh I appreciate that. Um and then uh Dr. McDonald.
▶ 1:00:23Um, uh, could you just walk me through, um, basically how many community care claims does VA process for payment on an annual basis? And if you have any examples of fraud or waste that you've identified and what the department would need to look for as a most problematic um, likelihood of of Sure. Sure. Um, I'm just opening my binder here.
▶ 1:00:50So, um it's going to vary year to year, but um for example, for the one-year period where the program integrity tool, and this is just this one year because I have it in front of me, was down, the community care, um number of claims that were processed, so they weren't able to be run through the program integrity tool for co-ayments was about 40 million. Um and the dollar amount attached to that was about 28.6 billion.
▶ 1:01:17Uh 28.6 6 billion in total community care, not suspected fraud. Correct. Correct. Yeah. Okay. And then do you have any ballpark figure of fraud or do you have any examples for us of things that went through the system until a more manual process was done to to determine that they were fraudulent? So things that our investigators look for when they're looking for fraud is they look to see if there are duplicate payments to providers for the same service.
▶ 1:01:43They look to see if providers are providing services to different veterans or in different locations in the same day. And so, um, they would have before the program integrity tool went offline used data from that to do that. Um, when it was offline, they were able to use the actual claim payment data to keep doing that. Okay. Thank you.
▶ 1:02:03I know we've seen examples of Medicaid fraud by providers in you know certainly that's done mostly at the community level whereas the VA is so predominantly within the the VA facilities and then the community care augments that uh knowing examples of just even Medicaid fraud that's taken place and other fraudulent billing and other things of that sort. I think it really does drive home the point of things that we need to be mindful of and recognizing.
▶ 1:02:30And I also think that the deterrent effect would hopefully also make itself worthwhile. So that if a provider knows that there's this, you know, watchdog agency or, you know, a system that would kind of analyze and and acrew uh risk factors that that would hopefully deter the likelihood of those events from happening. But appreciate the uh the testimony today and look forward to to working with you in pursuit of uh getting this bill done and across the finish line. So thank you, Madam Chair. Yield back. Thank you.
▶ 1:03:00So, in accordance with committee rule 5E, I ask unanimous consent that Representative Gray from California be permitted to participate in today's subcommittee hearing without objection. So ordered. And the chair now recognizes Mr. Gray for 5 minutes. Thank you, Chair Kiggins and Ranking Member Ramirez for allowing me to join you uh this afternoon to speak about my bill. I'd also like to thank the committee's ranking member, Congressman Tano, for co-sponsoring my legislation.
▶ 1:03:30My bill HR 3812, the Strive Act, would prohibit the VA from collecting co-pays from veterans in situations where the collection delay is due to the fault of the department. This includes a pause in collections, IT system failure, or an employee administrative error. This bill also provides the secretary with the authority to enter into co-pay waiverss on behalf of the veteran.
▶ 1:03:54As you may know, under current law, veterans are required to individually initi initiate a request for a waiver. That leaves the burden in the hands of the veteran. This bill rightfully places that burden on the government. No veteran should pay the cost of administrative failures or face unexpected costs when receiving care.
▶ 1:04:16That is why this bill would protect veterans from paying co-pays that are build for care that is over two years old or exceeds $2,000, including debts incurred following the pause of pharmacy co-pays with the EHRM program, the COVID copay relief expirations and other IT system Our nation has a responsibility to eliminate the barriers that stand in between veterans and their care. Dr. Mr.
▶ 1:04:43McDonald, from your role at the Office of the Inspector General, how often have you seen the IT system failures and administrative errors resulting in delayed co-pays and other financial burdens for veterans? We've seen this in our oversight work. For example, um one of the things places where we've seen this is when the program integrity tool was down, there was a delay in billing veterans for co-ayments for non-service connected care. um and it was down from February 2023 through August 2024.
▶ 1:05:13It's also our understanding that right now revenue operations is still working through the backlog of those claims. So some veterans could still experience um a delay in when they receive a bill for a co-ayment. Um and then the amount of the co-ayments they receive will vary depending on the services provided and their disability rating and income when they receive those bills. Thank you. Uh, Miss Waters, as I mentioned, our introduced text places the burden of entering into debt waiverss on the federal government.
