Oversight: “Counting the Money: Preventing Fraud and Abuse in VA’s Bonus Payment Practices for VA Employees”

1[House Hearing, 119 Congress]2[From the U.S. Government Publishing Office]34                     COUNTING THE MONEY: PREVENTING5                     FRAUD AND ABUSE IN VA'S BONUS6                   PAYMENT PRACTICES FOR VA EMPLOYEES78=======================================================================910                                HEARING1112                               BEFORE THE1314                       SUBCOMMITTEE ON OVERSIGHT AND15                              INVESTIGATIONS1617                                 OF THE1819                     COMMITTEE ON VETERANS' AFFAIRS2021                     U.S. HOUSE OF REPRESENTATIVES2223                    ONE HUNDRED NINETEENTH CONGRESS2425                             FIRST SESSION2627                               __________2829                         TUESDAY, JULY 22, 20253031                               __________3233                           Serial No. 119-323435                               __________3637       Printed for the use of the Committee on Veterans' Affairs3839[GRAPHIC NOT AVAILABLE IN TIFF FORMAT]4041                    Available via http://govinfo.gov4243                                __________4445                   U.S. GOVERNMENT PUBLISHING OFFICE4661-506                   WASHINGTON : 20254748-----------------------------------------------------------------------------------4950                     COMMITTEE ON VETERANS' AFFAIRS5152                     MIKE BOST, Illinois, Chairman5354AUMUA AMATA COLEMAN RADEWAGEN,       MARK TAKANO, California, Ranking55    American Samoa, Vice-Chairwoman      Member56JACK BERGMAN, Michigan               JULIA BROWNLEY, California57NANCY MACE, South Carolina           CHRIS PAPPAS, New Hampshire58MARIANNETTE MILLER-MEEKS, Iowa       SHEILA CHERFILUS-MCCORMICK,59GREGORY F. MURPHY, North Carolina        Florida60DERRICK VAN ORDEN, Wisconsin         MORGAN MCGARVEY, Kentucky61MORGAN LUTTRELL, Texas               DELIA RAMIREZ, Illinois62JUAN CISCOMANI, Arizona              NIKKI BUDZINSKI, Illinois63KEITH SELF, Texas                    TIMOTHY M. KENNEDY, New York64JEN KIGGANS, Virginia                MAXINE DEXTER, Oregon65ABE HAMADEH, Arizona                 HERB CONAWAY, New Jersey66KIMBERLYN KING-HINDS, Northern       KELLY MORRISON, Minnesota67    Mariana Islands68TOM BARRETT, Michigan6970                       Jon Clark, Staff Director71                  Matt Reel, Democratic Staff Director7273              SUBCOMMITTEE ON OVERSIGHT AND INVESTIGATIONS7475                   JEN KIGGANS, Virginia, Chairwoman7677AUMUA AMATA COLEMAN RADEWAGEN,       DELIA RAMIREZ, Illinois, Ranking78    American Samoa                       Member79JUAN CISCOMANI, Arizona              TIMOTHY M. KENNEDY, New York80KEITH SELF, Texas                    HERB CONAWAY, New Jersey8182Pursuant to clause 2(e)(4) of Rule XI of the Rules of the House, public83hearing records of the Committee on Veterans' Affairs are also84published in electronic form. The printed hearing record remains the85official version. Because electronic submissions are used to prepare86both printed and electronic versions of the hearing record, the process87of converting between various electronic formats may introduce88unintentional errors or omissions. Such occurrences are inherent in the89current publication process and should diminish as the process is90further refined.91                         C  O  N  T  E  N  T  S9293                              ----------9495                         TUESDAY, JULY 22, 20259697                                                                   Page9899                           OPENING STATEMENTS100101The Honorable Jen Kiggans, Chairwoman............................     1102The Honorable Delia Ramirez, Ranking Member......................     3103104                               WITNESSES105                                Panel I106107Ms. Tracey Therit, Chief Human Capital Officer, Office of Human108  Resources and Administration, Operations, Security, and109  Preparedness, Veterans Health Administration, U.S. Department110  of Veterans Affairs............................................     6111112        Accompanied by:113114    Mr. David Perry, Chief Officer, Workforce Management and115        Consulting, Veterans Health Administration, U.S.116        Department of Veterans Affairs117118Mr. Shawn Steele, Director of the Human Capital and Operations119  Division, Office of Audits and Evaluations, Office of Inspector120  General, U.S. Department of Veterans Affairs...................     7121122Dr. Sheila Elliott, President, Local 2328, American Federation of123  Government Employees...........................................     9124125                                APPENDIX126                    Prepared Statements Of Witnesses127128Ms. Tracey Therit Prepared Statement.............................    25129Mr. Shawn Steele Prepared Statement..............................    27130Dr. Sheila Elliott Prepared Statement............................    36131132                     COUNTING THE MONEY: PREVENTING133                     FRAUD AND ABUSE IN VA'S BONUS134                   PAYMENT PRACTICES FOR VA EMPLOYEES135136                              ----------137138                         TUESDAY, JULY 22, 2025139140             Subcommittee on Oversight and141                            Investigations,142                    Committee on Veterans' Affairs,143                             U.S. House of Representatives,144                                                    Washington, DC.145    The subcommittee met, pursuant to notice, at 2:08 p.m., in146room 360, Cannon House Office Building, Hon. Jen Kiggans147[chairwoman of the subcommittee] presiding.148    Present: Representatives Kiggans, Radewagen, Self, Ramirez,149Kennedy, and Conaway.150151          OPENING STATEMENT OF JEN KIGGANS, CHAIRWOMAN152153    Ms. Kiggans. I would like to welcome the members,154witnesses, and audience to this hearing for the subcommittee on155oversight and investigations. I appreciate my colleagues on the156dais and the witnesses for being here to discuss the chronic157issue of improper recruitment, retention, relocation, and158incentive payments. These are commonly referred to as the 3R's.159These incentives are tools provided to the U.S. Department of160Veterans Affairs (VA) by Congress to attract and retain quality161staff and positions that are consistently vacant or identified162as difficult to fill. While many Federal agencies can use these163incentive payments, they are particularly helpful for an agency164like the VA whose mission is to provide complex services and165quality health care to veterans across the entire country.166These incentives are designed to be a part of a benefits167package for positions in markets that are difficult to hire in,168like specialist physicians, nurses, and social workers in rural169areas. Congress gave Federal agencies the ability to pay these170incentives so that government entities like the Veteran Health171Administration can be competitive in attracting and keeping172quality healthcare professionals in a labor pool that is facing173staffing challenges across the country. As a nurse174practitioner, I understand these challenges firsthand.175    Unfortunately, recent reports have shown that these funds176have been proven to be paid out with very little oversight.177While this hearing was organized after the release of the June1782025 Office of Inspector General (OIG) report on the VA's poor179oversight of these incentive payments, the problems we will180discuss today are not new to the VA. In fact, in 2017 the OIG181released a similar report detailing oversight issues with182recruitment, relocation, and retention incentive payments.183Based on the OIG's oversight work stretching back to July 2014,184the 2017 and--the 2017 OIG report identified the need to185improve controls over the use of these incentives. Having found186that the VA did not properly authorize 33 percent of the187retention incentives that were awarded to senior executives.188The improper payments found in 2017 totaled more than $158189million in unsupported spending.190    As a result, the OIG made recommendations that the VA191develop internal controls to monitor policy compliance and192decrease the VA's reliance on retention incentives. Now, here193we are in July 2025 confronted with the same issues that the VA194has failed to improve since the first report. The only195difference is that now there is even more taxpayer dollars196involved. For example, between 2020 and 2023, relocation197payments grew by 85 percent, and retention payments have grown198by 131 percent, while recruitment bonuses have ballooned by a199staggering 237 percent. I believe anyone would agree that these200numbers are alarming when there is little data to back up the201massive increases. The 2025 report acknowledged that after the202initial report VA implemented processes to improve203authorization and review controls for the payments. However, VA204employees inconsistently followed them. This made the good205government improvements virtually useless. In response to the2062017 OIG audit, quality assurance teams were created at both207the Office of Human Resources (HR) and Administration,208Operations Security and Preparedness, and the Veterans209Integrated Service Network (VISN) level. However, the 2025 OIG210report found that while these teams identified errors, they did211not address systemic issues in the request and authorization of212incentives, did not proactively prevent incentive packages from213being processed and paid based on insufficient justifications.214    Additionally, the OIG found that 28 employees continued to215receive annual retention incentives for many years after the216initial award period expired. In one case, an employee217continued to receive annual incentive awards for more than 11218years after the initial award period. In total, the VA219improperly paid these employees a total of about $4.3 million.220Between 2020 and 2023, more than 134,000 employees received221incentive payments totaling $1.2 billion. 341 million of those222incentives were found by the OIG to be improperly documented.223The lack of documentation also hinders review efforts by224oversight bodies like the OIG, the U.S. Government225Accountability Office (GAO), and this committee.226    I echo what the OIG said in the report that the required227documentation helps provide assurance that incentives are228properly used and effective oversight of incentives also229requires sufficient documentation for review. In fact, OIG230noted that much of the data used in the report relied on231projections due to the VA's sparse documentation. I found it232shocking in the report that when cases of waste, fraud and233abuse were discovered, the VA's implementation of established234processes did not always guarantee that the issues were235appropriately resolved. The 2025 report cited an example where236Veterans Health Administration (VHA) awarded $30,000 in237relocation payments for an employee who never relocated. The238employee was a remote worker teleworking from home. When239someone receives a relocation incentive and never actually240relocates, that is wrong and a clear waste of taxpayer dollars.241Despite this clear case of impropriety, the VHA declined to242recoup the payments that were made to this employee. These are243taxpayer dollars set aside for veterans and for far too long244they have been carelessly handled. I am excited to hear the245Trump administration's plan to not only satisfy the OIG's246recommendations but their plan to make real, unnecessary247improvements, and corrections in how the VA manages and248oversees their incentive programs. The status quo is not249acceptable and we will continue to push the VA to make250improvements that lead to better care outcomes for the veterans251that are receiving VA services. I look forward to working with252Secretary Collins and his team to right the ship and create253real change at the VA.254    I now recognize Ranking Member Ramirez for her opening255comments.256257       OPENING STATEMENT OF DELIA RAMIREZ, RANKING MEMBER258259    Ms. Ramirez. Thank you, Chair Kiggans. Today's