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    Subject Term: Appeals

    6 publications with a total of 27 open recommendations including 11 priority recommendations
    Director: Daniel Bertoni
    Phone: (202) 512-7215

    5 open recommendations
    including 1 priority recommendation
    Recommendation: To further align efforts to address appeals workload and improve timeliness of decisions, and reduce the risk that efforts will not go as planned, the Secretary of Veterans Affairs should direct the Under Secretary for Benefits; the Chairman, Board of Veterans' Appeals; and the Chief Information Officer, as appropriate, to ensure development of a timely, detailed workforce plan for recruiting, hiring and training new hires. In particular, this plan should: (1) include detailed steps and timetables for updating training curriculum (such as preparing decisions in a virtual environment) and ensuring office space (such as telework guidance); and (2) incorporate risk mitigation strategies that consider how the timing of recruitment and training dovetails with uncertain time frames for implementing a new appeals process.

    Agency: Department of Veterans Affairs
    Status: Open

    Comments: VA took additional steps to recruit, hire, manage space and train additional FTEs to address appeals workloads. However, detailed workforce plans would help ensure timely hiring and proper supports and training. We will close this recommendation when VA provides documentation of its actions and related guidance in several areas: agency telework plan; case adjudication in an virtual environment; status of hiring for FY17; hiring goals for FY18; space management plan indicating how FY17 and FY18 hiring will be accommodated; and plans for ongoing training for remote teleworkers.
    Recommendation: To further align efforts to address appeals workload and improve timeliness of decisions, and reduce the risk that efforts will not go as planned, the Secretary of Veterans Affairs should direct the Under Secretary for Benefits; the Chairman, Board of Veterans' Appeals; and the Chief Information Officer, as appropriate, to develop a schedule for IT updates that explicitly addresses when and how any process reform will be integrated into new systems and when Caseflow will be ready to support a potential streamlined appeals process at its onset.

    Agency: Department of Veterans Affairs
    Status: Open

    Comments: VA concurred in principle with this recommendation. In July 2017, VA reported its latest actions to address this recommendation, including documentation of the 6-month road map. However, we continue to believe that while the agile process can help mitigate risks and avoid cost overruns and delays, VA should define schedules beyond 6 months. Such planning allows VA to take additional steps to consider the scope of potential changes required by a new appeals process and have a broad plan in place to ensure that all aspects of the new process are adequately supported by Caseflow.
    Recommendation: To further align efforts to address appeals workload and improve timeliness of decisions, and reduce the risk that efforts will not go as planned, the Secretary of Veterans Affairs should direct the Under Secretary for Benefits; the Chairman, Board of Veterans' Appeals; and the Chief Information Officer, as appropriate, to conduct additional sensitivity analyses based on the assumptions used in projection models to more accurately estimate future appeals inventories and timeliness. In doing so, consider running additional analyses on how these factors, in conjunction with one another, may affect the timeliness and cost of deciding pending appeals.

    Agency: Department of Veterans Affairs
    Status: Open

    Comments: VA concurred in principle with this recommendation, noting that it plans to refine the model on a regular basis. However, we continue to believe that additional analyses of potential hiring options and of the compounded effect of assumptions that VA identified is consistent with sound practices and will help the agency anticipate and plan for different contingencies. In addition, as VA goes forward with appeals process reform and begins to collect real-time data, these data could improve modeling accuracy and serve as a valuable management tool. VA also noted plans to analyze, update and refine the model. We will consider closing this recommendation when VA completes these efforts and provides documentation of plans for modeling inventories and resource needs.
    Recommendation: To further align efforts to address appeals workload and improve timeliness of decisions, and reduce the risk that efforts will not go as planned, the Secretary of Veterans Affairs should direct the Under Secretary for Benefits; the Chairman, Board of Veterans' Appeals; and the Chief Information Officer, as appropriate, to develop a more robust plan for closely monitoring implementation of process reform that includes metrics and interim goals to help track progress, evaluate efficiency and effectiveness, and identify trouble spots.

