Veterans' Benefits: Improvements Needed to Measure the Extent of Errors in VA Claims Processing
HRD-89-9
Published: Apr 13, 1989. Publicly Released: May 15, 1989.
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Highlights
In response to a congressional request, GAO assessed whether the Department of Veterans Affairs' (VA) Statistical Quality Control (SQC) System reliably estimated the extent of errors made in adjudicating veterans' claims for compensation and benefits.
Recommendations
Recommendations for Executive Action
| Agency Affected | Recommendation | Status |
|---|---|---|
| Department of Veterans Affairs | The Secretary of Veterans Affairs should improve the SQC system by requiring regional offices to: (1) select sample cases randomly; and (2) review cases within the required time period. |
Revised procedures issued in draft in October 1989 for immediate implementation, and in final in February 1990, specify how regional offices are to randomly select cases and more clearly state requirements to review only current-month cases.
|
| Department of Veterans Affairs | The Secretary of Veterans Affairs should improve the SQC system by SQC reviews to personnel who are independent of regional management. |
VA stated that resources are not available for implementing this recommendation. VA agreed to do so when it can dedicate appropriate full-time equivalent employees to its accomplishment. Under continuing budget constraints, VA is unlikely to implement this recommendation. GAO plans to include this issue in a broader review of the quality of VA services to veterans.
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| Department of Veterans Affairs | The Secretary of Veterans Affairs should improve the SQC system by improving the central office role by: (1) having validation reviews cover the same period and types of processing actions as the regional reviews being validated; and (2) enforcing regional office compliance with central office requirements. |
Revised procedures, issued in draft in October 1989 for immediate implementation, and in final in February 1990, require selection of validation cases for each region every week of the time period being validated. Also, VA established controls to ensure that regional offices comply with requirements for corrective action reports.
|
| Department of Veterans Affairs | To address the concerns of congressional committees, the Secretary of Veterans Affairs should consider developing a quality measurement system to supplement current quality control systems. At a minimum, VA should measure claims processing quality for individual programs and payment accuracy. |
Revised procedures, issued in draft in October 1989 for immediate implementation, and in final in February 1990, provide for determining national error rates by program. VA analyzes the national error rate data to identify the kinds of errors causing the most significant payment errors, and the corrective actions needed.
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Topics
Claims adjudicatorsClaims processingErrorsInternal controlsQuality controlQuestionable paymentsReporting requirementsStatistical methodsVeterans benefitsVeterans