The Justice Department and the FBI have joined the Veterans Affairs inspector general to investigate allegations of obstruction of justice at dozens of veterans hospitals across the country, according to a long-awaited report released Tuesday.

The report by the Department of Veterans Affairs Office of Inspector General said 93 VA health care sites across the country are being investigated in connection with falsifying scheduling records to hide delays in veterans’ health care and “attempting to obstruct OIG (Office of Inspector General) and other investigative efforts.”

“These investigations confirmed wait-time manipulations were prevalent throughout” the VA health system, the report said.

The document cited a “breakdown of the ethics system” within the VA health care program.

“The report cannot capture the personal disappointment, frustration and loss of faith of individual veterans and their family members with a health care system that often could not respond to their mental and physical needs in a timely matter,” the report said.

The VA system of 150 hospitals and 820 clinics serves about 6 million veterans each year.

The inspector general report focused largely on problems at the VA hospital in Phoenix, the epicenter of the scandal. Reports of deaths among veterans awaiting care first surfaced there, but investigators said they have not found conclusive evidence linking the deaths to delayed care.

Investigators found thousands of veterans in the Phoenix hospital who were not being seen by doctors and whose names were kept on secret lists to hide them from official records that might reflect scheduling delays. The VA has since worked to contact nearly all veterans whose care was delayed to either get them to a VA physician or pay for their care by private doctors.

Investigators said hospital executives and senior clinical staff were aware that false scheduling practices were being used.

Investigators learned that dozens of Phoenix VA scheduling staffers penciled into records the wrong dates or “fixed” other appointment data to mask delays in care. Some workers said they were instructed to do so by superiors.

Sharon Helman, the hospital director who has been placed on administrative leave with two other senior colleagues, instituted a program during 2013 billed as an effort to improve access for veterans, In fact, it was misleading and filled with inaccurate or unsupported data, the report said.

She cited those efforts in her self-assessment, and it factored into her job rating and ultimately led to a 1.5% pay increase from $169,900 to $172,449, plus a bonus of $8,495, according to the report. During the subsequent investigation, the VA rescinded both the pay increase and the bonus.

The report outlined 45 cases of shabby treatment and delays for veterans at Phoenix. Among them: staff trying to set up a promised appointment for a veteran three months after he died; coronary bypass surgery done on a veteran in his 60s five months late because no cardiology appointment was ever scheduled; after 10 months of delay, a veteran in his 40s who feared he had skin cancer was finally examined and the lesions found to be benign; another in his 70s tested likely for prostate cancer but waited 11 months before a biopsy led to a diagnosis.

The VA concurred with all 24 recommendations for improvement in the 143-page report issued Tuesday.

As news media began reporting on the problems in Phoenix, the Inspector General’s office was flooded with 225 allegations of wrongdoing at that hospital and nearly 450 connected with VA clinics and hospitals around the country.

Allegations emerged of veterans kept waiting months to see a doctor, their names kept off official waiting lists and tabulated in secret; and of appointment data being altered to make health care performance results look better.

As the inspector general launched an investigation, later joined by the Justice Department, whistle-blowers at VA hospitals and clinics across the country came forward to describe similar patterns.

The anticipated release of the report Tuesday prompted VA officials to prepare a full-court public relations response ahead of time. Selected news media were granted interviews with top VA officials days in advance. President Obama delivered remarks before the American Legion on Tuesday in Charlotte heralding steps to correct failings.

The new VA secretary, Robert McDonald, speaking at the same event, said the agency is working hard to change its practices and image.

“From here on out, we want veterans to know that when they walk through the VA’s doors, employees are ‘all in’ when it comes to meeting our missions, living our values and keeping veterans first and foremost in all that they do,” McDonald said. “Without that, there can be no trust.”

He said the number of veterans waiting for appointments has declined since May by 57%.

Talking points and a news release assembled by the VA ahead of the report’s release emphasized apologizing for what went wrong but also highlighting the investigation’s finding that none of the dozens of deaths of veterans waiting for care at the Phoenix VA hospital could be linked conclusively to the delays.

Sam Foote, a physician and whistle-blower in the scandal who worked at the Phoenix VA hospital and is now retired, said Tuesday that up to 63 veterans died while awaiting care at the hospital.

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The scandal caught fire in April when Rep. Jeff Miller, R-Fla., chairman of the House Veterans Affairs Committee, disclosed during a hearing on problems at the Phoenix facility that “it appears there could be as many as 40 veterans whose deaths could be related to delays of care.”

Miller issued a statement in reaction to Obama’s speech Tuesday, saying that so far no one has been fired in the scandal. “What we need from the president right now is more follow-through and less flash when it comes to helping veterans,” Miller said.

McDonald listed what job actions have been taken so far in the wake of the scandal, explaining that three senior executives and four high-level employees have been placed on administrative leave pending investigations; and two dozen health-care personnel have been removed from their positions.

A preliminary report issued in May concluded that the problems of delayed care and manipulated records were systemic. Then-VA Secretary Eric Shinseki resigned May 30 and his chosen replacement, McDonald, was confirmed by the Senate in July.

Meghan Hoyer contributed to this report.