    Agency: Department of Veterans Affairs
    Status: Open
    Priority recommendation

    Comments: VA agreed in principle with this recommendation. However, to fully implement it, VA needs to develop a monitoring plan with metrics and interim goals for implementing appeal process reform. Although VA agreed that developing such a plan is valuable for monitoring the implementation of process reform, VA also stated that it considered this recommendation complete and noted that preparing such a detailed plan depends on appeals reform legislation being enacted. While we recognize that VA cannot assume to know the exact provisions that may be included in future enacted legislation, we consider having a more robust monitoring plan - for example, that includes metrics and interim goals to help track implementation progress, evaluate efficiency and effectiveness of the reformed process, and identify trouble spots - to be essential to the successful implementation of a new appeals process.
    Recommendation: To better understand whether appeals process reform, in conjunction with other efforts, has improved timeliness, the Secretary of Veterans Affairs should direct the Under Secretary for Benefits; the Chairman, Board of Veterans' Appeals; and the Chief Information Officer, as appropriate to develop a strategy for assessing process reform--relative to the current process--that ensures transparency in reporting to Congress and the public on the extent to which VA is improving veterans' experiences with its disability appeals process.

    Agency: Department of Veterans Affairs
    Status: Open

    Comments: VA concurred in principle with this recommendation and reported on its plans to measure veteran wait times as well as use customer satisfaction surveys to measure the success of the new appeals process. However, while we agree that metrics based on the different options could be valuable for VA, the Congress, and the public, we disagree that VA's focus on measuring timeliness by option is in the best interest of the veteran. Because veterans may pursue more than one option under VBA, the Board or both, we believe that VA's approach does not take into account the veteran's perspective of how long it took for them to receive a final appeal decision. Metrics from the veterans' overall perspective would complement, not replace, metrics for VBA, the Board, and each option. The absence of such metrics raises questions as to how the agency will ensure appropriate resources are devoted to managing appeals under the new versus old process, or intended results are achieved as the new process is implemented. Further, while the legislation requires VA to report a number of metrics, the agency still needs to implement the legislation. We will consider closing this recommendation when VA develops a plan for collecting metrics consistent with this recommendation.
    Director: Yvonne D. Jones
    Phone: (202) 512-2717

    2 open recommendations
    Recommendation: To help ensure the accuracy of MSPB's reporting on whistleblower appeals received and closed, the Chairman of MSPB should update MSPB's data entry user guide to include additional guidance and procedures to help improve the identification of appropriate whistleblower appeal closing codes to use.

    Agency: Merit Systems Protection Board
    Status: Open

    Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
    Recommendation: To help ensure the accuracy of MSPB's reporting on whistleblower appeals received and closed, the Chairman of MSPB should add a quality check in MSPB's data analysis and reporting process to better identify discrepancies or other anomalies in data queries and the resulting datasets.

    Agency: Merit Systems Protection Board
    Status: Open

    Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
    Director: Valerie Melvin
    Phone: (202) 512-6304

    2 open recommendations
    Recommendation: To provide greater transparency in the reporting of FOIA litigation costs, Congress could consider requiring Justice to provide a cost estimate for collecting and reporting information on costs incurred when defending lawsuits in which the plaintiffs prevailed.

    Agency: Congress
    Status: Open

    Comments: Congress has not yet considered if it plans to amend FOIA regarding the reporting of costs for defending lawsuits in which the plaintiffs prevailed.
    Recommendation: Congress could consider amending the act to require Justice to reflect in its Litigation and Compliance reports, changes in the award of attorneys' fees and costs resulting from the appeals process and settlement agreements between agencies and plaintiffs, if deemed to be cost-effective.

    Agency: Congress
    Status: Open

    Comments: Congress has not yet considered if it plans to amend FOIA to require Justice to make changes to its Litigation and Compliance reports.
    Director: James Cosgrove
    Phone: (202) 512-7114

    5 open recommendations
    including 1 priority recommendation
    Recommendation: As CMS continues to implement and refine the contract-level RADV audit process to improve the efficiency and effectiveness of reducing and recovering improper payments and to improve the accuracy of CMS's calculation of coding intensity, the Administrator should modify that calculation by taking actions such as the following: (1) including only the three most recent pair-years of risk score data for all contracts; (2) standardizing the changes in disease risk scores to account for the expected increase in risk scores for all MA contracts; (3) developing a method of accounting for diagnostic errors not coded by providers, such as requiring that diagnoses added by MA organizations be flagged as supplemental diagnoses in the agency's Encounter Data System to separately calculate coding intensity scores related only to diagnoses that were added through MA organizations' supplemental record review (that is, were not coded by providers); and (4) including MA beneficiaries enrolled in contracts that were renewed from a different contract under the same MA organization during the pair-year period.