▶ 1:05:42Do you believe this would improve consistency and fairness for veterans impacted by the departmental heirs? I'm going to defer that question to Miss Yes, thank you. Uh, we agree that there is a greater opportunity for consistency and more forwardleaning in protecting our veterans.
▶ 1:06:04I think again our concerns with the legislation included in the testimony get at making sure that the legislation is consistent and we are able to equally address veterans needs without opening the door to um perverse incentives under the policy. Thank you. Um, Miss Waters, how many veterans are impacted by these delayed co-pays from internal failures and errors like the pit pause and the EHRM pharmacy co-pay issue?
▶ 1:06:33Or Miss Duke, do you want to take that? I I'll I'll take that one. Um so um we we don't know the full number until we've fully ingested all of the data from the pit paws because um one of the things that we are working our way through is whether or not the veterans who have received care are liable for co-ayments or whether they're exempt.
▶ 1:06:56Um but I've I've been shown data that uh suggests over 85,000 veterans uh were impacted uh with the pit pause. That sounds consistent with what we've seen. Okay. Thank you. Uh to me, this data further emphasizes the need for this critical legislation. Veterans should not face barriers to care they have rightfully earned at a time when the administration uh seems focused on fraud and abuse. Reckless cuts often make the bureaucratic process even worse.
▶ 1:07:26This bill is an example where the burden is placed on the federal government to make veterans lives easier. And uh that really should be the gold standard in my opinion for reform. I look forward to continuing this conversation with the Department of Veteran Affairs to ensure this legislation addresses both the agency and veteran needs. And with that, uh I yield back. Thank you very much. And with that, the first panel witnesses is now excused. And I'd like to invite the second panel of witnesses to come forward.
▶ 1:09:14Thank you and welcome to our second panel. We will hear today from the following witnesses. Mr. Cole Lyall, the director of the veterans affairs and rehabilitation division in Washington DC office of the American Legion and Mr. Cody Carbone, the director of government relations at the digital chamber and Mr. Edward O'Brien of the Medical University of South Carolina. I would now like to welcome you all and also ask you to stand and please raise your right hand.
▶ 1:09:43Do you solemnly swear the testimony you are about to provide is the truth, the whole truth, and nothing but the truth. Thank you. You may be seated and let the record reflect that all witnesses have answered the affirmative. Thank you all for your attendance and testimony this afternoon. Mr. Lyall, you are now recognized for five minutes to deliver your testimony on behalf of the American Well, thank you uh Chairwoman Kiggins, Ranking Member Ramirez, and distinguished members of the subcommittee. On behalf of National Commander James Lorsier Jr.
▶ 1:10:13and the more than 1.5 million dues paying members of the American Legion, thank you for the opportunity to testify today on pending legislation. It is an honor to represent an organization that for over a hundred years has stood as a voice for America's veterans, guided by grassroots resolutions passed at the local post level and elevated through our national convention.
▶ 1:10:33Today, the American Legion supports nearly all the bills under consideration because they reflect a bipartisan commitment to strengthening accountability, improving access, and safeguarding the dignity of those who have worn the uniform. First, we strongly support HR 984, which provides equitable relief to veterans harmed by administrative errors. With the implementation of the PACT Act and record volume of claims submitted, the risk of human error has grown.
▶ 1:11:01Veterans should not bear the financial and psychological burden for mistakes beyond their control. The American Legion in 2024 alone facilitated nearly 25 million in debt relief. We know firsthand the impacts these errors can have. We also support HR1663, the Veteran Scam and Fraud Evasion or Vsafe Act. Veterans are 40% more likely to be targeted by financial scams and many fall victim due to unique vulnerabilities tied to military service.
▶ 1:11:29Creating a dedicated fraud officer at VA is not only overdue, it's essential. Veterans deserve the same protections afforded to consumers in the private sector. On accountability, the Legion backs HR 3185, which ensures that VA employees under investigation for misconduct cannot simply retire or transfer without consequences. This legislation rightly balances due process with the need to maintain trust in the VA workforce. We must hold ourselves to the same standards of honor and integrity we expect from those we serve.
▶ 1:12:01We also commend efforts to modernize and streamline access to care. HRs 3482 and 3494 address long-standing problems with community care scheduling and inventory management. Problems that continue to delay care and waste taxpayer dollars. These bills harness smart technology to serve veterans more efficiently and safely. While we support these bills, uniform training for VA staff, particularly for scheduling, will prove vital to ensure successful and effective implementation across the enterprise.