hearings260topic is critically important. We are examining the use and the261oversight of the ``3R's incentives'' at VA. Recruitment,262retention, and relocation bonuses. The so called 3R's help VA263attract talent. Earlier this month, Secretary Collins264celebrated the VA will lose nearly 30,000 employees by the end265of the fiscal year. I find that despicable. I want to be clear.266Every VA employee is mission critical. Every VA employee267ensures veterans get the care and benefits they have earned and268deserve. If we care about veterans' care and services, it is269more important than ever that we discuss how the VA keeps270employees.271    As Secretary Collins deconstructs, decimates, and272demoralizes the workforce. Veteran care is already being273negatively impacted by the destruction of the VA workforce. For274instance, we know that doctor appointments for veterans have275been canceled due to staffing shortages. We know this because276veterans have told us themselves. How do we course correct? How277do we ensure the VA has a workforce it needs to support the278care veterans have earned and deserve? First, we have to ensure279that the VA is a place where people feel valued, not disposable280and not attacked. As a former executive director of a nonprofit281organization, I know that public sector agencies like the VA282and nonprofit organizations cannot compete with the private283sector in terms of salary in many places across the country. In284tough markets, 3R's incentives help make VA offer more285competitive wages. They are a tool to attract and retain highly286qualified employees to the agency. I understand that this287hearing is meant to focus on the VA Inspector General's288findings from report released earlier this summer that the VA289needs more oversight of 3R's incentives. I do not disagree that290the VA must be a good steward of taxpayer dollars and that we291must ensure that the correct employees are receiving the292correct pay for the correct period of time. No objection, no293disagreement there.294    At the same time, we must ensure that the VA's oversight of295the 3R's incentives does not make them a more burdensome and296less useful tool for leaders who need them to recruit and to297retain staff. We need to hold two objectives at the same time.298The process must work and it must allow to be competitive by299working quickly and efficiently. If we do not meet both of300these goals, I fear that greater layers of bureaucracy may301disincentivize leaders from offering 3R awards. I look forward302to hearing from our witnesses today about how we can strike a303balance to ensure 3R incentives are being used properly,304efficiently, and routinely. I am going to show a series of305posters with data pulled directly from the VA's workforce306dashboard published on June 27th, 2025. Numbers do not lie. We307can see here a sharp decline in both recruitment and retention308since Secretary Collins took the helm. The VA has seen an over30945 percent reduction in job applicants this year compared to310last year. VA saw an over 56 percent reduction in new employees311actually starting jobs. The VA lost 4,144 employees in mission312critical occupations as defined by the VA since the beginning313of this fiscal year. Compare that to the Biden administration314only losing 111 employees in mission critical occupations315during the same period in 2024. As of losing 4,100 employees in316VA designated mission critical occupations was not bad enough,317I want you guys to take a closer look at how many employees318Secretary Collins has lost in some key veteran facing roles. To319be clear, these numbers are not net losses. They are net320losses, not just normal attrition. The numbers we are looking321at account for any new hires. Again, these are positions that322are not subject to the hiring freeze and were exempt from the323Deferred Resignation Program (DRP). What you are seeing is that324since the start of this fiscal year, the VA has lost a net of3251,720 registered nurses, 1,147 medical support assistants, 604326physicians, 193 police officers, 77 psychologists, 358 social327workers, 1,081 veteran claim examiners, 868 custodial workers.328By its own data, the VA has had over 7,500 employees in veteran329facing roles leave their jobs this Fiscal Year and their330positions have not been backfilled.331    How can Secretary Collins look at us and at veterans with a332straight face and say that veterans care has not been affected333by staffing changes when he has lost at least 7,500 veteran334facing employees? The numbers we are looking at and their335impact on veteran care is upsetting. If you are not mad yet,336just take a look at our next poster so we can get a sense of337why these employees have left the VA. Reasons for leaving, a338series of concerns, for example, geographical relocation,339desired work schedule not offered, lack of trust and confidence340in senior leaders. Again, lack of trust and confidence in341senior leaders from social workers, medical and dental are342talking about the work schedule offered does not work for their343ability to serve the veterans. Then you see over and over and344over lack of trust and confidence in senior leaders, lack of345trust and confidence in senior leaders. You also see here from346contracting officers unethical behavior on the part of347leadership or the organization. That is why medical and dental,348general administration, psychologists, social workers, HR349specialists, HR assistants, cemetery caretakers, Veterans claim350exam, processing personnel, contracting officers, and351Information Technology (IT) specialists are leaving. Any352quality leader I know who got this feedback in their exit353interview would do some serious self-reflection. The VA has a354failure of leadership crisis and Secretary Collins is to blame.355Secretary Collins accuses us of fear mongering and lying when356we raise the alarm that veteran care is being impacted. But357these numbers do not lie. There is just no possible way that VA358could lose 7,500 veteran facing employees without care being359impacted. The Secretary could turn the ship around to attract360and maintain more employees to care for veterans and the 3R361incentives are one of those tools. He is not because he does362not want to turn the ship around. He is committed to363destructive collision course. Let us look at the dashboard even364closer.365    Just take a look at the reduction in the use of The366Sergeant First Class Heath Robinson Honoring our Promise to367Address Comprehensive Toxics (PACT) Act authorities like368recruitment and retention incentives from year 2024 to year3692025. Last year during the Biden administration, retention370incentives were used nearly 20,000 times. This year, under371Collins and Trump, only 7,000 times. Recruitment incentives372were used 6,000 times in year 2024, but they have barely used373them 1,000 times this year. Take a look at this number. Special374Contribution Awards. These are used when a VA employee goes375above and beyond the call of duty when caring for veterans.376When Biden was president, nearly 30,000 special contribution377awards were given to VA employees. Under Collins, barely 7,000378awards have been made. Here is the bottom line. It is not that379VA employees are less meritorious than they were under Biden.380It is that no matter what the VA employees do, they will never381really receive 3R awards because the Trump administration,382through Secretary Collins, wants them to leave. They want every383employee to be pushed out so they can decimate the VA's384workforce and destroy it in order to justify privatizing the385VA. Secretary Collins has made VA employees his target and in386doing so has targeted veterans who rely on VA for their care387and benefits. Yes, it is more important than ever that we do388everything we can to keep VA employees working and caring for389our veterans. Secretary Collins tenure at the VA has been one390of torment. For months, VA employees have worried they would391lose their jobs and livelihood through Reduction in Force392(RIF). Now Secretary Collins promises that a ``Large-scale393RIF'' is off the table for the time being. We all remain394concerned that if he is leaving the door open to eliminate395positions through the reorganization and consolidation, and396veterans worry that their service and care will be impacted by397the changes in the VA workforce. Well, veterans are right. How398can we expect to provide high quality services through a399robust, talented workforce under these kinds of conditions?400Again, the instability, the uncertainty, the volatility is the401point. Veterans deserve a VA that they can rely on. Secretary402Collins is undermining the VA and its workforce at every chance403he gets. It is why I look forward to our conversation today and404hearing for our witnesses.405    With that, I yield back.406    Ms. Kiggans. Thank you, Ranking Member Ramirez. I will now407recognize the witnesses testifying before us today. We have Ms.408Tracey Therit, chief human capital officer, Human Resources and409Administration, welcome back. Mr. David Perry, chief officer,410Workforce Management and Consulting, Veterans Health411Administration. Mr. Shawn Steele, the director of the Human412Capital and Operations Division, Office of Audits and413Evaluations of the Office of the Inspector General. Dr. Elliot,414Dr. Sheila Elliot, president for the American Federation of415Government Employees (AFGE) Local 2328. Welcome. If the416witnesses will please stand for me and raise your right hand.417Do you solemnly swear that the testimony you are about to418provide is the truth, the whole truth, and nothing but the419truth?420    [Witnesses sworn.]421    Ms. Kiggans. Thank you. You may be seated. Let the record422reflect that the witnesses answered in the affirmative.423    Ms. Therit, you are now recognized for 5 minutes to provide424the VA's testimony.425426                   STATEMENT OF TRACEY THERIT427428    Ms. Therit. Good afternoon, Chairwoman Kiggans, Ranking429Member Ramirez, and distinguished members of the committee.430Thank you for this opportunity to discuss how VA is improving431governance and oversight of recruitment, relocation, and432retention, 3R's in our incentive payment practices. As pay caps433for healthcare professionals at VA have not kept pace with434rising salaries for healthcare professionals and specialists,435the 3R's program is a critical component of VA's incentive436plan. I am joined today by Mr. David Perry, acting chief, Human437Capital Management, Veterans Health Administration. VA will438always fulfill its duty to provide veterans, families,439caregivers and survivors with the health care and benefits that440they have earned. To ensure all veterans and VA beneficiaries441continue to receive their earned benefits and services, VA is442always recruiting dedicated professionals. As of July 2025,443more than 350,000 critical positions are exempt from the hiring444freeze. While VA has historically offered 3R's incentives to445address occupational shortages and facilities hiring446initiatives, the department must provide greater accountability447and stewardship of taxpayer resources by enhancing our448procedures, documenting requirements, and providing oversight449of these incentives.450    Starting in 2017, VA updated department policy on 3R451incentives to establish internal controls and provide452oversight. Specifically, VA began requiring annual453certification of the incentive so it was appropriate and in454compliance with policy and succession plans to reduce long-term455reliance on incentives and established residency before payment456of receipt. In the years since, VA has continued iterating and457implementing additional improvements including the following,458requiring a standard form to capture all the required459information by law, aligning the use of 3R's with shortage and460hard to fill positions, obtaining authorization and461justification before including 3R incentives in job462announcements, tracking unfulfilled service obligations,463improving coordination of debt collection and enforcing debt464collection and reviewing incentives annually and terminating465them in a timely manner when they are no longer needed.466However, there is always room for improvement and VA