    Agency: Department of Health and Human Services: Centers for Medicare and Medicaid Services
    Status: Open

    Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
    Recommendation: As CMS continues to implement and refine the contract-level RADV audit process to improve the efficiency and effectiveness of reducing and recovering improper payments. The Administrator should modify CMS's selection of contracts for contract-level RADV audits to focus on those contracts most likely to have high rates of improper payments by taking actions such as the following: (1) selecting more contracts with the highest coding intensity scores; (2) excluding contracts with low coding intensity scores; (3) selecting contracts with high rates of unsupported diagnoses in prior contract-level RADV audits; (4) if a contract with a high rate of unsupported diagnoses is no longer in operation, selecting a contract under the same MA organization that includes the service area of the prior contract; and (5) selecting some contracts with high enrollment that also have either high rates of unsupported diagnoses in prior contract-level RADV audits or high coding intensity scores.

    Agency: Department of Health and Human Services: Centers for Medicare and Medicaid Services
    Status: Open

    Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
    Recommendation: As CMS continues to implement and refine the contract-level RADV audit process to improve the efficiency and effectiveness of reducing and recovering improper payments. The Administrator should enhance the timeliness of CMS's contract-level RADV process by taking actions such as the following: (1) closely aligning the time frames in CMS's contract-level RADV audits with those of the national RADV audits the agency uses to estimate the MA improper payment rate; (2) reducing the time between notifying MA organizations of contract audit selection and notifying them about the beneficiaries and diagnoses that will be audited; (3) improving the reliability and performance of the agency's process for transferring medical records from MA organizations, including assessing the feasibility of updating Electronic Submission of Medical Documentation for use in transferring medical records in contract-level RADV audits; and (4) requiring that CMS contract-level RADV auditors complete their medical record reviews within a specific number of days comparable to other medical record review time frames in the Medicare program.

    Agency: Department of Health and Human Services: Centers for Medicare and Medicaid Services
    Status: Open
    Priority recommendation

    Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
    Recommendation: As CMS continues to implement and refine the contract-level RADV audit process to improve the efficiency and effectiveness of reducing and recovering improper payments. The Administrator should improve the timeliness of CMS's contract-level RADV appeal process by requiring that reconsideration decisions be rendered within a specified number of days comparable to other medical record review and first-level appeal time frames in the Medicare program.

    Agency: Department of Health and Human Services: Centers for Medicare and Medicaid Services
    Status: Open

    Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
    Recommendation: As CMS continues to implement and refine the contract-level RADV audit process to improve the efficiency and effectiveness of reducing and recovering improper payments. The Administrator should ensure that CMS develops specific plans and a timetable for incorporating a RAC in the MA program as mandated by the Patient Protection and Affordable Care Act.

    Agency: Department of Health and Human Services: Centers for Medicare and Medicaid Services
    Status: Open

    Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
    Director: Valerie C. Melvin
    Phone: (202) 512-6304

    5 open recommendations
    including 1 priority recommendation
    Recommendation: To improve VA's efforts to effectively complete the development and implementation of VBMS, the Secretary of Veterans Affairs should direct the Under Secretary for Benefits and the Chief Information Officer to develop an updated plan for VBMS that includes (1) a schedule for when VBA intends to complete development and implementation of the system, including capabilities that fully support disability claims, pension claims, and appeals processing and (2) the estimated cost to complete development and implementation of the system.

    Agency: Department of Veterans Affairs
    Status: Open
    Priority recommendation

    Comments: The Department of Veterans Affairs (VA) concurred with our recommendation calling for an updated plan for the Veterans Benefits Management System. However, as of June 2017, the department had not developed a plan that included a schedule for when the Veterans Benefits Administration intends to complete development and implementation of the system, as well as the estimated cost of doing so. We will continue to monitor VA's actions in response to this recommendation.
    Recommendation: To improve VA's efforts to effectively complete the development and implementation of VBMS, the Secretary of Veterans Affairs should direct the Under Secretary for Benefits and the Chief Information Officer to establish goals for system response time and use the goals as a basis for periodically reporting actual system performance.