▶ 1:12:32The Legion would also recommend VA schedulers have the ability to provide veterans with an applesto apples comparison of weight times in conversations with the individual With regard to electronic health records, the American Legion supports the draft legislation to modernize the VA's EHR system. The past two decades of failed attempt and fragmented leadership have cost time, money, and trust.
▶ 1:12:55Many of this bill's provisions, including the establishment of a baseline for standardized clinical work, clinical workflows, develop clearly defining leadership roles, and securing personal data, will go a long way towards program sustainability and successful deployment at future sites. Finally, we support legislation that prohibits co-pay collections from veterans when the delay is the VA's fault.
▶ 1:13:19With recent extended pauses to VA collection of co-pays in EHRM pharmaceuticals and the program integrity tool, many veterans are receiving delayed bills in the thousands of dollars, which creates financial hardship on those with fixed incomes. Veterans should not receive a bill years after receiving care due to internal system delays or administrative error. Chairwoman Kiggins, Ranking Member Ramirez. Our veterans do not ask for special treatment.
▶ 1:13:45They only ask for the care and benefits they earned delivered with competence, integrity, and compassion. The bills under discussion today move us closer to that standard. The American Legion is proud to support these efforts. Thanks to subcommittee for its advocacy on behalf of our nation's veterans, and I look forward to answering your questions. Thank you, Mr. Lyle. The written statement of Mr. Ly will be entered into the hearing record.
▶ 1:14:11In accordance with committee rule 5E, I ask unanimous consent that representative Maize from South Carolina be permitted to participate in today's subcommittee hearing without objection. So ordered. Mr. Carbone, you are now recognized for five minutes to deliver your testimony on behalf of the digital chamber. Chairwoman Kiggins, Ranking Member Ramirez, and distinguished members of the subcommittee, thank you for the opportunity to testify before you this afternoon.
▶ 1:14:38My name is Cody Carbone and I proudly serve as the CEO of the Digital Chamber. The Digital Chamber is a nonprofit trade organization committed to promoting blockchain adoption. We envision a fair and inclusive digital ecosystem where everyone has the opportunity to participate. I am here today on behalf of our membership representing over 200 companies across the globe.
▶ 1:15:01We sincerely appreciate the subcommittee's interest in harnessing emerging technologies to advance to enhance the services provided to those who have served our nation. Congresswoman Nancy Mace has introduced HR 3455, the Veterans Affairs Distributed Ledger Innovation Act of 2025, directing the US Department of Veterans Affairs to study how blockchain technology can revolutionize the delivery of veterans benefits and Her efforts highlight bipartisan recognition that
▶ 1:15:31outdated 20th century systems are failing our veterans and that modern tools like blockchain must be explored. Modernization cannot wait. Blockchain has the potential to transform the VA. The VA possesses a commendable history of innovation ranging from the pioneering implementation of electronic med electronic medical records to recent advancements in cloud computing and artificial intelligence.
▶ 1:15:57However, many of the legacy systems that once placed the VA at the cutting edge are now straining under 21st century demands, leading to slowing claims, fragmenting health records, and leaving veterans to navigate a maze of paper and outdated portals. The VA provides critical benefits and care to a community of nearly 17 million US military veterans along with their families and survivors.
▶ 1:16:23Ensuring that these veterans receive efficient, transparent, and reliable services must be a national priority. We stand at a moment when the digital revolution can be utilized in the service of those who served us. What is blockchain? Blockchain is not a buzzword or a speculative asset. its infrastructure, a digital ledger that can secure records, automate trust, and facilitate coordination across silos without requiring central gatekeepers.
▶ 1:16:52In practice, that means a veteran doesn't have to submit the same paperwork three times to three different agencies. Their medical records are available available where and when they need them without compromising privacy. Benefits are paid on time with audit trails that prevent fraud and ensure accountability. Credentials, discharge documents, and proof of service can be cryptographically verified in seconds. This isn't theory.
▶ 1:17:19These are real world applications already working in financial services, health care, global supply chains, and even some government settings. What's missing is the commitment to apply these tools where they're most needed. While blockchain presents solutions, it is crucial to note that blockchain is not a cure all. Implementing innovation requires careful planning. The digital chamber and industry partners are ready to assist and share expertise as the VA and Congress explore these applications.
