Well, beyond the exorbitant amount of money we're spending on both agencies, of course. But regarding the difficulties we've had, if we had leadership that was interested in solving problems, it's actually a pretty simple task--certainly one that after years of delay ought to be done. More or less, it's called a "process audit", and every ISO certified organization--and yes, this would include hospitals like those run by the VA, and yes, it would also include service (or malservice as it were) organizations like the IRS.
How is it done? Well, you either select a customer at random, or use the case file when you have complaints, and you walk through the process and see how well the records match what's supposed to happen. If you find that something is wrong, that is a "finding". "Findings" are divided into "minor" and "major" findings, and falsifying records is always a major finding that calls for clear corrective action. If a major finding is uncorrected after a year, that is grounds for the accrediting agency to revoke accreditation--and that, in turn, is grounds for firing managers.
Now since there are auditing agencies that work with the IRA and VA, and they did note the problems for the VA as far back as 2009. What do we conclude?
Well, either the Obama administration has nobody on staff that understands basic process audits, or they have intentionally prevented major findings from being corrected. Given that these issues (and many others are dragging on with significant noncompliance in terms of providing requested information to Congress, you know what my guess is.
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