    Agency: Department of Veterans Affairs
    Status: Open

    Comments: The Department of Veterans Affairs (VA) concurred with this recommendation and reported that the Veterans Benefits Management System (VBMS) program office has developed draft metrics for performance of the system. Specifically, VA stated that the office has established key performance indicators as a basis for monitoring the response times of the most commonly executed user transactions (or work events) within VBMS. According to the department, these indicators have been incorporated into the application's continuous monitoring tools for all service level agreements and these agreements are enforced by the VA Service Level Management Board. Nevertheless, as of June 2017, VA had not identified its goals for VBMS response times, nor had the department reported actual system response times. We will continue to monitor VA's actions toward addressing this recommendation.
    Recommendation: To improve VA's efforts to effectively complete the development and implementation of VBMS, the Secretary of Veterans Affairs should direct the Under Secretary for Benefits and the Chief Information Officer to reduce the incidence of high- and medium-priority level defects that are present at the time of future VBMS releases.

    Agency: Department of Veterans Affairs
    Status: Open

    Comments: The Department of Veterans Affairs (VA) concurred with this recommendation and, in June 2017, reiterated its plans and procedures for decreasing the incidences of defects in each system release. However, the incidences of high- and medium-priority level defects at the time of recent VBMS releases (i.e., releases 10.1 and 11.0) had increased relative to the number of defects present at the time of the earlier release (i.e., release 8.1) that we described in our report. We will continue to monitor VA's actions and progress in response to this recommendation.
    Recommendation: To improve VA's efforts to effectively complete the development and implementation of VBMS, the Secretary of Veterans Affairs should direct the Under Secretary for Benefits and the Chief Information Officer to develop and administer a statistically valid survey of VBMS users to determine the effectiveness of steps taken to make improvements in users' satisfaction.

    Agency: Department of Veterans Affairs
    Status: Open

    Comments: The Department of Veterans Affairs (VA) concurred with this recommendation and in January 2017, conducted a survey of VBMS users that was sent to over 16,000 claims processors at each of its 56 regional offices. Although 52 percent of respondents indicated that they were very satisfied or satisfied with VBMS, the department received only about 2500 responses to the survey for a 15 percent response rate. This low response rate raises concern about whether the survey results are statistically valid. We have requested additional information from VA to determine any actions the department has taken to ensure the statistical validity of its survey results and will assess any information that is provided.
    Recommendation: To improve VA's efforts to effectively complete the development and implementation of VBMS, the Secretary of Veterans Affairs should direct the Under Secretary for Benefits and the Chief Information Officer to establish goals that define customer satisfaction with VBMS and report on actual performance toward achieving the goals based on the results of GAO's survey of VBMS users and any future surveys VA conducts.

    Agency: Department of Veterans Affairs
    Status: Open

    Comments: The Department of Veterans Affairs (VA) concurred with this recommendation and conducted a survey of VBMS users in January 2017. However, as of June 2017, the department had yet to develop customer satisfaction goals for VBMS that would provide users with an expectation of the system response times they should anticipate, and management with an indication of how well the system is performing relative to performance goals.
    Director: Maurer, Diana C
    Phone: (202) 512-8777

    8 open recommendations
    including 8 priority recommendations
    Recommendation: To better ensure that FBI whistleblowers have access to recourse under DOJ's regulations should the individuals experience retaliation, and to minimize the possibility of discouraging future potential whistleblowers, the Attorney General should clarify in all current relevant DOJ guidance and communications, including FBI guidance and communications, to whom FBI employees may make protected disclosures and, further, explicitly state that employees will not have access to recourse if they experience retaliation for reporting alleged wrongdoing to someone not designated in DOJ's regulations.

    Agency: Department of Justice
    Status: Open
    Priority recommendation

    Comments: As of March 1, 2017, the Department of Justice (DOJ) has not responded to GAO requests for information on any efforts DOJ has taken to address this recommendation.
    Recommendation: To ensure that complainants receive the periodic updates that they are entitled to and need to determine next steps for their complaint, such as whether or not to seek corrective action from OARM, Counsel, DOJ-OPR should tailor its new case management system or otherwise develop an oversight mechanism to capture information on the office's compliance with regulatory requirements and, further, use that information to monitor and identify opportunities to improve DOJ-OPR's compliance with regulatory requirements.