▶ 1:17:50HR 3455 is a prudent first step in identifying high value opportunities and addressing any associated risks with the deployment of blockchain technology at the VA. It is a necessary step toward ensuring the VA's technology matches its mission to care for those who have borne the battle. In conclusion, chairwoman, I would like to express my gratitude to you and the subcommittee for your exemplary leadership in examining emerging technologies related to veteran services and opportunities to reduce government waste.
▶ 1:18:21I am appreciative of the opportunity to provide testimony today on this significant matter. I am prepared to respond to any questions or inquiries and to continue collaborating with you and the subcommittee in an effort to improve the systems that support our veterans. Thank you. Thank you, Mr. Carbone. The written statement, the written statement of Mr. Carbone will be entered into the hearing record. Dr. O'Brien, you are now recognized for five minutes to deliver your testimony on behalf of the Medical University of South Carolina. Uh, thank you for having me.
▶ 1:18:49Thank you to the committee and thank you to the veterans in attendance. Um, my name is Dr. Edward O'Brien. I am associate professor of medicine at the medical university of South Carolina. Prior to this role, I had the privilege of serving as an attending physician for six years at the Ralph H. Johnson VA Medical Center and also in Charleston, South Carolina, where also completed some residency training. Uh, this hearing is deeply personal to me. The Ralph H. Johnson VA Medical Center is named in honor of a Marine who gave his life in Vietnam to save my uncle, Lieutenant Kh McCclary, also a proud Marine.
▶ 1:19:18My grandfather and father also served in the United States Marine Corps. The bond I feel with the veteran community is not only professional, it's personal. Over the past 15 years, I've worked at the intersection of VA and academic medicine, and I've seen firsthand how critical it is to maintain strong, stable, and streamlined relationships between VA medical centers and their academic affiliates. The partnerships between the VA and institutions like MUSC are essential for delivering the best possible care to our nation's veterans.
▶ 1:19:46The bills under consideration today would enhance those connections and ensure that veterans receive timely, highquality care, whether within the VA or in the community setting, specifically to HR 3482. This bill creates a direct digital scheduling link between the VA and community providers. I've seen the benefits of this model firsthand. By incorporating MUSC's specialist directly into the VA scheduling platform, we've drastically reduced delays in consults and increased transparency for both patients and care teams.
▶ 1:20:17Allowing VA staff to view and book community appointments will empower schedulers, reduce weight times, and improve outcomes. Our VA system, including Congresswoman Mesa's district, has shown excellent results, as highlighted below. We've built a strong academic affiliation with the Ralph H. Johnson VA. We've started utilizing the EPS system roughly January 2024, but have really ramped up only within the last 6 months.
▶ 1:20:42As of May 2025, we've scheduled a total of 1,863 appointments utilizing the EPS system. Of those, 34% have been scheduled appointments at our system at MUSC. The Ralph Hates Johnson VA center currently utilizes EPS to schedule directly into 26 subsp specialties at MUSC in real time. I won't go through all the specialties, but the highlights are the majority of the specialies are orthopedics, hematology, oncology, a lot of specialties you might consider.
▶ 1:21:10Data shows for the Charleston veterans who are eligible for and elect to utilize community care, scheduling the community care appointment through EPS reduces veteran weight time by an average of 8.8 On average, this weight time is reduced by 33% for all sites using EPS for community care within our area scheduling versus traditional community care scheduling, which involves calling, In my time at MUSC and the Ralph H.
▶ 1:21:39Johnson VA Medical Center, I've cared for thousands of veterans. When the VA collaborates well with local academic affiliates, veterans receive coordinated, specialistdriven, highquality, timely care. These legislative proposals all share a commitment to that mission, modernization, accountability, integrity, and faster access to care. Thank you for the opportunity to advocate for these important reforms and I stand ready to assist the committee or answer any questions as well. Thank you, Dr. O'Brien. The written written statement of Dr. O'Brien will be entered into the hearing record.
▶ 1:22:09We will now proceed to questioning and I recognize myself for five minutes. Mr. Ly, what is a recent example of a more sophisticated and complex scam towards veterans that the American Legion is aware of? Thank you, Chairwoman McKiggins. Um, I could take that for the record and get back with uh a specific case or two.