must467continue to refine its governance of those incentives,468including proper documentation in their use, ensuring correct469signatures are in place, ensuring justification in employing4703R's is sound. VA must develop stronger oversight mechanisms471and discontinue the use of multiyear incentives.472    Finally, VHA is implementing a comprehensive strategy to473enhance the management and oversight of the incentives program,474includes continuing to monitor internal control procedures and475guidance to ensure 3R documentation is appropriately maintained476in accordance with VA policy. VHA will also conduct a program477to monitor quarterly and utilize uniform checklists and478templates nationwide. VHA is developing training and materials479to ensure proper documentation for succession plans,480performance ratings and to strengthen the technical review. VHA481is creating oversight plans and a strengthened technical review482program to assess every incentive for technical adherence. At483an enterprise level, oversight monitoring component will act as484a second level check at the national level. VHA aims to support485the compliance with record retention requirements and486furthermore specific performance metrics will be tied to487operational leadership and human resources leadership. They are488being developed and reinforcing the importance of proper489governance and oversight of incentive programs. VA is committed490to addressing these issues that have been identified by the491Inspector General's report and strengthening the process to492support the VA mission. We are confident that the steps that we493have taken and will continue to take will strengthen our494incentives program and the governance and oversight required,495leading to more effective outcomes and better service to496veterans. While the 3R's incentive program is an important tool497for the department in attracting and retaining talent, it is498not enough for the VA to remain competitive with industry. VA499looks forward to working with the committee on strategies to500ensure that VA is an employer of choice for physicians in501critical need specialties.502    I am proud to be part of the noble mission to care for our503Nation's veterans. I look forward to working with each of you504on the committee to more effectively and efficiently provide505enhanced oversight and governance of the incentive payment506practices, ensuring VA can continue to provide the best care507and services to veterans and their families.508    It concludes my testimony and my colleague and I welcome509any questions that you may have for us. Thank you, thank you.510511    [The Prepared Statement Of Tracey Therit Appears In The512Appendix]513514    Ms. Kiggans. Thank you, Ms. Therit. Mr. Steele, you are now515recognized for 5 minutes to provide the VA's OIG's testimony.516517                   STATEMENT OF SHAWN STEELE518519    Mr. Steele. Chairwoman Kiggans, Ranking Member Ramirez, and520members of the subcommittee thank you for the opportunity to521testify on the OIG's independent oversight of VHA's management522of recruitment, relocation and retention incentives. These523incentives are meant to help VA entice candidates to accept524hard to fill positions or to retain high quality staff. Our525work focused on identifying whether VHA used incentives526effectively, complied with the law and VA policy, and acted as527strong stewards of taxpayer dollars. As the OIG has documented,528VHA faces significant staffing shortages in key positions, also529known as critical need occupations. This long-standing530challenge affects clinical positions as well as nonclinical531support and security functions. Critical need occupations are532often difficult to fill due to the limited number and quality533of candidates, unfavorable employment trends, and lack of534appeal for the position's duties or geographic location. Our535work shows that despite VHA's ability to hire non-536competitively, they continue to experience staffing shortages537for positions fundamental to the safe and effective delivery of538care to veterans. Other OIG reports highlighted weaknesses in539VA's processes and controls governing the use of pay540incentives.541    Our 2017 audit found that VA needed to improve controls542over recruitment, relocation and retention incentives to ensure543they were strategically and prudently used. We also reported in544May 2024 that VA awarded $10.8 million in critical skill545incentives to nearly all VHA and Veterans Benefits546Administration (VBA) central office executives without required547support showing the employee possessed a high demand skill or548skill that is at a shortage. Over 182 senior executives549received payments averaging about $60,000 each. Subsequently,550over 90 percent of those funds had been recouped. We closed the551recommendations for both the 2017 and 2024 reports because VA552provided sufficient evidence to show action had been taken to553implement needed changes. However, the OIG continued to monitor554VA's use of these important staffing tools. Last month, we555published a report that evaluated VA's controls over and556governance of recruitment, relocation and retention incentives.557It focused on awards paid to VHA employees from fiscal years5582020 through 2023 and tested many of VA's actions taken in559response to the 2017 OIG report. Overall, we found that VA used560incentives extensively to address critical staffing needs. In561fiscal years 1922 and 1923, nearly 90 percent of incentives562went to employees and occupations on staffing shortage lists.563    However, VA did not effectively govern the process to564ensure that VHA officials consistently captured information565required to support the awards. Key forms were missing or566lacked sufficient justifications and approval signatures. This567information helps confirm incentives are properly used and is568needed to carry out effective oversight. Consequently, we found569that VA's prior corrective actions to implement our 2017 report570recommendations were not sustained as policies were not571routinely followed. Overall, we estimated that the award572justification could not be verified or is insufficient for 30573percent of VHA employees that received incentive payments. This574amounted to about $341 million in incentives that were not575adequately supported. Our team also found 28 VHA employees who576received retention incentive payments long after their award577period had expired. These individuals were improperly paid for578an additional 8 years, on average totaling about $4.6 million.579    In conclusion, the OIG's oversight work has highlighted580VHA's ongoing challenges with addressing severe occupational581shortages in essential positions. Our reports have also shown582that attempts to narrow those staffing gaps through583recruitment, relocation, and retention incentives do not584consistently follow requirements. It is also concerning that585these issues are not routinely detected by VA's quality control586measures. VHA must emphasize to responsible personnel the587importance of following policies and procedures to safeguard588against improper payments. OIG teams will continue to monitor589VHA staffing needs and the use of incentive payments. In doing590so, VHA will be held accountable for securing qualified591personnel to provide high quality care to veterans while making592the most effective use of taxpayer dollars.593    Chairwoman Kiggins, this concludes my statement. I would be594happy to answer any questions you or members of the595subcommittee may have.596597    [The Prepared Statement Of Shawn Steele Appears In The598Appendix]599600    Ms. Kiggans. Thank you, Mr. Steele. Dr. Elliot, you are now601recognized for 5 minutes to provide your testimony.602603                  STATEMENT OF SHEILA ELLIOTT604605    Dr. Elliott. Thank you, Chairwoman Kiggans, Ranking Member606Ramirez, and members of the subcommittee. AFGE, and the607National VA Council appreciate the opportunity to testify608today. My name is Dr. Sheila Elliot. For the last 35 years, I609have served as Treasurer/Steward at Hampton VA Medical Centre.610I have also served over 15 years as the president of AFGE Local6112328 which represents most direct patient care staff at612Hampton, VA, and the surrounding clinics. On behalf of the613320,000 VA employees AFGE represents, approximately a third614whom are veterans. It is a privilege to offer AFGE's views on615how the VA should improve recruitment and retention, both with616the recruitment, retention and relocation bonus program and617beyond. On June 12, 2025, the OIG released a report on the618recruitment, relocation and retention incentives bonus program.619The OIG highlighted several problems with the administration620and oversight of the program that AFGE agrees with. Chief among621the problems identified is the failure of VA human resources.622While VA did use this tool to recruit and retain clinicians,623there were problems in how the bonus program was managed. AFGE624has previously criticized the HR modernization that the OIG is625citing here, agreeing with the conclusion that it has led to626increased turnover at the VA.627    Additionally, AFGE believes that HR not being in the628facilities and lacking familiarity with the workforce and the629veterans they serve increases their turnover. This undermines630the ability of HR to serve employees as well as administer the631bonus program. In preparation for this hearing, when contacting632the Hampton, VA, we could find no repository of data to show633who has received these bonuses. However, after reaching out634directly to 800 bargaining unit members at our hospital, AFGE635had 9 bargaining union members who reported that there were 4636recruitment bonuses, 4 retention bonus, and 1 relocation bonus637awarded between 2021 and 2025. While AFGE is pleased that at638least 9 employees receive these bonuses, we have no way of639knowing if this benefit is properly utilized compared to the640rest of VA.641    Regardless, I can say with decades of experience at this642facility that there is significant room for improvement both at643the hospital and the brand-new North Battlefield Outpatient644Clinic which opened this year 27 percent staffed. We urge the645VA to use these bonuses and other tools to increase capacity at646the clinic and the hospital. Beyond the bonus program, AFGE has647other suggestions to improve recruitment and retention. As the648committee is aware of in March, President Trump signed an649Executive Order (EO) eliminating the collective bargaining650rights of 1.5 million Federal employees at agencies including651VA. Continuing to deny large swaths of the VA workforce,652collective bargaining rights will continue to harm recruitment653and retention. As there is a critical shortage of clinicians in654this country, many quality candidates who want to serve the VA655may avoid the agency to receive both union protections and656better salaries in the private sector. This is particularly657egregious as Secretary Collins played favorites when choosing658whom to exempt from the executive order, not by job description659or duties, but by which union represents the employee in660question. AFGE members lost their collective bargaining rights661despite having identical jobs for employees who are exempted662and retained their rights. AFGE urges members of this committee663to support H.R. 2550, the Protect America's Workforce Act,664which would nullify this illegal executive order. AFGE has long665argued for the benefits of telework for employees who can666perform their duties remotely. This is particularly true for667clinicians who practice in whole or in large part through668telemedicine.669    However, since most telework has been rescinded by this670administration, many clinicians have had to report to a VA671facility and then have been required to interact with patients672remotely, often in crowded bullpens discussing private matters.673This has harmed morale and retention of mission critical and674hard to recruit clinicians at the VA. This has negatively675affected retention at Hampton and reflects VA's overly broad676approach to telework and telehealth. I hope that my testimony677today leads this committee subcommittee to help improve678recruitment and retention at the VA.679    Thank you and I look forward to