Verifying Eligibility for Military Health Care:

Some Progress Has Been Made, but Reliability Problems Remain

HRD-83-1: Published: Dec 1, 1982. Publicly Released: Dec 1, 1982.

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GAO reviewed the Defense Enrollment Eligibility Reporting System (DEERS) to determine whether it would improve the eligibility determination process and provide accurate data on beneficiaries for use in military health resource planning. The DEERS was initiated specifically to accumulate accurate and timely data on all active duty and retired military sponsors, survivors, and dependents relating to their eligibility for health care benefits. This report discusses the problems experienced in the DEERS under the Uniformed Services Health Care System.

GAO learned that the DEERS will have an estimated beneficiary population of 11.5 million when the system is completed in 1985. When fully implemented, the estimated cost of this computer-based system is about $33 million, with an annual operating cost of $6 million. In its review, GAO noted that the system contains many errors, which cause inaccurate replies to users' eligibility queries, and result in a lack of confidence in the system's reliability. Although the Department of Defense has made progress, needed improvements include: (1) obtaining more complete and accurate beneficiary enrollment data; (2) entering more accurately beneficiary information into the system; and (3) prompt reporting of beneficiary changes to the system.

Recommendations for Executive Action

  1. Status: Closed - Implemented

    Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.

    Recommendation: The Secretary of Defense should direct the military services to emphasize the implementation of procedures for identifying and enrolling dependents who have not been entered in the DEERS.

    Agency Affected: Department of Defense

  2. Status: Closed - Implemented

    Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.

    Recommendation: The Secretary of Defense should direct the military services to implement and monitor the application of more stringent verification procedures when determining the eligibility of children age 21 and over.

    Agency Affected: Department of Defense

  3. Status: Closed - Implemented

    Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.

    Recommendation: The Secretary of Defense should direct the military services to aggressively research the eligibility of dependents whose sponsor cannot be found in the DEERS.

    Agency Affected: Department of Defense

  4. Status: Closed - Implemented

    Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.

    Recommendation: The Secretary of Defense should direct the military services to more closely review the enrollment documents submitted to the DEERS to ensure their legibility and accuracy.

    Agency Affected: Department of Defense

  5. Status: Closed - Implemented

    Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.

    Recommendation: The Secretary of Defense should direct the DEERS Steering Group to monitor the DEERS Support Office efforts to promptly investigate and resolve erroneous information identified by system users.

    Agency Affected: Department of Defense

  6. Status: Closed - Implemented

    Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.

    Recommendation: The Secretary of Defense should direct the DEERS Steering Group to develop a comprehensive quality assurance program for assessing, on a systematic basis, the quality of the DEERS information and the actions needed to improve it.

    Agency Affected: Department of Defense

  7. Status: Closed - Implemented

    Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.

    Recommendation: The Secretary of Defense should direct the DEERS Steering Group to delay enrollment of dependents outside the United States until the enrollment problems discussed in the chapter are resolved.

    Agency Affected: Department of Defense

  8. Status: Closed - Implemented

    Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.

    Recommendation: The Secretary of Defense should direct the services to develop programs to educate sponsors on the need for reporting changes in dependent status when they occur.

    Agency Affected: Department of Defense

  9. Status: Closed - Implemented

    Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.

    Recommendation: The Secretary of Defense should direct the services to require that sponsors comply with the DEERS update procedures when processing dependent status changes in finance or emergency records.

    Agency Affected: Department of Defense

  10. Status: Closed - Implemented

    Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.

    Recommendation: The Secretary of Defense should direct the military services to improve the accuracy and completeness of sponsor information submitted to the DEERS.

    Agency Affected: Department of Defense

  11. Status: Closed - Implemented

    Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.

    Recommendation: The Secretary of Defense should direct the DEERS Steering Group to establish standards on how quickly status changes must be updated in the DEERS and the degree of accuracy that the system must achieve in order for it it be considered effective. These standards should be used in assessing the system's overall reliability and cost effectiveness.

    Agency Affected: Department of Defense

 

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