▶ 1:22:32Uh, I will say that the FTC has noted a recent uptick in identity theft and other forms of financial crimes uh in the military and veteran communities. Um, I will also just note that per the Consumer Sentinel Network data book, uh, most recent report released this year, the military community lost 25% more by scammers, uh, for year 2024 than the year before, totaling up to a $584 million loss.
▶ 1:23:02Do you hear from your members that they are actually receiving information from the VA about how to prevent or protect themselves from these this type of pro of fraud and the prevention efforts that the VA has in place? Are they receiving that information? I'll have to take that for the record. Just curious if they're at least aware of of some of the efforts. Uh could you explain the Legion's position on what improved accountability measures at the VA would do for Veterans Trust?
▶ 1:23:31I think um generally speaking, we we want a VA that is accountable uh to the veterans that they served. I think the Legion has historically supported multiple efforts to increase accountability uh at the VA.
▶ 1:23:47There have been uh many instances, again I can follow up and provide specific cases where legionnaires across the country um have experienced issues with VA providers uh who were then transferred uh to another facility or they were given another appointment with another VA provider because of those issues, but I can follow up with specifics.
▶ 1:24:11Is there anything that the American Legion specifically is doing for veterans to prevent them from being victims of frauds or do you refer them to a certain organization if they come to you with these problems? We have uh several thousand veteran service officers across the country who routinely interact with veterans on the ground at the local post level uh to help them identify resources obviously to help prevent the fraud before it happens in the first place.
▶ 1:24:38Identify scams uh but then also again if they fall victim to one of these scams work with the VA to provide relief for that or uh debt waiverss for for veterans. Does the VA have a reporting system where or a database that you can report uh to the Department of Veteran Affairs so that they can be on the lookout for these potential scams that may be affecting other localities as well?
▶ 1:25:02I know the VA routinely puts out uh information for veterans, you know, in in multiple different ways. Uh I am not aware of a specific database, but I can take that for the record as well. That would that would be another good idea for us to think about. But thank you. And then a last question for Mr. Lyall. Does it concern you that the OIG has characterized the VA's national ordering system as unsustainable? And how does this contribute to waste, fraud, and abuse at the VA?
▶ 1:25:29Uh, I think the I believe you're referring to HR 3494 uh with the OIG complaints. Um there have been multiple instances particularly in I think the medical center in Houston um across the country of of waste and abuse in the supply chain.
▶ 1:25:51Uh, and I think this bill in particular, one of the reasons we support it is, as the VA noted, I think the savings that the VA would garner based on the implementation of this bill uh to prevent that level of of waste and abuse in the supply chain system uh would not only benefit taxpayers, but veterans themselves because oftent times you see uh some of these supply chain issues can lead to delayed surgeries or I agree.
▶ 1:26:20And let's see. I will now yield five minutes to the ranking member for her questions. Thank you, Chairwoman. I'm thankful um to the witnesses that are here with us today and even more thankful Representative Gray was able to join us today as he's the sponsor the only one Democratic bill on today's agenda and one that seeks to alleviate unnecessary financial burdens that may serve as a barrier to veterans healthcare access. Dr.
▶ 1:26:50O'Brien, I have a question for you. Your testimony highlights research to this point. How might waving co-pays in certain situations increase healthcare utilization for vulnerable populations? Uh, thank you for the question. I've I've seen firsthand a lot of patients not fill prescriptions because of co-pay concerns, you know, not not um seek care, not seek specialist care.
▶ 1:27:14And so that's a that's a real issue, you know, and that the whole concept of co-pays obviously was put forth kind of to decrease utilization back in the day, you know. And the second aspect was to have other people have skin in the game, right? My concept is I think the veterans already have the skin in the game by serving. So the the more we can do to get rid of the co-pays for the veterans, I think the better. I agree with that. Thank you, Dr. O'Brien. Mr. Lao, thank you for joining us today again. Um, as our VSSO representative, I was happy to see the American Legion support HR 3812.
▶ 1:27:45What impact would the passage of the Strive Act and the reduction of delayed co-ayments have for the Legion's membership? Well, thank you, Ranking Member Ramirez. I appreciate the question. Uh, the American Legion uh has multiple overseas departments uh that we have conducted system worth saving visits, regional office action, review visits of different sites, identify best practices, talk about the biggest challenges so they don't become systemic issues.
