Washington – An internal audit by the VA found that staff at the Department of Veterans Affairs outpatient clinic in Rochester "felt pressure to manipulate" appointment data to hide delays in medical care for veterans.

The audit's findings reveal why the Minneapolis VA Health Care System and the Rochester clinic were among 112 VA facilities around the country flagged this summer for additional scrutiny.

Former VA Secretary Eric Shinseki ordered the nationwide review after coverups of extended wait times were discovered at some facilities.

The Minneapolis VA oversees a network of 13 clinics in western Wisconsin and Minnesota, including the Rochester location. Officials there are awaiting a final report from the VA Office of the Inspector General in Washington, D.C., before taking action.

"When there's a further level of review, we will then take the appropriate … suggested or needed actions," said Patrick Kelly, director of the Minneapolis VA system.

The VA has urged caution in interpreting the findings. The initial report, though, was enough to spur investigations into whether hospital administrators ordered the manipulation of data to inflate performance numbers, which were tied to bonuses. The VA moved this week to fire six employees at sites in Wyoming and Colorado.

Rep. Tim Walz, D-Minn., a member of the House Veterans' Affairs Committee, said new VA Secretary Robert McDonald must "root out bad actors" in the system.

"The audit information is troubling, but not shocking given the culture we've uncovered at VA in recent months and the pressure to hit unrealistic wait-time goals," said Walz, whose First District includes Rochester.

Republican and Democratic leaders in Congress this week reached an agreement to provide $10 billion in emergency funding to the VA to allow veterans to seek private care rather than face long wait times at VA medical facilities.

Walz was a member of the House-Senate conference committee that negotiated the deal.

The VA ordered the audit of its health system after reports surfaced that schedulers, unable to meet tight deadlines for appointments, were keeping secret wait lists or entering appointment dates other than the ones requested by veterans.

The review found rampant manipulation by employees, but site-specific details didn't emerge until this week.

"To say that many veterans across Minnesota are happy with the care they receive from VA facilities is missing the point," said Jason Quick, Minnesota state director for Concerned Veterans for America, an advocacy group with funding linked to the conservative Koch brothers. "That's only once they get past the bureaucrats to a doctor."

As part of the audit, staffers asked 43 schedulers in the Minneapolis VA Health Care System whether they were instructed to alter scheduling data or felt pressured to do so.

Five schedulers in the Minneapolis region said they received instructions to alter appointment data. One scheduler said they were told to track appointments outside the system. The Minneapolis system has about 900 schedulers total, Kelly said.

VA policy is to enter the date the veteran requests as the "desired date" even if that time is not available. That date is then used to track waiting times for veterans to get appointments.

Not 'trying to hide'

Kelly said the red flags raised by the audit were tied to compliance issues at two Minneapolis clinics and "never any issue of integrity or trying to hide anything."

Released this week, the report follows up on an audit of more than 900 Veterans Affairs facilities across the nation. The review found no offenses in the St. Cloud VA Health Care System.

Complaints about the Hibbing VA clinic, run by a private company, prompted Rep. Rick Nolan, D-Minn., of the Eighth District to hold a hearing in July. More than two dozen complaints about treatment and scheduling have been filed since the clinic was taken over by Cincinnati-based Sterling Medical Associates last year.

Nolan said he would continue to pressure the VA and the company to make improvements.