The Other Three Hospitals: $1.5 Billion in Overruns Beyond Aurora

Aurora wasn’t a fluke. GAO’s review of VA’s four biggest hospital builds found cost increases of 59–144% across all of them — nearly $1.5B total — with delays up to 74 months and a change-order process that manufactured both.

The Aurora hospital — $328 million estimated, $1.7 billion delivered — is the famous one. GAO’s 2013 review of the VA’s four largest medical-facility projects shows it was the pattern, not the exception: Denver, Las Vegas, New Orleans and Orlando together ran nearly $1.5 billion over, with per-project increases of 59 to 144 percent and delays averaging 35 months.

GAO’s causes were managerial: VA had not fully used medical equipment planners; construction staff roles were so unclearly defined that contractors got conflicting direction and expensive redesigns followed; and the change-order approval process was so layered it generated delays and costs by itself.

VA concurred with GAO’s recommendations while disputing GAO’s depiction of the increases; GAO stood by its methodology. The eventual verdict came from Congress, which stripped the VA of authority over major construction and handed it to the Army Corps of Engineers — the institutional equivalent of taking away the keys.

"a total cost increase of nearly $1.5 billion"
— GAO-13-302

Source: GAO — VA Construction: Additional Actions Needed to Decrease Delays and Lower Costs of Major Medical-Facility Projects (GAO-13-302). Part of the VA Fraud library — see also the case files for the prosecutions these systems produced.