▶ 1:28:15uh and I think the ability to uh provide care in those remote areas uh would be strengthened by provisions in this particular bill. Particularly considering that in some areas uh in Puerto Rico, for example, the uh staffing for VA providers at those facilities have decreased by I think 40% after those those incidents.
▶ 1:28:41So, I think uh it could help significantly for delivery of care. Great. Thank you, Mr. L. I have another follow-up question for you. The discussion draft to modernize the electronic health record before us maintains language that prevents the inappropriate use or monetization of veterans protected health information or we say PHI because we love acronyms um and personalized identified uh identified information.
▶ 1:29:07So my question to you is how important is it that this language remain in this bill and could you elaborate on the significance of protecting veteran data and its implications for the American Legion's Absolutely. Thank you uh again ranking member Ramirez. We just had a conversation about the increased likelihood of veterans to be taken advantage of by scams.
▶ 1:29:29Obviously, the increased uh or the not protecting veteran data data increases the likelihood that their personally identifiable information, particularly in healthcare, could get misused uh and and and uh negatively impact not only their healthcare and benefits delivery, but their psychological care uh and stress that they would undergo from from their data being sold to to third parties. Yeah. No, thank you for that.
▶ 1:29:58I just want to note before I ask a couple more questions, I agree with you. It's extremely important that as we move forward with modernization efforts that we ensure that we're protecting all of the information of our veterans, especially in this instance when to your point, they're constantly um victims of a a number of scams and frauds and especially some of our senior veterans who are experienced this on a regular basis. So, thank you for that. Dr. O'Brien, I want to come back to you.
▶ 1:30:24I was impressed to see the work that the VA and the Medical University of South Carolina have performed in decreasing scheduling weight times utilizing the external provider scheduling system. One of the challenges we've heard with the some of the EPS sites is the awareness and engagement aspect with community providers. How many MUSC medical University of South Carolina providers are engaged and sharing their scheduled their schedules with VA?
▶ 1:30:50So, prior to this May, there was about a hundred, but we added 300. So, now there's about 410 or 15 currently. 4 and what? About 415 providers currently. Got it. And so, one last follow-up question for you. How might the department improve their outreach efforts into the community care provider network to ensure success in the scheduling tool? That's a great question. I I uh the fact that I'm kind of in charge of this veterans aspect and wasn't unaware of it.
▶ 1:31:19um is interesting. Um so I think maybe even having a liazison to go to at least to these large academic centers right in these states where the most of the doctors are concentrated and at least provide awareness there to start makes the most sense I think. Thank you Dr. O'Brien. Chairwoman I yield back. The chair now gives five minutes to Mr. Barrett for questions. Thank you madam chair and uh to the panelists. Thank you for being here today.
▶ 1:31:44Um I wanted to uh discuss with you bill that I introduced the veterans community care scheduling improvement act. Um this would really uh I hope benefit veterans on the community care side who are looking to schedule appointments in a timely manner. Um I have the privilege of chairing the uh subcommittee on technology and modernization. We heard testimony about this and how it's inconsistent throughout the VA and that it's not widely um rolled out in as many um uh VA hospitals as we would like.
▶ 1:32:13leading to inefficiencies with how veterans will schedule care that they are required. Sometimes that'll be most timely and efficient within the VA network. Other times it will be more timely and efficient outside and might be closer to home and whatnot through the community care program. Um Dr. O'Brien, I wanted to start with you for a moment.
▶ 1:32:34Uh you mentioned in your testimony that um EPS cut down veteran wait times um by nine days in the area that you serve. Uh can you tell us how that has worked and what the kind of success is attributed to? Sure.
▶ 1:32:50I think the first I would say avenue of success has been we have a really great system or team at the VA themselves who we work directly with who I used to work with in the emergency department actually group of nurses who are aware of the amount of providers that we have at MUSC and as we've added providers to the system there's more opportunity to schedule veterans geographically andor by specialist within our system and um I know that this is a a two-way street where the VA has the scheduling ability.
▶ 1:33:21They have systems that will allow them to see the availability on the provider side outside of the VA and there has to be some reciprocal sharing of information that way. Did you find that process to be difficult at all for for you know for your organization as you were trying to to get this done? I would say the the new process that I'm familiar with is a million times better than the than the old way fax machines. We were physically taking paperwork back and forth before. Okay. Thank you.