    Agency: Department of Justice: Office of Professional Responsibility
    Status: Open
    Priority recommendation

    Comments: As of March 1, 2017, the Department of Justice (DOJ) has not responded to GAO requests for information on any efforts DOJ has taken to address this recommendation.
    Recommendation: To better ensure that DOJ is fulfilling its commitment to improving efficiency in handling these complaints, Office of Attorney Recruitment and Management (OARM) and Office of the Deputy Attorney General (ODAG) should provide parties with an estimated time frame for returning each decision, including whether the complaint meets threshold regulatory requirements, merits, and appeals. If the time frame shifts, OARM and ODAG should timely communicate a revised estimate to the parties.

    Agency: Department of Justice: Office of the Deputy Attorney General
    Status: Open
    Priority recommendation

    Comments: As of March 1, 2017, the Department of Justice (DOJ) has not responded to GAO requests for information on any efforts DOJ has taken to address this recommendation.
    Recommendation: To better ensure that DOJ is fulfilling its commitment to improving efficiency in handling these complaints, Office of Attorney Recruitment and Management (OARM) and Office of the Deputy Attorney General (ODAG) should provide parties with an estimated time frame for returning each decision, including whether the complaint meets threshold regulatory requirements, merits, and appeals. If the time frame shifts, OARM and ODAG should timely communicate a revised estimate to the parties.

    Agency: Department of Justice: Justice Management Division: Human Resources and Administration: Office of Attorney Recruitment and Management
    Status: Open
    Priority recommendation

    Comments: As of March 1, 2017, the Department of Justice (DOJ) has not responded to GAO requests for information on any efforts DOJ has taken to address this recommendation.
    Recommendation: To better ensure that DOJ is fulfilling its commitment to improving efficiency in handling these complaints, DOJ Office of Professional Responsibility (DOJ-OPR), Office of the Inspector General, OARM, and ODAG should jointly assess the impact of ongoing and planned efforts to reduce the duration of FBI whistleblower retaliation complaints throughout the entire investigation, adjudication, and appeal process to ensure that these changes are in fact shortening total complaint length, without sacrificing quality.

    Agency: Department of Justice: Office of the Deputy Attorney General
    Status: Open
    Priority recommendation

    Comments: As of March 1, 2017, the Department of Justice (DOJ) has not responded to GAO requests for information on any efforts DOJ has taken to address this recommendation.
    Recommendation: To better ensure that DOJ is fulfilling its commitment to improving efficiency in handling these complaints, DOJ Office of Professional Responsibility (DOJ-OPR), Office of the Inspector General, OARM, and ODAG should jointly assess the impact of ongoing and planned efforts to reduce the duration of FBI whistleblower retaliation complaints throughout the entire investigation, adjudication, and appeal process to ensure that these changes are in fact shortening total complaint length, without sacrificing quality.

    Agency: Department of Justice: Justice Management Division: Human Resources and Administration: Office of Attorney Recruitment and Management
    Status: Open
    Priority recommendation

    Comments: As of March 1, 2017, the Department of Justice (DOJ) has not responded to GAO requests for information on any efforts DOJ has taken to address this recommendation.
    Recommendation: To better ensure that DOJ is fulfilling its commitment to improving efficiency in handling these complaints, DOJ Office of Professional Responsibility (DOJ-OPR), Office of the Inspector General, OARM, and ODAG should jointly assess the impact of ongoing and planned efforts to reduce the duration of FBI whistleblower retaliation complaints throughout the entire investigation, adjudication, and appeal process to ensure that these changes are in fact shortening total complaint length, without sacrificing quality.

    Agency: Department of Justice: Office of Professional Responsibility
    Status: Open
    Priority recommendation

    Comments: As of March 1, 2017, the Department of Justice (DOJ) has not responded to GAO requests for information on any efforts DOJ has taken to address this recommendation.
    Recommendation: To better ensure that DOJ is fulfilling its commitment to improving efficiency in handling these complaints, DOJ Office of Professional Responsibility (DOJ-OPR), Office of the Inspector General, OARM, and ODAG should jointly assess the impact of ongoing and planned efforts to reduce the duration of FBI whistleblower retaliation complaints throughout the entire investigation, adjudication, and appeal process to ensure that these changes are in fact shortening total complaint length, without sacrificing quality.

    Agency: Department of Justice: Office of Inspector General
    Status: Open
    Priority recommendation

    Comments: As of March 1, 2017, GAO has not received information from the Department of Justice about any steps taken to address this recommendation.