answering your questions.680681    [The Prepared Statement Of Sheila Elliott Appears In The682Appendix]683684    Ms. Kiggans. Thank you, Dr. Elliot. We will now proceed685with questions. However, before I do that, I would like to make686sure the record is clear regarding not just mental health687services that are offered at the Hampton VA. We have pushed and688will continue to push veterans to receive the care we need it.689That is why I have advocated for additional facilities in my690district that provide these services. In addition, and more691specifically that North Battlefield VA Clinic in Chesapeake, I692wanted to clarify and echo Secretary Collins words about that693facility. It is opening in deliberate phases to ensure safe,694effective and high-quality care as services and staffing scale695up responsibly. While some public comments have696mischaracterized this phase rollout, the facts are clear. The697Clinic opened in April 2025. I was at the ribbon cutting with698150 staff and core services including primary care, mental699health, and pharmacy. To quote, Dr. Elliot, that was 27 percent700and it was always intended to expand in waves. In July, dental701and additional mental health services came online and by702January 2026 the facility is scheduled to be fully operational703with radiology, optometry, telehealth and more. This is a704standard and prudent approach for bringing a major healthcare705facility online. As we grow more patients, we grow more staff.706Spreading misinformation about staffing levels or service707delays only undermines the hard work being done to provide the708best possible care to our veterans. I remain committed to709ensuring this facility and all our VA healthcare facilities710reach full potential and deliver the timely high-quality care711the veterans in Chesapeake and across Hampton Roads have712earned.713    In conclusion and for clarification additionally from714Secretary Collins, I am pleased the department of the VA is not715going to pursue a large-scale reduction of force and have been716reassured that any early retirements will come from redundant717positions and non-essential personnel. This will safeguard718operations of the VA and thus ensure services to our veterans.719I am confident that Secretary Collins will prioritize720maintaining a robust health care workforce at the VA to ensure721veteran care and benefits are not impacted. We can all agree722that giving our veterans the care they need is essential. Under723President Trump I know that our veterans will be put first. In724fact, the VA's performance has continued to improve under his725leadership. With disability claim backlog already down nearly72630 percent, the work Secretary Collins is doing to modernize727the VA's operations and get our veterans the quality of care728they need is a breath of fresh air. By June, the VA had already729processed 2 million disability claims, accelerated the730implementation of the integrated electronic health record731system and made it easier for survivors to get benefits. These732accomplishments on behalf of our veterans deserve recognition.733    With that, I have questions, and my first question will be734for Ms. Therit. Ms. Therit, the OIG found that the VISN quality735assurance teams conducted reviews after the incentives were736awarded. Can you explain why the VA's review process appears to737be reactive instead of proactive?738    Ms. Therit. Chairwoman Kiggans, regarding the VISN's review739process, I am going to ask Mr. Perry to respond to that740question.741    Ms. Kiggans. That is fine.742    Mr. Perry. Thank you, Chairman, for that question. We agree743where the VISN is needed to do a more proactive approach. We744are shifting that responsibility over to the compensation745aspect of the VISN to do that on the front end versus the back746end. We recognize that there is a gap in our process that we747are making a modification adjustment until now.748    Ms. Kiggans. Will the VISNs be talking to each other then749to come up with a more standard approach?750    Mr. Perry. Yes, overall, we are taking that approach to751look at standardization. I think what we saw back in 2017,752where it was down at the facility level, we had about 150 ways753of doing it. We have made improvements, that is 18. We do have754some areas to improve to make sure that the 18 are doing it755consistently. Consistently according to policy.756    Ms. Kiggans. That would be great. Consistency would be757helpful. I go back to Ms. Therit, but either Ms. Therit or Mr.758Perry, would you please explain step by step how one of these 3759incentive payments would be approved, starting with the first760step to the actual payment to the employee.761    Ms. Therit. Chairwoman Kiggans, I appreciate the work of762the office of the Inspector General because their very763detailed, actionable reporting helps us to improve. We made764improvements from the 2017 report, and we will continue to make765improvements based on the 2025 report. Recruitment and766relocation incentives are one category of 3R's. The recruitment767incentive is to attract individuals into the Federal768Government. The relocation incentive is to help move employees769into locations that are hard to fill or where there is a770specific need. There is a standard form 10016 that is completed771for both of those incentives. One of the deficiencies in 2017772that we rectified in 2025 was that our department policy and773procedures did not align with regulation. Now we have a774department-wide policy. Everybody should follow it775consistently. We have standard forms that every supervisor who776is recommending an incentive, every HR official who is777reviewing an incentive, and every approving official would778utilize. That is for the recruitment and relocation process. We779have a similar 10017 that is used for retention.780    Retention incentives are typically shorter-term.781Recruitment and relocation can be up to a 4-year service782obligation. Retention incentives, we typically look at a 1-year783retention incentive service period. The reason being for784retention purposes we are looking at somebody who is likely to785leave Federal service and has a unique skill that we cannot786afford to walk out the door. We need a short period of time to787put that succession plan in place to either develop someone788with those skills to step in when they depart or to be able to789recruit somebody before they leave. That is the process and the790steps from someone recommending an incentive for an individual791under one of those three sets of parameters to then HR792reviewing the requirements based on regulation and then for the793approving official to sign off on it. Once the individual is794identified, then they too have responsibilities. Signing the795service obligation, making sure that they relocate if it is a796relocation incentive, making sure they are new to the Federal797service if it is a recruitment incentive. For retention798incentives, we have a 1-year hard stop where supervisors need799to review and recertify that that is still needed. Otherwise,800it will be terminated automatically.801    Those are just some of the steps that we take with802recruitment, relocation, and retention incentives. Some of the803things that we have in place and where the Inspector General804(IG) has identified more steps that we need to take to have805better oversight and compliance that we are willing and806currently in the process of doing that.807    Ms. Kiggans. That approving official who is in their next808step in the chain of command, who would they report to?809    Ms. Therit. Chairwoman Kiggans, we have delegations of810authority for our 3R's incentives. Typically, in the Veterans811Health Administration, which is the subject matter of the812report. A recommending official would be a medical center813director. Approving official could be up to a network director.814It depends on the percentages of the incentives that are being815offered. Sometimes it is higher, but that is typically how the816delegations of authority flow. Now we also have breach of817agreement procedures that we follow to make sure that if818somebody does not fulfill their obligation that we are going819back and initiating and collecting those debts. Again, these820are taxpayer dollars. We do not want to see these incentives821misused or abused. I know there were instances in the report822that were identified. We do not want that to continue to823happen. The breach process is the individual employee who is824asking for a waiver of repayment will go to their supervisor.825That supervisor will take it the whole way up the chain of826command to the under secretary of health in the Veterans Health827Administration. If they approve that request to waive payment,828then it comes to my office. Our assistant secretary for Human829Resources and Administration Operations Security and830Preparedness would be responsible for that process. That is831just an example of the levels at which these are reviewed and832the seriousness with which we take things like breach of833agreements.834    Ms. Kiggans. Thank you for that very thorough explanation.835How long has that exact chain that you just described been in836place? Is that new this year in 2025?837    Ms. Therit. I would say it dates back to 2020, when we838revised our departmental policy. We do have statistics, if the839committee is interested in terms of how many cases go through840that process. The percentage that reach my office, it is a841small percentage, maybe 1 a month, and a very low percentage842that is approved because the standard for waiving a breach of a843service obligation is very high. It is stipulated in law as844repayment would be against equity and good conscience or not in845the best interest of the government. When we are paying846individuals and they are not upholding their end of the847agreement, that is something that we want to pursue.848    Ms. Kiggans. Thank you. My time has expired. I am sure that849we will have a second round of questioning, but I will yield to850our ranking member.851    Ms. Ramirez. Thank you, Chairwoman. Dr. Elliot, I want to852first thank you for being here and taking time away from your853day job as a pharmacist at the Hampton VA Medical Center. I854understand you are also the caregiver of your mother, is that855correct?856    Dr. Elliott. Yes.857    Ms. Ramirez. Well, you are a superwoman, and I am really858grateful for your participation and your continued dedication859to your VA brothers and sisters at the AFGE. You mentioned in860your testimony that there is a lack of clarity in how and when8613R incentives are used at your facility in Hampton. Do you862think that if 3R incentives were made widely and frequently863used at Hampton, the facility would be able to onboard and keep864more employees?865    Dr. Elliott. We used to have a process whereby we had hard866to recruit and hard to fill positions at our facility. I do not867know where that process is at this time. I have not heard868anything of it for the last several years now, especially since869we have been decentralized with respect to the HR staff. That870is supposed to be the--those people on that list are supposed871to be the designees of various recruitment, retention bonuses,872and so forth. In my 35 years there, I have never seen a873relocation bonus for a line staff person, no matter what their874job was. Typically, those had been reserved for top management.875The various relocation bonuses.876    Ms. Ramirez. Dr. Elliot, I wanted to ask you if you had any877reactions to how the secretary is characterizing staffing at878North Battlefield Clinic, sincere on the ground, actually879working there?880    Dr. Elliott. I can tell you this from the standpoint of a881veteran. I go to--this is what the veteran said during a panel.882I go to the VA at North Battlefield, have my primary care883appointment. However, if I want to receive other services such884as X-ray and those sorts of things, I still have to drive to885Hampton. That is problematic.886    Ms. Ramirez. That is, well, thank you, Dr. Elliot. I want887to now turn it over to Ms. Therit. Ms. Therit, how many888employees has VA lost through ``natural attrition'' since889January of this year?890    Ms. Therit. Ranking Member Ramirez, we do look at that data891on a