▶ 1:33:50Um and then based on what you've seen, um do you believe the VA should be required to track how much time and money is saved with tools like EPS? Yes. Okay. Would uh setting performance goals help hold the department accountable in your opinion? I think so. Okay. Very good. Thank you. Uh Mr. Lyle, appreciate you being here. I'm a life member of the American Legion. Invite you out to Howell sometime in my district. We have a great post there and uh we'd love to have you sometime as a guest. Um, and thank you for the American Legion support of this bill.
▶ 1:34:20Uh, do you believe veterans would get faster care if VA schedulers not only um and not just the contractors that set these appointments had the tools to book appointments directly with outside providers? Uh, yes. Short answer to that question. Uh, scheduling since the uh mission act has been one of the main challenges of implementing community care.
▶ 1:34:43Obviously the VA in this bill particularly I was the American Legion was encouraged to see that the secretary could utilize an already existing u contract and we are aware of of the EPS contract wellhive being deployed that has been very successful as I pointed to in the opening statement. I think uh the implementation just requires increased communication with new areas to ensure that providers are trained to be able to use the system.
▶ 1:35:12But uh very encouraging data and results from that program and I think it helps eliminate one of the main issues with community with the community care program. Yeah, I had a referral myself for a u aiology appointment through the VA not long ago and uh a provider a a vendor called because it got out basically outsourced uh from the VA and uh they asked me my availability. I gave them some times.
▶ 1:35:40Of course, I travel back and forth here to Washington most weeks and I had dates that I was not available back home. And I gave them those dates I wasn't available. And they called me back, I don't know, the next day and scheduled me an appointment on a date I wasn't going to be in Michigan. That necessitated me to then call into the call line. I'm, you know, clogging up the phone lines for somebody else that also wants to call in and schedule something inefficiently. And I told them my situation. They said, "Oh, well, we couldn't accommodate your scheduling request. So, our process we follow is we just give you the next available appointment.
▶ 1:36:10I'm like, well, the next available appointment on a day I'm 600 miles from home doesn't actually accommodate the needs that I have. It's not about, you know, scheduling me the next available. It's finding the time that works for me. And it was a very inefficient methodology that kind of in a personal sense exposed some of this that I was able to see. And I'm hopeful through doing this bill and the the follow through with that that it will help um, you know, prevent that inefficiency from from becoming too problematic for other veterans.
▶ 1:36:36So with that, I am out of time and Madam Chair, I yield back and appreciate the ability to to ask questions today. Thank you. The chair now recognizes Miss Mace for 5 minutes. Um, thank you, Madam Chair, for allowing me to wave on to this hearing today. And I want to thank you to our witnesses who are appearing before our veterans affairs subcommittee.
▶ 1:36:55Um, distributed technology like blockchain has the potential to create an unchangeable auditable trail of interactions, allowing VA systems to verify claims more efficiently, reduce duplicate records, and track services and payments with precision. If leveraged properly, this could mean faster, more accurate decisions, and reduced costs.
▶ 1:37:13My bill HR 3455, the Veterans Affairs Distributed Ledger Techn in Innovation Act, would direct the Secretary of Veterans Affairs to study how distributed te ledger technology like blockchain could improve the veterans claims adjudication process and help prevent waste, fraud, and abuse in the administration of veterans benefits. We owe it to our vets to process their claims quickly and efficiently. We also owe it to our citizens to ensure their money is spent wisely.
▶ 1:37:40This bill would examine how leveraging distributed ledger technology such as blockchain could help us meet both of these objectives. I want to extend a special thank you to the medical University of South Carolina, Dr. O'Brien, for being here today. MUSC's work in South Carolina has a tremendous impact on our veterans and on our state. MUSC is one of the premier academic and healthc care institutions in the country and continues to set the bar for patient care, research, and training. Appreciate your work at the Ralph H. Johnson Medical BA Center.
▶ 1:38:09I have family who uh have been treated there for years and they do a fine job of protecting our veterans. I will readily admit even as a daughter of a veteran, I don't always know what programs are available to my family members and so we do have some work to do. Um so my first question is going to go to Mr. Carbone today.
▶ 1:38:26Why should Congress consider distributed ledger technology for modernizing veteran services and how does it compare to the leg legacy systems that are in play Thank you for the question, Congresswoman, and thank you for your leadership on this bill. I think you said it best. Veterans deserve our best, and the legacy systems, frankly, just haven't met the moment. And we've seen that with some of the delays in some of the GI Bill processing benefits. Right now, legacy systems are siloed.
