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.

Additional Materials:

Contact:

Joseph F. Delfico
(202) 512-7215
contact@gao.gov

 

Office of Public Affairs
(202) 512-4800
youngc1@gao.gov

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.

GAO found that SQC did not have accurate and reliable information on claims processing accuracy, since: (1) VA regions did not randomly select case samples or review cases within the required time period; (2) VA regions used the same staff that adjudicated the claims to review them for errors; and (3) the VA central office did not adequately validate the regions' reported error rates or ensure that the regions complied with SQC procedures. GAO also found that VA often inappropriately used SQC data to estimate national claims processing errors, because SQC could not accurately project total claims processing error rates, specific program error rates, or payment accuracy.

Recommendations for Executive Action

  1. Status: Closed - Implemented

    Comments: 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.

    Recommendation: 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.

    Agency Affected: Department of Veterans Affairs

  2. Status: Closed - Not Implemented

    Comments: 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.

    Recommendation: The Secretary of Veterans Affairs should improve the SQC system by SQC reviews to personnel who are independent of regional management.

    Agency Affected: Department of Veterans Affairs

  3. Status: Closed - Implemented

    Comments: 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.

    Recommendation: 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.

    Agency Affected: Department of Veterans Affairs

  4. Status: Closed - Implemented

    Comments: 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.

    Recommendation: 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.

    Agency Affected: Department of Veterans Affairs

 

Explore the full database of GAO's Open Recommendations »

Sep 20, 2016

Sep 19, 2016

Sep 16, 2016

Jul 29, 2016

Jul 28, 2016

Jun 27, 2016

Jun 6, 2016

May 11, 2016

Apr 28, 2016

Mar 21, 2016

Looking for more? Browse all our products here