regular basis. I believe the last statistics that I saw of892all of the separations, those are voluntary and involuntary893actions, about 20,000 that have occurred over the last few894months.895    Ms. Ramirez. Twenty thousand over the last few months, is896that what you just said?897    Ms. Therit. Over the last few months since the beginning of898the year?899    Ms. Ramirez. I just wanted to make sure I had heard900correctly. How many of those employees are in veteran facing901roles like direct care or benefits counseling? What would you902say?903    Ms. Therit. Ranking Member Ramirez, the number that I cited904was the aggregate level, so I would have to go back and break905that down to look more specifically at direct care position.906    Ms. Ramirez. Ms. Therit, if you could go ahead and follow907up on that, I would really appreciate it. The follow-up908question I have to that is if you know if those positions were909backfilled.910    Ms. Therit. Ranking Member Ramirez, as I mentioned, about911350,000 positions are exempt from the hiring freeze. I do see912data on a bi-weekly basis of the job announcements that are913posted and the individuals that we are bringing on board. I914know we are bringing several thousand a pay period back into915the VA. I know those--that statistic is actually reported on916the workforce dashboard each month as well.917    Ms. Ramirez. Got it. Ms. Therit, when you follow up, if you918can try to get me a little bit more detail, that would be919really helpful. I want to go back to these posters on the VA920workforce dashboard dated June 28, 2024. Last year. There is a921note at the very top that says ``top risk'' and then reads,922``Delays or termination use of PACT Act Title 9 authorities923will have a negative impact and recruitment and retention.''924Now, those PACT Act authorities referenced here included925recruitment and retention incentives, among other bonuses. Is926that correct? Mr. Therit?927    Ms. Therit. Yes, it is, ma'am.928    Ms. Ramirez. Why was there, why has there been such a stark929downward trend in the use of 3R incentives from year 2024 to930year 2025?931    Ms. Therit. As mentioned earlier, there has to be a932justification for using a recruitment or a retention incentive.933In many situations, I know Dr. Elliot mentioned our hard to934fill and our shortage occupations, and I think Mr. Steele has935mentioned it as well, that we are able to post those job936announcements, get qualified candidates and bring them on937without using an incentive.938    Ms. Ramirez. Ms. Therit, this is my last question for this939round and we will come back the second round. Is there a delay940or termination of using these authorities having a negative941impact on recruitment and retention at the VA?942    Ms. Therit. At this moment in time, we are able to post and943fill those positions that are being vacated in our direct care944positions.945    Ms. Ramirez. You are not noticing just yet the negative946impact on recruitment and retention of the VA? Is that what you947are saying?948    Ms. Therit. Correct, ma'am.949    Ms. Ramirez. Thank you. With that, I yield back.950    Ms. Kiggans. Thank you. The chair now recognizes Mr.951Conaway for 5 minutes.952    Mr. Conaway. Thank you, Madam Chair. I guess before I ask953my questions, I cannot help but put some more close, if you954will, on the statements of our ranking member. When you hear955about the intention, the leaked intention of the number of956employees that the Secretary intends to cut from the VA, it is957hard to imagine that anyone who might think about entering a958career in public service and working at the VA would look upon959the VA as a place to land and to work and to engage in public960service, taking care of our valuable and hopefully appreciated961veterans. This kind of announcement from the top cannot help962but hurt the effort to retain frontline healthcare963professionals and others who are so critical to the operation964of that facility. People, you know, obviously need nurses, you965need doctors, but you also need someone to make sure that966people get food delivered to them. You need to make sure that967you have got a pharmacy that is working. You need to make sure968that the cleaning services are working and that the building969and the facility is secure. You need people to do all of those970jobs and to want to come to work and have that work971appreciated. It is hard for us on this side of the aisle to972hear and to understand these--these obvious dynamics with973respect to their union rights and their prospects for a career974that is both satisfying, rewarding, and appreciated by their975government, by their employees, that that is not going to have976a profound impact on the ability of the VA to do its work and977to honor our commitment to veterans, and that it is not part of978a grand plan, as ranking members pointed out to privatize these979services. We are seeing this across at least the signs of this980and I think very definite pattern across the Federal workforce981and the Federal Government. I am a physician myself. I have982worked, I have trained at a VA facility for part of my983training. I served on a military base as a physician there. I984certainly treated a lot of veterans even in private practice985after leaving the service because my district is at home of a986military base, Joint Base McGuire.987    We have a lot of veterans who live in that area and were988patients of mine. I understand how important the VA is to them989and their ability to use the VA when they need it for their990care. I am disturbed to hear about what is happening with the991physician workforce, the losses there, and particularly the992ability of psychologists and psychiatrists to treat patients993because of the attack on remote work. Just because someone is994being seen remotely does not mean that anything that is said in995the interactions between their physician and someone who is996receiving their care remotely should not be protected. Their997privacy should not be protected there. When you consider people998now being put in cubicles or putting in spaces where their999conversations are not secure and private, that impacts the kind1000of care that they wish to give and how they ought to practice1001that lifesaving care. As we know, there is so many dislocations1002with mental health in the service. I understand, Ms. Elliot,1003Dr. Elliot, pardon me, that you have an example of a change in1004this retention policy and the loss of remote work. Can you1005comment on the impact of that situation at Hampton? At the1006Hampton VA?1007    Dr. Elliott. Thank you. At our facility we have a 431008percent lack of--well, our recruitment is 43 percent behind,1009meaning that out of 100 positions, 43 of them are vacant. We1010are in the process now of losing a psychologist to another1011facility because that particular psychologist lived far away1012and could not come to Hampton with no relocation bonus offered.1013That psychologist was able to get a relocation bonus from1014someplace else. That is where that psychologist is going. I1015guess instead of being 43 percent behind the eight ball, we are101644 percent in a couple of weeks when that psychologist leaves.1017Now, to add insult to injury there, even though we know that1018psychologist is leaving, we do not recruit, begin recruitment1019until after the psychologist is gone. Therefore, all of that1020psychologist work is borne by someone else or patients are1021rescheduled and rescheduled and rescheduled until someone comes1022in to fill that post.1023    Mr. Conaway. Thank you. Madam Chair, I yield back. I see it1024is my time.1025    Ms. Kiggans. Thank you. I have a couple of other questions.1026Dr. Elliot, just for clarification, that psychologist you, I am1027sorry. Oh, Mr. Kennedy, let us start with, sorry, Mr. Kennedy,1028we will recognize you for 5 minutes.1029    Mr. Kennedy. Thank you very much. Thank you all for being1030here today. I have some deep concerns about what is transpiring1031at the VA across this country. I know veterans, not only in my1032district, but across the Nation are disturbed about the news1033that is continuing to come out of the VA that will impact their1034care. Just to take a quick trip down memory lane, back in1035February, the VA dismissed 1,000 employees outright as February103613th. Eleven days later, on February 24th, the VA cut another10371400 employees. 2,400 people cut from serving our veterans in1038this Nation. It was the beginning of a despicable pattern that1039we have seen coming out of this administration. In March, this1040committee discovered through a leaked memo that the VA planned1041to cut more than 80,000 employees, which Secretary Collins then1042confirmed. Now we are being told that the VA will not make this1043cut, but would reduce the number of employees by nearly 30,0001044by the end of the fiscal year. Seventeen thousand already gone,1045meaning there is going to be another 12,000. More than 12,0001046additional cuts, the largest in VA history.1047    These reductions will affect critical frontline staff,1048including healthcare workers and benefits personnel. I recall1049what Secretary Collins told this committee in May, and I am1050going to quote the Secretary. ``The VA staffing structure is1051aimed at finding ways to improve care and benefits for veterans1052without cutting care and benefits for veterans. We are going to1053maintain the VA's mission essential jobs like doctors, nurses1054and claims processors, while phasing out Michigan mission, non-1055mission essential roles.'' That is not what we are seeing. I1056want to believe that that would be true, but if it is not true,1057then this committee responsible for VA oversight has been1058misled. I have a couple of questions. Ms. Therit, you visited1059multiple VA facilities and have spoken with a wide range of1060employees. Based on what you have seen, similar roles face1061similar challenges nationwide. Why were collective bargaining1062rights preserved for nurses and facility workers at the1063Milwaukee, VA, but stripped from their counterparts in the1064community that I represent in Buffalo despite nearly identical1065job functions?1066    Ms. Therit. Representative Kennedy, the executive order1067related to labor relations is currently under litigation. There1068is a stay related to that executive order. We are complying1069with that litigation right now.1070    Mr. Kennedy. Okay, so no answer. The only clear difference1071that I can see is union affiliation. Buffalo workers are1072represented by unions that have filed lawsuits against this1073administration, unlike those in Milwaukee, that raises serious1074concerns about political retribution and retaliation. Can you1075explain it all these decisions, how they were made, and whether1076the union activity played a role?1077    Ms. Therit. Representative Kennedy, I am at this point in1078time based on the stay in that particular case, I cannot answer1079that question.1080    Mr. Kennedy. Okay, no answer again, thank you. Dr. Elliot,1081after having conversations with VA employees in Buffalo, two1082things are clear to me. They take deep pride in serving our1083veterans and they rely on their union to protect their rights1084and help them provide the best possible care. As you know,1085President Trump's EO 14251 misused the national security1086exemption in Title 5 to remove employees, including those at1087Hampton, VA, and Buffalo, from the bargaining unit. You just1088mentioned in your testimony that 43 percent reduction in hiring1089that you are behind. Based on your experience, has the VA's1090approach to collective bargaining helped or hurt your ability1091to attract and retain staff?1092    Dr. Elliott. I would say that it has, we have been, I1093guess----1094    Mr. Kennedy. It has?1095    Dr. Elliott. It has--it has reduced our ability to recruit1096and retain. It has. I also would like to say, if you do not1097mind, this situation about the 30,000 employees that are1098targeted as far as a number goes. In 1989, I met a nurse named1099Ms. Eddie Riggs. She told me that a failure to plan is a plan1100to fail. You probably have heard that. When you rely on random1101reductions, there can be danger there. You do not know which1102critical and which non critical position is