106VA17

Categories of individuals covered by the system:
The following categories of individuals will be covered by the system: (1) Employees, (2) veterans, (3) third parties such as contractors who conduct official business with the Veterans Health Administration (VHA), and (4) subjects of complaints and complainants. Complainants are individuals who have reported a possible violation of law, rules, policies, regulations, or external program requirements, such as third-party payor billing guidelines.

Categories of records in the system:
Records (or information contained in records) in this system include allegations made by individuals calling VHA's Compliance Line, or through another source, to report a possible violation of law, rules, policies, regulations, or external program requirements such as third-party payor billing guidelines. Records also may contain reports of the reviews or investigations conducted at the medical center, VISN, or Headquarters level to verify the reported allegations and take remedial action as needed. The VHA Compliance Office will maintain a copy of these reports. Information in this system regarding reports of suspected non-compliance may include: (1) The name, home and work address and phone number of the complainant; (2) the name of the subject of the complaint; (3) the name and/or patient number of veteran patient who received services associated with the complaint; (4) the date when the allegation was reported; (5) the date, location and nature of the alleged wrongdoing; and (6) the Compliance Office's identification number assigned to the case. The records may also include correspondence between the Compliance Office and the Compliance Line contractor as to the status of each case (open or closed).

Information in the investigation records may include: (1) The name of the subject of an investigation; (2) the names of individuals whose work was reviewed as part of the investigation; (3) the names and/or patient numbers of veteran patients whose medical records were reviewed in order to investigate the allegation; (4) the station at which an investigation took place; (5) the time period when the investigation took place; (6) the nature of the allegation; (7) the outcome of the investigation; (8) the recommended action; and, (9) the Compliance Office's identification number assigned to the case. Information may be in the form of a narrative summary or synopsis, exhibits, or internal documentation and memoranda.

Records in the system will be a combination of computerized files and paper files. Both paper and electronic records may contain the information listed above, and may relate to complainants and subjects of complaints.

Authority for maintenance of the system:
Title 38 United States Code, section 501.

Purpose(s):
The purpose is to establish a process to receive reports of suspected compliance violations, and to maintain a system to respond to such allegations.

Routine uses of records maintained in the system, including categories of users and the purposes of such uses:

1. The record of an individual who is covered by this system may be disclosed to a Member of Congress or staff person acting for the member when the member or staff person requests the records on behalf of and at the request of that individual.
2. Any information in this system may be disclosed to a Federal agency, upon its official request, to the extent that it is relevant and necessary to that agency's decision regarding: the hiring, retention or transfer of an employee, the issuance of a security clearance, the letting of a contract, or the issuance or continuance of a license, grant or other benefit given by that agency. However, in accordance with an agreement with the U.S. Postal Service, disclosures to the U.S. Postal Service for decisions concerning the employment of veterans will only be made with the veteran's prior written consent.
3. Any information in this system may be disclosed to a State or local agency, upon its official request, to the extent that it is relevant and necessary to that agency's decision on: The hiring, transfer or retention of an employee, the issuance of a security clearance, the letting of a contract, or the issuance or continuance of a license, grant or other benefit by the agency; provided, that if the information pertains to a veteran, the name and address of the veteran will not be disclosed unless the name and address is provided first by the requesting State or local agency.
4. Any information in this system, except the name and address of a veteran, may be disclosed to a Federal, State or local agency maintaining civil or criminal violation records, or other pertinent information such as prior employment history, prior Federal employment background investigations, and/or personal or educational background in order for VA to obtain information relevant to the hiring, transfer or retention of an employee, the letting of a contract, the granting of a security clearance, or the issuance of a grant or other benefit. The name and address of a veteran may be disclosed to a Federal agency under this routine use if this information has been requested by the Federal agency in order to respond to the VA inquiry.
5. Any information in this system, except the name and address of a veteran, which is relevant to a suspected violation or reasonably imminent violation of law, whether civil, criminal or regulatory in nature and whether arising by general or program statute or by regulation, rule or order issued pursuant thereto, may be disclosed to a Federal, State, local or foreign agency charged with the responsibility of investigating or prosecuting such violation, or charged with enforcing or implementing the statute, regulation, rule or order issued pursuant thereto.
6. The name and address of a veteran, which is relevant to a suspected violation or reasonably imminent violation of law, whether civil, criminal or regulatory in nature and whether arising by general or program statute or by regulation, rule or order issued pursuant thereto, may be disclosed to a Federal agency charged with the responsibility of investigating or prosecuting such violation, or charged with enforcing or implementing the statute, regulation, rule or order issued pursuant thereto, in response to its official request.
7. The name and address of a veteran, which is relevant to a suspected violation or reasonably imminent violation of law concerning public health or safety, whether civil, criminal or regulatory in nature and whether arising by general or program statute or by regulation, rule or order issued pursuant thereto, may be disclosed to any foreign, State or local governmental agency or instrumentality charged under applicable law with the protection of the public health or safety if a qualified representative of such organization, agency or instrumentality has made a written request that such name and address be provided for a purpose authorized by law.
8. Any information in this system may be disclosed to the U.S. Office of Special Counsel, upon its official request, when required for the Special Counsel's review of the complainant's allegations of prohibited personnel practices.
9. The name, address, and other identifying data, including title, date and place of birth, social security number, and summary information concerning an individual who, for fraudulent or deceitful conduct either as an employee or while conducting or seeking to conduct business with the Agency, has been convicted of violating Federal or State law or has been debarred or suspended from doing business with VA, may be furnished to other Federal agencies to assist such agencies in preventing and detecting possible fraud or abuse by such individual in their operations and programs. This routine use applies to all information in this system of records which can be retrieved by name or by some identifier assigned to an individual, regardless of whether the information concerns the individual in a personal or in an entrepreneurial capacity.
10. Records from this system of records may be disclosed to a Federal agency or to a State or local government licensing board and/ or to the Federation of State Medical Boards or a similar non- government entity which maintains records concerning individuals' employment histories or concerning the issuance, retention or revocation of licenses, certifications, or registration necessary to practice an occupation, profession or specialty, in order for the agency to obtain information relevant to an agency decision concerning the hiring, retention or termination of an employee or to inform a Federal agency or licensing boards or the appropriate non- government entities about the health care practices of a terminated, resigned or retired health care employee whose professional health care activity so significantly failed to conform to generally accepted standards of professional medical practice as to raise reasonable concern for the health and safety of patients in the private sector or from another Federal agency. These records may also be disclosed as part of an ongoing computer matching program to accomplish these purposes.
11. Relevant information from this system of records related to final adverse actions taken against a health care provider, supplier, or practitioner may be disclosed to the Health Integrity and Protection Data Bank (HIPDB) (45 CFR part 61). The information to be reported includes: (1) The name and Taxpayer Identification Number (as defined in section 7701 (a)(41) of the Internal Revenue Code of 1986) of any health care provider, supplier, or practitioner who is the subject of a final adverse action; (2) the name of any health care entity, if known, with which a health care provider, supplier, or practitioner, who is the subject of a final adverse action, is affiliated or associated; (3) the nature of the final adverse action and whether such action is on appeal; and (4) a description of the acts or omissions and injuries upon which the final adverse action was based, and such other information as the Secretary, Department of Health and Human Services, determines by regulation is required for appropriate interpretation of information reported. Information reported will be considered confidential and shall not be disclosed except as specified in the HIPDB regulations.
12. Disclosure of relevant information may be made to individuals, organizations, private or public agencies, etc., with whom VA has a contract or agreement to perform such services as VA may deem practicable for the purposes of laws administered by VA, in order for the contractor or subcontractor to perform the services of the contract or agreement.
13. For program review purposes and the seeking of accreditation and/or certification, disclosure may be made to survey teams of the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), College of American Pathologists, American Association of Blood Banks, and similar national accreditation agencies or boards with which VA has a contract or agreement to conduct such reviews but only to the extent that the information is necessary and relevant to the review.
14. Disclosure may be made to the National Archives and Records Administration (NARA) in records management inspections conducted under authority of Title 44 United States Code.

Policies and practices for storing, retrieving, accessing, retaining, and disposing of records in the system:

Storage:
All reports of suspected noncompliance will be documented in a computerized database and assigned a unique identification number. Paper files may also be maintained which contain documents collected in association with reviewing the case, such as memoranda, policies, or examples of work produced as a result of the complaint.

Retrievability:
Both electronic and paper case files will be stored and individually retrieved by the unique identification number, not by name.

Safeguards:
Access to computerized information in the database is restricted to authorized personnel on a need-to-know basis by means of passwords and authorized user identification codes. Computer system documentation will be maintained in a secure environment in the VHA Office of the Chief Financial Officer (CFO) Compliance Office, and in the Compliance Offices at the network and medical center locations. Physical access to printouts and data terminals will be limited to authorized personnel in the Compliance Program.

Access to file folders is restricted to authorized personnel on a need-to-know basis. Paper files are maintained in file cabinets or closets and are locked after duty hours. These files are under the control of the Compliance Officer or his/her designees. Buildings are protected from unauthorized access by a protective service.

Retention and disposal:
Computerized records will be retained indefinitely. Periodic system back-ups will be employed for record protection. If disk space is limited, the records will be archived to tape or disk in accordance with established practice. Paper records will be maintained and disposed of in accordance with records disposition authority approved by the Archivist of the United States.

System manager(s) and address:
VHA Chief Financial Officer (17), Department of Veterans Affairs, 810 Vermont Avenue, NW., Washington, DC 20420.

Notification procedure:
An individual who wishes to know if a record is being maintained by the VHA CFO Compliance Office under his or her name in this system or wants to determine the contents of such records should submit a written request or apply in person to the VHA CFO (17).

Record access procedures:
An individual who seeks access to or wishes to contest records maintained under his or her name in this system may write, call or visit the VHA CFO (17).

Contesting record procedures:
(See Record Access Procedures above.)

Record source categories:
The information in this system will be obtained from calls that are received on the Compliance Line and reports received through other sources. Information is obtained from VHA employees, veterans, third parties such as contractors, and VHA records which may include billing data, patient medical records, policies and procedures, and memoranda.

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