The VA hospitals were under pressure from the top of the organization to increase the number of patients who could be seen within 30 days.   The VA employees quickly rigged a system to make the charting look like people were being seen timely when they actually weren’t.  Yes, one way to improve quality of care is to cook the books.

There is intense pressure to make changes like this because there are countless regulations that flow downhill from the bureaucracy.  Many of the regulations are silly and almost all are burdensome to an organization and ultimately result in compromising care rather than improving it.  Fudging the numbers and making something look different on paper is unfortunately common.