going to be1103reduced. Let us say, for example, if out of that 30,000, 10,0001104of them are doctors, we cannot tolerate that. Or if 15,000 of1105them are nurses, we cannot.1106    Ms. Kiggans. Gentlemen's time has expired.1107    Mr. Kennedy. Thank you. I yield back.1108    Ms. Kiggans. We are going to move into a second round of1109questioning and we will do 2 minutes for an additional round of1110questions. Ms. Therit, do you anticipate the VHA will develop1111the necessary guidance regarding quality control checks by the1112OIG's recommended completion date in September?1113    Ms. Therit. Chairwoman Kiggans, I do. I know Mr. Perry has1114additional information on that.1115    Ms. Kiggans. Thank you. Can you please tell us how VISN1116leadership will be involved in monitoring the 95 percent1117compliance rate?1118    Mr. Perry. Yes, Chairwoman. As I previously stated, we are1119working now on shifting the responsibility of the oversight to1120the compensation side of the VISN to hold that accountability1121line to make sure that the proper documentation, technical1122review, and approvals are in place. That will be done by the1123end of this year.1124    Ms. Kiggans. How long----1125    Mr. Perry. This fiscal year.1126    Ms. Kiggans. How long, okay, so how long do you anticipate1127it will take for the majority of VISNs to meet that 95 percent1128target?1129    Mr. Perry. We have already started that now. That includes1130my team rolling out the additional training and oversight to1131ensure that they do come into compliance by the end of this1132fiscal year.1133    Ms. Kiggans. Okay, thank you. Ms. Therit, do VHA officials1134have the authorization to approve exceptions to limitations1135placed on incentive payments?1136    Ms. Therit. VHA officials at the, through the delegation of1137authority are able to approve incentives up to a certain1138threshold and then those depending on the incentive may have to1139come up to the office of the Secretary, depending on the1140position.1141    Ms. Kiggans. Who is responsible for approving the exception1142and who provides a check on this person?1143    Ms. Therit. My office conducts an oversight review of those1144incentives and would also be able to work with Mr. Perry's team1145to make sure that they are following policy and proper1146procedures.1147    Ms. Kiggans. In your experience, are those exceptions more1148frequently approved for administrative positions or clinical1149positions?1150    Ms. Therit. Chairwoman Kiggans, they are more frequently1151approved for clinical positions.1152    Ms. Kiggans. Thank you. Mr. Steele, I was shocked to hear1153that the VHA could not provide OIG evidence for recertification1154for those recurring incentive payments. Do you believe this is1155an issue with HR Smart or a result of inadequate oversight by1156the HR servicing teams?1157    Mr. Steele. We saw a breakdown of both systems and people.1158HR Smart lacked the automation to halt the process if certain1159requirements were not met. In that situation, it does put more1160onus on people to enter data correctly and conduct back-end1161oversight to ensure that the process ceases when it should.1162    Ms. Kiggans. Thank you. My 2 minutes have expired. I yield1163to the ranking member.1164    Ms. Ramirez. Thank you, Chair. Ms. Therit, I want to follow1165up again with you. The 8-corner staff have been meeting1166routinely with Mark Engelbaum, the assistant secretary for HR.1167Our staff has requested a detailed breakdown of data on1168employees who have left the VA since January through the DRP,1169Voluntary Early Retirement Authority (VERA), or natural1170attrition. Unfortunately, the numbers that VA provided as a1171follow up fall woefully below the level of detail requested.1172Are you able to produce by location, occupation, detailed data1173on the number of employees who have taken the DRP, who have1174taken VERA, who have resigned, who have retired? Are you able1175to get that information for us?1176    Ms. Therit. Ranking Member Ramirez, yes, I can get that1177information.1178    Ms. Ramirez. Great. What about the number of job offers1179that have been declined by applicants since January of this1180year? Is that a data point that you have the capability of1181pulling?1182    Ms. Therit. Ranking Member Ramirez, our talent acquisition1183system is USA staffing and it does capture some information on1184declinations, but it may not provide the detailed information1185that you are asking.1186    Ms. Ramirez. Okay. Please provide me everything that in1187fact is being collected? Mr. Therit, can you please commit to1188working with us on providing the detailed data in a reasonable1189time?1190    Ms. Therit. Ranking Member Ramirez, I welcome the1191opportunity to work with this.1192    Ms. Ramirez. Great. Thank you, Ms. Therit. I do not imagine1193you will have this number on top of your head because I am sure1194there is a lot going on and a lot of information you have to1195try to memorize for these hearings. I want to bring to you an1196answer, I want you to bring an answer back for the record, how1197many veteran care appointments at the VA have been canceled1198since January of this year due to staffing shortages? If you1199have the answer, I will take it now. If not----1200    Ms. Therit. Ranking Member Ramirez, I do not. I do not know1201if Mr. Perry does.1202    Ms. Ramirez. Do you have that? No?1203    Mr. Perry. We do not, but we can take that----1204    Ms. Ramirez. Keeping come back with it.1205    Mr. Perry. Yes.1206    Ms. Ramirez. I would really appreciate knowing how many1207veteran appointments have been canceled. I am going to leave it1208at that. Mr. Steele, I really wanted to ask you a question, but1209I am hopeful others can. Thank you.1210    Ms. Kiggans. The chair now recognizes Mr. Conaway for 5,1211for 2 minutes.1212    Mr. Conaway. I thought we were changing the order, Madam1213Chair. Thank you for recognizing me, Madam Chair. Just before I1214get to one of my questions, I just want to make a comment about1215H.R. 1, the big cruel bill, as I call it. I am very concerned1216that medical students going to medical school, very expensive1217process, that there is now a cap on those loans that students1218may give. It is going to particularly be a problem for those1219students who do not come from wealthy families where they are1220going to have to try to figure out how to make up that gap.1221What do you think that this, that this issue of cutting support1222for medical education, how do you think that is going to impact1223the VA? You have trained most of the physicians in the country.1224    Ms. Therit. Dr. Conaway, I would say that when we talk1225about 3R's, there are also other incentives and you speak to1226scholarship programs, debt reduction programs, and if you look1227at the job opportunity announcements that are posted for the1228VA, many of our Veterans Health Administration job opportunity1229announcement include those benefits. I will ask Mr. Perry to1230just----1231    Mr. Conaway. I am going to reclaim my time because I want1232to get another question in. Pardon me for that, but I must push1233on. In 2024, the VA reported a loss of 608 physicians. Just a1234series of questions. You may not have them, but I want to get1235them in before my time is up. How many job postings does the VA1236currently have for physicians? Do you know by chance, if you do1237not know off the top of your head, I will just leave them for1238the record. How many physicians has the VA onboarded in the1239past month? What is the VA doing to attract and retain1240physicians? Why do you think we are seeing such a loss in1241physicians? I will leave it at that. If you have questions, any1242of those, I see my time is up, but I look forward to your1243answer offline.1244    Ms. Kiggans. The gentleman's time has expired. The chair1245now recognizes Mr. Kennedy for 2 minutes.1246    Mr. Kennedy. Thank you. I want to just go back to the1247Secretary and what he said to this committee in May, that the1248VA would maintain mission essential jobs like doctors, nurses1249and claims processors. According to the VA's monthly workforce1250dashboard, estimated losses for Fiscal Year 1925 are 1,7201251registered nurses, 604 physicians, and 1,081 veteran claim1252examiners. These are mission critical roles which run directly1253against Secretary Collins points that current and future cuts1254to the VA will not impact the delivery of care and benefits. As1255an occupational therapist, I have seen firsthand on the ground1256what happens when health care facilities are short staffed and1257that health care is not provided to individuals. Right now, our1258veterans are being provided care by American heroes on the1259ground in these facilities. You know what? They are exhausted.1260Not because they do not care, but because they ultimately are1261having trouble keeping up because they are getting cut in1262staffing. When that happens in our VA, it is our veterans that1263are paying the price. Even though we have been told mission1264critical employees are not being cut, evidence on paper is that1265in fact there is a different story. We have credibility issues1266at the VA and with this administration happening right now.1267These cuts are impacting veteran care, and veterans should not1268have to wait longer or see fewer specialists or receive delayed1269benefits. As members of this committee, we have a sacred1270responsibility to uphold this Nation's promise to our veterans.1271These cuts are not only shortsighted un-American.1272    Ms. Kiggans. The gentleman's time has expired.1273    Mr. Kennedy. I yield back.1274    Ms. Kiggans. Dr. Steele and Dr. Elliot. Thank you to each1275of you for coming to testify today. The solution is not just1276identifying weak policies, but following through with the1277guardrails that ensure effective oversight. It is clear more1278attention needs to be focused on ensuring the VA is following1279Congress's intention when paying these incentives. The fact1280that we are still having a conversation on this issue after1281more than a decade since the OIG's 2017 report on improper1282bonus payments indicates we must do something different. It1283does not take a rocket scientist to figure out that providing1284quality and safe patient care is a better use of tax dollars1285and accounting mistakes. These bonuses, when used correctly,1286enable the VA to pay attractive salaries to valuable clinical1287staff and other VA employees who serve our veterans. These1288incentive payments should go to staff dedicated to providing1289world class care for our veterans. When the VA cannot retain1290its good employees or recruit talented staff, patient care is1291the first to suffer. I have seen this firsthand as a nurse1292practitioner. I will not allow it to happen while I am1293chairwoman of the subcommittee. I am encouraged the OIG1294identified better documentation as a means of improving the1295bonus payment processes as well. Aside from the waste stemming1296from the improper payments, it is not possible to conduct a1297thorough review of where processes went wrong when there is no1298paper trail. That is why I was happy to vote with my House1299colleagues yesterday for Senate Bill 423, the Protecting1300Regular Order for Veterans, or PRO Act. This bipartisan bill1301would provide additional guardrails on incentive payments paid1302to members of the senior executive service and I hope the VA1303will take them seriously. I am looking forward to further1304collaboration with Secretary Collins and the Trump1305administration to assist with our oversight efforts. I am1306grateful for the clarity that today's testimony offers. Ranking1307Member Ramirez, do you have any closing remarks?1308    Ms. Ramirez. Thank you, Chairwoman. World class care cannot1309be achieved when you have lost 1,720 registered nurses. Cannot1310be achieved when 1,147 medical support assistant staff leave or1311604 physicians leave. When asked why they are leaving, they say1312lack of trust and confidence in senior leaders. The information1313contained in VA's workforce dashboard is critical to our1314oversight and to showing the public the true picture of what is1315happening at the VA under Secretary Collins. It is hard to call1316us liars and say our claims are