▶ 1:38:53They're fragile, and they're unable to scale with the modernization that the VA needs. What blockchain can do is cut down on some of those silos, and it can cut down on some of those central points of failure. It puts everything on a unified shared ledger that is transparent and auditable and I think it'll really help automate the processes we have today. What about fraud and abuse? How can we use blockchain to reduce the amount of fraud abuse? Well, it's one of the beauties of blockchain.
▶ 1:39:19It's immutable and it's transparent and so it is almost impossible to have fraud on there. those those different instances of fraud or abuse will be checked immediately and there will be multiple people who have access to the distributed ledger to understand where they're coming from and to cut those immediately. So explain to those who may not be familiar with blockchain technology how is it impossible?
▶ 1:39:40So when there's a input to the distributed ledger that goes and every single node or computer that has access to the technology sees that that input has been made. So it is audible and transparent at the same time. if there is any other additional input or is there any falsified record, every single person who has access to the network would have to confirm that that input is legit.
▶ 1:40:03And so if you have, you know, the only way to really tamper with the blockchain or to submit some kind of fraudulent claim is if every single person who has access to the network and everyone who has oversight across the VA decides that that was an accurate input. Okay, great. And then I have um a question for Dr. O'Brien. Can you speak to some of the innovative ways MUSC is improving care for our veterans in South Carolina? Oh, sure.
▶ 1:40:26Um, I would say one big one is um we're building uh we have a comprehensive cancer center and we're uh expanding the geography of our cancer center throughout the state to be within the geographic radius of where our veterans are needed. I think that's one of the big ones. Great. And I have one minute left. So, I'm going to ask a question, the same question of all three of you. If there's one thing that you could do today for our veterans, just one thing, can be small, can be big. What is the one thing you would do? Dr. O'Brien, you're first. It's a trick. It's not a trick question. Boy. Well, one thing.
▶ 1:40:56Might get in trouble for this. I'd probably give him the world's greatest insurance. Mr. Lyall, u the American Legion testified in our legislative priorities that we would like to see the VA's approach to suicide prevention change and not be just through the lens of mental health because suicide is not always just a mental health problem. It's usually a conglomeration of different issues. Uh so big picture, change how we look at at suicide and adjust programs accordingly. Mr.
▶ 1:41:26Carbone, pass modernization legislation to ensure that benefits are paid out within seconds and minutes and not days, weeks, and months or years or years. Thank you, Madam Chair, and I yield back. Thank you very much. And thank you to all of our witnesses for attending this hearing and providing testimony to improve several of these bills. I appreciate the comments and suggestions from both the first and second panels.
▶ 1:41:49As I said previously, our work on the subcommittee relies on dialogue and consultation with the experts who have immediate insight and how into how these legislative fixes will impact veterans lives. Thank you to our colleagues from the technology and modernization subcommittee for their great work in improving the digital infrastructure at the VA. Finally, thank you to the members who waved on for this legislative hearing to speak about their bills and the importance of getting things right for veterans. I look forward to further discussions on how we may continue to improve the proposals that we received testimony on today.
▶ 1:42:18With that, I yield to the ranking member for her closing statement. Thank you, Chair Kiggins. And I want to thank all of the um witnesses that were here in both first and second panel. All the testimonies today, especially VAS, point to this committee needing to have more conversations on these bills before they're ready for advancement.
▶ 1:42:36These programs from the electronic health record and supply chain to appointment scheduling and fraud, waste, and abuse detection are too critical to VA's operations and our veterans quality of care for us to rush forward with incomplete plans. We, as a committee of jurisdiction, must sit down with stakeholders and make the necessary changes to ensure each one of these bills is ready for the VA to implement soundly and as effectively as possible.
▶ 1:43:03I hope we can find time to have these conversations before the markup this legis before we mark up this legislation. And I do appreciate um the followup that I'll be getting from the VA on a number of items that I requested in the first panel. With that, chair, I yield back. Thank you again to our witnesses for being here today. I ask unanimous consent that all members shall have their shall have five legislative days on which to revise and extend their remarks and include any extraneous material. Hearing no objections.
▶ 1:43:33So ordered and this hearing is now