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Internal VA documents show the depth of fraudulent scheduling, manipulation of data and in some cases intimidation of staff to hide delays in medical care to veterans in the 6-million patient national system, according to documents provided to USA TODAY.

Workers at the Department of Veterans Affairs outpatient clinic in Wilmington, N.C., told auditors they "were fearful of retaliation" if they did not manipulate appointment data.

At the Edward Hines Jr. VA hospital in Hines, Ill., near Chicago, "staff felt they would be subject to disciplinary action" if appointment records were not changed, one report shows.

Managers instructed or "encouraged" schedulers to falsify appointment data at such VA medical facilities as those in Leeds, Mass.; Martinsburg, W.Va.; Jacksonville, N.C.; Virginia Beach, Cincinnati and Cleveland, according to the documents.

The audit by the VA's Veterans Health Administration was ordered earlier this year by then-VA Secretary Eric Shinseki. The results were provided to President Obama on May 30, the day Shinseki resigned.

The Senate on Tuesday confirmed Obama's nomination of former Procter & Gamble CEO Robert McDonald as Shinseki's successor. McDonald, 61, of Cincinnati, was unanimously approved to replace Acting VA Secretary Sloan Gibson, who took over after Shinseki resigned.

Internal investigations found that clinic or hospital chiefs may have manipulated appointment data in order to look better on performance evaluations upon which their bonuses were based.

"As these new details make painfully obvious ...some VA executives are so driven in their quest for performance bonuses, promotions and power that they are willing to lie, cheat and put the health of the veterans they were hired to serve at risk," said Rep. Jeff Miller, R-Fla., chairman of the House Committee on Veterans' Affairs.

Investigating auditors complained that during their visit to a VA hospital in Hudson Valley, N.Y., someone in the room coached schedulers on how to answer the auditors' questions.

One auditor visiting an VA outpatient clnic in Horsham, Pa., near Philadelphia, wrote: "staff were encouraged to inaccurately enter ... (dates) in an attempt to game the system."

About a VA clinic in Rochester, Minn., another auditor wrote: "staff encouraged and felt pressure to manipulate... (appointment data) in order to meet performance measure."

Secret lists of veterans whose care was delayed were kept by VA hospitals or clinics in places such as Richmond, Va., Washington, D.C., and Lebanon, Pa.

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

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