a hoax when we have the data1317from VA to back up concerns that veteran care and benefits are1318being impacted under Collins leadership. The information for1319the public that is listening can be accessed at va.gov/1320employee/workforce-dashboard. I urge everyone watching this1321hearing to go now and review the data and make a judgment for1322yourself on how this administration's actions have and will1323continue to impact world class care for our veterans. We know1324that this administration has a history of deleting or hiding1325files and tampering with information they do not agree with. To1326ensure that these documents remain a part of the public record1327and are not deleted, removed or hidden, I request unanimous1328consent to enter issues 1 through 26 of VA's workforce1329dashboard into the dashboard.1330    Ms. Kiggans. Without objection. So, ordered.1331    Ms. Ramirez. Thank you, Chairwoman. With that, I yield1332back.1333    Ms. Kiggans. Thank you, Ranking Member, and thank you all1334for being here today. Ms. Therit, Mr. Perry, Mr. Steele, Dr.1335Elliot, I know you all took time out of your busy schedules and1336I appreciate that. I am sure you were prepared to discuss the1337real issues at the VA, including the title of our subcommittee,1338which just as a reminder was Counting the Money, Preventing1339Fraud and Abuse in the VA's bonus payment practices for VA1340employees. I appreciate your insight on the issue that is why1341we called this hearing today. As a navy veteran and a nurse1342practitioner, I know how critical it is for the VA to provide1343consistent, high-quality care to those who have served. I am1344married to a veteran. I am the mom to future veterans. I1345represent tens of thousands of veterans. My own parents are1346veterans. It is an issue near and dear to my heart and to my1347district.1348    I am encouraged that the VA has decided against large scale1349layoffs and is instead taking a more thoughtful and measured1350approach to improving operations. I also worked at the VA for1351several years or for several months as a nurse practitioner. It1352was a short time because I am a geriatric nurse practitioner1353and could not utilize my geriatric skill base as much as I1354wanted to. I remember that there were a lot of really good1355people doing really hard work. The physicians, the doctors and1356nurses, the pharmacists, the allied health professionals, the1357people who were in one building taking care of people who1358walked through our front door. I also remember on my lunch1359break I would take walks and see buildings full of other people1360that did not provide patient care. I did not know what they1361did, but I knew where I was called to work and where I was able1362to touch patients and to impact lives of veterans. I think1363there is room. Just as this was before my time in politics,1364just looking at what that facility looked like, knowing that1365there was room to probably downscale, I want to make sure that1366our best resources are going to the patient care.1367    Reducing 30,000 positions through attrition rather than1368eliminating clinical roles is a more reasonable path forward. I1369know that is what the Secretary is focused on doing. I support1370efforts to streamline the department and I give more decision-1371making authority to local medical center directors who are1372closest to the veterans they serve. Decentralizing operations1373can help VA facilities respond more quickly to local needs and1374improve overall outcomes for patients. At the same time, I am1375closely monitoring how these changes may impact support staff1376who play a critical role in ensuring providers can focus on1377delivering care. I believe restructuring can be positive, but1378only if it is done transparently, with input from frontline1379workers and full oversight from Congress. The lack of clarity1380around some of the VA's reorganization efforts is concerning,1381and I will continue to push for more communication and1382accountability. Congress must be a partner in the process, not1383an afterthought, and the VA leadership must work1384collaboratively to keep veterans and employees informed. I will1385continue advocating for investments in VA services that1386prioritize patient care, benefits delivery and support for the1387dedicated workforce. Ultimately, this is not a partisan issue.1388This is about keeping our promises to those who have worn the1389uniform. Veterans deserve a VA that serves them efficiently,1390compassionately and without disruption. Again, thank you all1391for being here today. I ask unanimous consent that all members1392shall have 5 legislative days on which to revise and extend1393their remarks and include any extraneous material.1394    Hearing no objection. So, ordered. This hearing is now1395adjourned.1396    [Whereupon, at 3:19 p.m., the subcommittee was adjourned.]13971398=======================================================================13991400                         A  P  P  E  N  D  I  X14011402=======================================================================14031404                    Prepared Statements of Witnesses14051406                              ----------14071408                  Prepared Statement of Tracey Therit14091410    Good afternoon, Chairwoman Kiggans, Ranking Member Ramirez, and1411distinguished members of the Committee. Thank you for the opportunity1412to discuss how VA is improving governance and oversight of recruitment,1413relocation, and retention (3R) incentive payment practices. As pay caps1414for health care professionals at VA have not kept pace with rising1415salaries for health care professionals and specialists, the 3R program1416is a critical component of VAs incentive plan. I am joined today by Mr.1417David Perry, Acting Chief, Human Capital Management, Veterans Health1418Administration (VHA).1419    Everything VA does is to ensure Veterans receive the care and1420services they deserve while instilling a culture of caring, customer1421service, and accountability that always puts Veterans first. This noble1422mission, coupled with a variety of hiring flexibilities and incentives,1423enables VA to attract and retain a highly qualified workforce. VA also1424offers a comprehensive benefits package, generous leave allowances,1425state-of-the-art research and innovation programs, as well as top-of-1426the-line training opportunities.1427    VA will always fulfill its duty to provide Veterans, families,1428caregivers, and survivors with the health care and benefits they have1429earned. To ensure all Veterans and VA beneficiaries continue to receive1430their earned benefits and services, VA is always recruiting dedicated1431professionals. As of July 2025, more than 350,000 mission-critical1432positions are exempt from the Federal hiring freeze. While VA has1433historically offered 3R incentives to address occupational shortages1434and facilitate hiring initiatives, the Department must provide greater1435accountability and stewardship of taxpayer resources by enhancing1436procedures, documenting requirements, and providing oversight of these1437incentives.1438    Starting in 2017, VA updated Department policy on 3R incentives to1439establish internal controls and improve oversight. Specifically, VA1440began requiring annual certification that the incentive was appropriate1441and in compliance with policy; had succession plans to reduce long-term1442reliance on incentives; and established residency before payment1443receipt. In the years since, VA has continued iterating and1444implementing additional improvements including the following:14451446      Requiring a standard form to capture all information1447required by law.14481449      Aligning the use of 3Rs with shortage/hard-to-fill1450positions.14511452      Obtaining authorization/justification before including 3R1453incentives in the job announcement.14541455      Tracking unfulfilled service obligations.14561457      Improving coordination on debt collection and enforcing1458debt collection.14591460      Reviewing retention incentives annually and terminating1461them in a timely manner if they were not needed.14621463    3R incentives help VA fill critical positions providing direct care1464and services to Veterans. Moreover, offering these incentives enables1465VA to address periods of increased demand or sustained industry-wide1466staffing shortages. For example, 3R incentives helped VA rapidly1467respond and compete for talent amid the pandemic and continue to aid in1468attracting doctors and nurses to areas of growing need because of the1469Sergeant First Class Heath Robinson Honoring our Promise to Address1470Comprehensive Toxics Act of 2022.1471    However, there is always room for improvement, and VA must continue1472to refine its governance of these incentives, including proper1473documentation of their use, ensuring the correct signatures are in1474place, and ensuring the justification for employing a 3R incentive is1475sound. VA must also develop stronger oversight mechanisms and1476discontinue the use of multi-year retention incentives.1477    Accomplishing this requires VA to build upon current policy and1478process, enhancing systems, and training on 3R incentives. The1479Department is establishing quality control and accountability measures1480and ensuring oversight responsibilities are risk-based and completed in1481a timely manner. VA is also identifying ways to improve automation and1482technology, which has enabled VA to complete documents in the system,1483to centrally store documents, to build in controls and alerts, and to1484create dashboards and recurring reports.1485    Finally, VHA is implementing a comprehensive strategy to enhance1486the management and oversight of VA incentive programs. This includes1487continuing to monitor internal control procedures and guidance to1488ensure that 3R documentation is appropriately maintained in accordance1489with VA policy. VHA will conduct program monitoring quarterly and1490utilize uniform checklists and templates nationwide. Additionally, VHA1491is developing training and materials to ensure proper documentation for1492succession plans, performance ratings, and certifications. To better1493enforce policy compliance, VHA is creating oversight plans and a1494strengthened technical review program to assess every incentive for1495technical adherence. An enterprise-level oversight monitoring component1496will act as a second-level compliance check at the national level. VHA1497aims to support compliance with record retention requirements.1498Furthermore, specific performance metrics tied to operational1499leadership and human resources (HR) leadership are being developed to1500reinforce the importance of proper governance and oversight for VA1501incentive programs.1502    As a part of this Administration's workforce optimization efforts,1503VA has identified several ideas for improving VA to better serve1504Veterans. One of the proposals being discussed is centralizing HR1505functions, which would strengthen the HR structure to process, monitor,1506and review 3R incentives. The current structure has been cited as being1507too decentralized with multiple layers of bureaucracy. VA will continue1508to keep Congress informed through initiatives such as monthly Eight1509Corners briefings from Assistant Secretary for Human Resources and1510Administration/Operations, Security, and Preparedness Mark Engelbaum as1511the Department continues its reviews of organizations and services.1512    VA is fully committed to addressing the issues identified in the1513Inspector General's report, ``Recruitment, Relocation, and Recruitment1514Incentives for VHA Positions Need Improved Oversight,'' and to1515strengthening our processes in support of VA's mission. To date, we1516have closed one of the eight recommendations and are on schedule to1517close five more in September 2025. We will complete the final two1518recommendations by March 2026. We are confident that the steps we have1519already taken and continue to take will strengthen our incentive1520program governance and oversight, leading to more effective outcomes1521and better service to the Nation's Veterans.1522    While the 3R incentive program is an important tool for the1523Department in attracting and retaining a vibrant