Some 100,000 veterans across the country are waiting long periods to see doctors, according to an internal Department of Veterans Affairs audit released Monday.
The VA says it already has contacted 50,000 veterans trying to get them quicker medical care.
A total of 57,436 veterans across the country have waited 90 days to see a doctor and still did not have an appointment as of May 15, the VA said. The agency also found evidence that in the past 10 years, nearly 64,000 veterans who sought VA care were simply never seen by a doctor.
"VA is moving aggressively to contact these veterans," the audit report said.
Late Monday night, acting VA Inspector General Richard Griffin told a House committee that his investigators identified "some supervisors" in the department who ordered manipulations of appointment data. Griffin says his office is reviewing with the federal prosecutors whether criminal charges will be filed against the VA supervisors.
The systematic manipulation of appointments records across the massive veterans health care system to show high performance when there wasn't any led former secretary Eric Shinseki to resign late last month.
It remains unclear how many veterans were harmed by delays in care, although at least hundreds of thousands within a year's time were forced to wait longer to see a doctor than the ambitious timetable of 14 days established by the agency.
Sloan Gibson, the interim secretary of the Department of Veterans Affairs, said last week that 18 Arizona veterans had died while awaiting doctor appointments at the hospital in Phoenix. But he said it is unclear whether their deaths were the result of those delays.
Investigators have found that 13% of VA schedulers across the country were instructed how to set up appointments at the convenience of an overburdened system rather than the veteran and that 8% kept unofficial lists of patients whose care was delayed.
An analysis of data made public Monday shows that at 19 VA facilities across the country, new patients were waiting longer than 60 days to see a primary care doctor in May. The longest delays were in Hawaii, where veterans were waiting an average of 145 days to see a primary doctor for the first time. At the Hawaii facility, the time elapsed was nearly 100 days longer than what had been officially reported.
Independent of the audit by the VA is an investigation into the scandal by Griffin, the acting inspector general, who said Monday that his staff is investigating 69 VA medical facilities across the country.
The VA audit released Monday revealed that there was at least some level of manipulated scheduling at three of every four agency medical facilities -- whether a hospital or a clinic. Unofficial lists of veterans whose care was delayed were kept at 70% of medical facilities, the audit found.
A key problem that surfaced at the VA hospital in Phoenix, where the scandal first erupted when a retired doctor raised red flags, were allegations of "secret lists" of hundreds of veterans who could not be seen by a doctor because none were available.
The audit found instances in which appointment records were altered at 90 VA outpatient clinics. At 24 sites, staffers said "they felt threatened or coerced to enter" false appointment dates by superiors.
Staffers at 14 facilities said they were punished for not manipulating appointment records. "A number of respondents presented detailed descriptions or instructions from supervisors to change or alter date," the report said.
Staffers described "a numbers-driven system with unrealistic performance measures as having created a highly stressful work environment that limits the focus on serving the veteran," according to the report.
In a statement Monday, the VA said "where appropriate, (it) will initiate the process of removing senior leaders."
"VA's first goal is to get veterans off wait lists and into clinics," the agency said. Officials said they intend to do this by temporarily expanding services at certain clinics, sending more veterans to private clinics at VA expense and employing mobile medical units.
The VA said it will cost an estimated $300 million in the next two to three months to pay for non-VA care for those veterans who can't be seen quickly enough at a department hospital or clinic.
An initial audit report that Shinseki provided President Obama along with an offer to resign on May 30 — an offer the president accepted the same day — described a health system with a "systemic lack of integrity."
Concerned that hospital officials were orchestrating the cover-up of delays to make their performance reviews look better — reports upon which salary increases and bonuses are based — Shinseki in one of his final actions removed wait-time standards from the personnel review process.
The early version of the VA audit concluded that the 14-day goal was too ambitious and unattainable given the insufficient number of doctors available to treat a population of aging veterans along with thousands from the Iraq and Afghanistan wars who have a complex set of injuries, wounds and behavioral health problems.
A VA system of 150 hospitals and 820 outpatient clinics treats about 6 million veterans each year and has 9 million enrolled as patients. While the nation's total population of veterans is declining — as the massive World War II and Korean War generations pass away — an aging population coupled with the influx of new veterans from the most recent wars has led to steady increases in outpatient appointments to nearly 85 million a year.