Health Care:

Processing of Claims Resulting From the Swine Flu Program

HRD-81-33: Published: Jan 14, 1981. Publicly Released: Feb 19, 1981.

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GAO reviewed the timeliness of the Department of Justice in processing swine flu claims and lawsuits and the adequacy of staffing and resources available to Justice to handle swine flu claims. GAO reviewed the general method for processing claims filed against the federal government, the specific method established to process claims resulting from the swine flu program, and the procedures established by Justice and the Department of Health and Human Services (HHS). It determined from the claim files the length of elapsed time to decide claims and compiled descriptive data on the claims, such as the status of claims and the number of claims filed according to the nature of the alleged injury. GAO obtained limited information on the processing of lawsuits resulting from the swine flu program and determined Justice's role in swine flu litigation and data gathering. GAO sampled 722 swine flu claims and statistically determined the average amount of time it took to process them.

GAO found that no criteria existed to objectively assess the timeliness of swine flu claims processing; however, some claims processing procedures were identified which took a long time. GAO was unable to determine the average time it took to process lawsuits and whether they were being handled in a timely manner. Almost 4000 claims and 1000 lawsuits have been filed against the government alleging injury, death, or other damage resulting from the 45 million swine flu immunizations given under the program. Neither Justice nor HSS maintained statistics on the status of swine flu claims and lawsuits or on the nature of injuries alleged by individuals. Justice performed all the necessary fact-finding and legal analyses pursuant to claims processing and made recommendations to HHS on the action to take on claims, while HHS retained authority for determining final action to be taken on claims. It took, on the average, about 403 calendar days from the date that a claim was received by HHS to the date Justice made a recommendation on the action to take on the claim. Factors which slowed processing time were the failure or tardiness of claimants to respond to Justice's requests for information, the lack of an adequate system to follow-up on requests for information, and the lack of adequate staffing arrangements for performing medical review. Justice's efforts to develop procedures to process the claims were reasonable. If a federal mass immunization program is repeated, sufficient staff and timeframes should be established for follow-up activities.

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