and talented1524workforce, it is not enough for VA to remain competitive with industry.1525VA looks forward to working with the committee on strategies to ensure1526VA is an employer of choice for physicians (in critical need1527specialties).15281529Conclusion15301531    I am proud to be part of this noble mission to care for the1532Nation's Veterans. I look forward to working with each of you on this1533Committee on ways to more effectively and efficiently provide enhanced1534oversight and governance of incentive payment practices, ensuring that1535VA can continue to provide the best care and services to Veterans and1536their families. This concludes my testimony. My colleague and I are1537prepared to respond to any questions you may have.15381539                   Prepared Statement of Shawn Steele1540[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]15411542                  Prepared Statement of Sheila Elliott15431544    Chairwoman Kiggans, Ranking Member Ramirez, and Members of the1545Oversight and Investigations Subcommittee:15461547    The American Federation of Government Employees, AFL-CIO (AFGE) and1548its National Veterans Affairs Council (NVAC) appreciate the opportunity1549to testify at today's subcommittee hearing titled ``Counting the Money:1550Preventing Fraud and Abuse in VA's Bonus Payment Practices for VA1551Employees.'' My name is Dr. Sheila Elliott, and for the past 35 years,1552I have and continue to serve as a Pharmacist at the Hampton, VA, VA1553Medical Center. I have also, until retiring last month, proudly served1554over 15 years as the president of AFGE Local 2328, which represents1555most direct patient care staff at the VAMC and its surrounding clinics.1556    On behalf of the 320,000 Department of Veterans Affairs (VA)1557employees AFGE represents, approximately a third of whom are veterans1558themselves, it is a privilege to offer AFGE's views on how the VA1559should improve recruitment and retention for the VA workforce, both1560within the scope of recruitment, retention, and relocation bonus1561program, and beyond.15621563        OIG Report15641565    On June 12, 2025, the VA OIG released a report titled1566``Recruitment, Relocation, and Retention Invectives for VHA Positions1567Need Improved Oversight'' (``OIG report'').\1\ As the report states,1568``[t]o address occupational shortages and facilitate hiring efforts, VA1569leverages Federal regulations that allow agencies to offer recruitment,1570relocation, and retention incentives to encourage candidates to accept1571positions that are difficult to fill or to keep high-quality staff who1572may otherwise leave.'' \2\, \3\ In this report, OIG1573highlighted several problems with the administration and oversight of1574this recruitment, retention, and relocation bonus (``RRR bonus '')1575program that AFGE agrees with.1576---------------------------------------------------------------------------1577    \1\ ``Recruitment, Relocation, and Retention Invectives for VHA1578Positions Need Improved Oversight'' VA OIG 23-01695-94 Page i June 12,157920251580    \2\ Id.1581    \3\ Citing ``Recruitment, relocation, and retention incentives are1582authorized under 5 U.S.C. Sec. Sec.  5753 and 5754 are extended to1583title 38 employees under the authority of 38 U.S.C. Sec.  7410. Title158438 employees are those individuals appointed under 38 U.S.C. Sec.15857401, which permits the VA Secretary to hire personnel necessary for1586the health care of veterans and can include physicians, nurses, and1587dentists.''15881589---------------------------------------------------------------------------1590        HR Modernization15911592    Chief among the problems identified in this report is the failure1593of VA Human Resources (HR). While VA did use this tool to recruit and1594retain VHA clinicians, there were clearly problems in how the RRR bonus1595program was administered to ensure that the correct employees were1596receiving the benefits and that the process was carried out1597appropriately. Many of these problems were first identified by the OIG1598in 2017.\4\ Unfortunately, the report goes on to note that the ``OIG1599team found VHA did not take sufficient steps to sustain or enforce the1600updated VA policies to ensure incentive packages were completed1601appropriately before payments were initiated. Further, VISN human1602resources staff acknowledged they did not always adhere to policy.''1603\5\ The report then digs deeper by identifying ``Beginning in Fiscal1604Year 2019, VA also consolidated human resources responsibilities from1605the facility level to the VISN level, including oversight of1606incentives. During this transition, according to human resources1607officials, turnover led to a shortage of trained staff to conduct1608incentive oversight responsibilities.'' \6\1609---------------------------------------------------------------------------1610    \4\ VA OIG, Audit of VA's Recruitment, Relocation, and Retention1611Incentives.1612    \5\ Recruitment, Relocation, and Retention Invectives for VHA1613Positions Need Improved Oversight'' VA OIG 23-01695-94 Page 11 June 12,161420251615    \6\ Id at 12.1616---------------------------------------------------------------------------1617    AFGE has continuously criticized the HR centralization or1618modernization that the OIG is citing here, agreeing with the conclusion1619that it has led to increased turnover at the VA. Additionally, AFGE1620believes that HR not being in the facilities, and lacking familiarity1621with the workforce and the veterans they serve, exacerbates this1622turnover. In aggregate, this undermines the ability of HR professionals1623to properly serve employees generally, as well as administering the RRR1624bonus program. Furthermore, the OIG's citing of multiple instances of1625poor record keeping not only proves that certain employees may have1626incorrectly received the reward, but it also makes it harder to1627determine who has correctly received RRR bonuses.1628    In preparation for this hearing, when contacting the Hampton VAMC,1629we could find no public repository of data to show who has received RRR1630bonuses over the past several years. However, after reaching out to 8001631bargaining unit members at Hampton VAMC this month on our own, AFGE had1632nine bargaining unit members self-report, from a variety of1633professions, that four recruitment bonuses, four retention bonuses, and1634on relocation bonus were awarded. These bonuses were awarded between16352021 and 2025.1636    While AFGE is pleased that at least nine employees received these1637RRR bonuses, we have no way of knowing if this benefit is being under,1638properly, or over utilized at Hampton VAMC compared to the rest of VHA.1639However, regardless of its relative utilization to other facilities, I1640can say with decades of experience at this facility that there is1641significant room for improvement, both at the VAMC itself and the1642brand-new North Battlefield Outpatient Clinic, which opened in 20251643with only 150 of 550 staffing positions filled. While AFGE acknowledges1644that medical facilities are not filled overnight, we urge the VA to1645use, and this committee to question the VA on how, this RRR bonus1646program is being used to fill positions and increase capacity at the1647North Battlefield Outpatient Clinic and at the Hampton VAMC?16481649Other ways to improve Recruitment at Retention:16501651    In addition to improving the RRR bonus program, AFGE has many other1652priorities within this committee's jurisdiction that would directly1653improve recruitment and retention.16541655        AFGE/NVAC Collective Bargaining Agreement:16561657    As this committee is aware, on March 27, 2025, President Trump1658signed the Exclusions from Federal Labor-Management Relations Programs1659Executive Order 14251 (EO) eliminating the collective bargaining rights1660of 1.5 million Federal employees at agencies including VA. This EO1661abuses the National Security exemption in Title 5 to eliminate1662collective bargaining rights in agencies that have little or no1663national security mission, including the VA workforce. Is strikes down1664a central pillar of the 1978 Civil Service Reform Act enshrined in1665Title 5 of the U.S. Code that governs the merit-based system of1666selecting most Federal employees, protects whistleblowers, and provides1667due process to Federal employees who have been unfairly disciplined or1668terminated.1669    Continuing to deny large swaths of the VA workforce collective1670bargaining rights, will continue to harm recruitment and retention. As1671there is a critical shortage of health professionals in this country,1672why would high quality candidates want to serve in the VA, when they1673would retain not only union protections, but better salaries in the1674private sector? This is particularly egregious, as Secretary Collins1675played favorites when choosing whom to exempt from the EO, not by job1676description or duties, but by which union represents the employees in1677question. AFGE, as well as several of our sister unions, were not1678granted an exemption, and our members, despite having identical jobs to1679those in other facilities who were exempted from this EO, lost their1680collective bargaining rights. AFGE urges members of this committee to1681co-sponsor and support H.R. 2550, the ``Protect America's Workforce1682Act,'' which would nullify this illegal executive order.16831684        Reforming 38 USC 742216851686    As AFGE has testified to before this subcommittee, 38 USC 7422 has1687had a negative effect on recruitment and retention for Title 381688employees at the VA. Under this statute, the VA can invoke 7422 to deny1689a grievance for a Title 38 employee based on ``professional conduct or1690competence'' (including ``direct patient care'' or ``clinical1691competence''), peer review, or ``the establishment, determination, or1692adjustment of employee compensation.''1693    AFGE is proud to have worked with members of this committee in1694bipartisan fashion to craft the narrowly tailored ``VA Correct1695Compensation Act'' to better define the compensation language of the1696statute. AFGE has also long supported the ``VA Employee Fairness Act''1697(H.R. 3261) which would effectively abolish 7422.1698    Any legislative action to rein in the abuse of 7422 by management1699would be a critical step to improve recruitment and retention of the VA1700workforce. However, while AFGE and other unions are subjected to EO170114251, there is no contract for affected Title 38 employees to file a1702grievance under. AFGE urges, particularly after the result of1703litigation or legislation related to EO 14251, for this committee to1704reform 7422 to better retain its Title 38 workforce.17051706        Telework17071708    AFGE has long argued for the benefits of allowing telework or1709remote work for employees who can perform their duties remotely. Within1710the VHA space, this is particularly true for clinicians who practice in1711whole or in large part through telemedicine. However, since most1712telework has been rescinded by this administration, many clinicians1713have had to report to a VA facility, and have been required to interact1714with patients remotely, often in crowded bullpens, to discuss private1715matters. This has harmed morale and retention of mission-critical and1716hard-to-recruit clinicians at the VA. Ironically, one of the RRR1717bonuses that AFGE could find was awarded to a former Hampton VAMC1718employee who for the last 3 years was a remote mental healthcare1719provider who was leaving their position due to the end of remote work.1720However, instead of leaving the VA, this employee received a relocation1721bonus to move to another facility. This has negatively affected the1722capacity of Hampton and reflects VA's overly broad approach to telework1723and telehealth.17241725        Conclusion17261727    I hope that my testimony today leads the subcommittees to better1728consider ways to improve recruitment and retention at VA for1729clinicians. AFGE and the NVAC stand ready to work with the House1730Veterans' Affairs Committee and VA to make these recommendations and1731better enable VA employees to serve veterans. Thank you, and I look1732forward to answering your questions.17331734                                 [all]