VA DISABILITY EXAMS:

Improved Oversight of Contracted Examiners Needed

GAO-19-213T: Published: Nov 15, 2018. Publicly Released: Nov 15, 2018.

Additional Materials:

Contact:

Elizabeth H. Curda
(202) 512-7215
curdae@gao.gov

 

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

The Veterans Benefits Administration has increasingly turned to contractors to conduct the medical exams that veterans may need for disability claims. According to VBA, contractors help it avoid delays in the claims process. VBA awarded up to $6.8 billion in exam contracts in 2016.

This testimony examines VBA's oversight of these contractors. We found the agency does not know the extent to which contractors are meeting the exam contract's quality and timeliness standards. The agency identified some contractor performance problems, but the incomplete information gathered on performance highlights the inadequacy of VBA's oversight.

 

This is a photo of dog tags and a stethoscope atop an American flag.

This is a photo of dog tags and a stethoscope atop an American flag.

Additional Materials:

Contact:

Elizabeth H. Curda
(202) 512-7215
curdae@gao.gov

 

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

What GAO Found

The Veterans Benefits Administration (VBA) has limited information on whether contractors who conduct disability compensation medical exams are meeting the agency's quality and timeliness targets. VBA contracted examiners have completed a growing number of exams in recent years (see figure). VBA uses completed exam reports to help determine if a veteran should receive disability benefits. VBA reported that the vast majority of contractors' quality scores fell well below VBA's target—92 percent of exam reports with no errors—for the first half of 2017. Since then, VBA has not completed all its quality reviews, but has hired more staff to do them. VBA officials acknowledged that VBA also does not have accurate information on contractor timeliness. VBA officials said the exam management system used until spring 2018 did not always retain the initial exam report completion date, which is used to calculate timeliness. In spring 2018, VBA implemented a new system designed to capture this information.

Disability Compensation Medical Exams Completed by Contractors, Fiscal Years 2012-2018

Disability Compensation Medical Exams Completed by Contractors, Fiscal Years 2012-2018

VBA monitoring has addressed some problems with contractors, such as reassigning exams from contractors that did not have enough examiners to those that did. However, the issues GAO identified with VBA's quality and timeliness information limit VBA's ability to effectively oversee contractors. For example, VBA officials said they were unable to track the timeliness of exam reports sent back to contractors for corrections, which is needed to determine if VBA should reduce payment to a contractor. The new system implemented in spring 2018 tracks more detailed data on exam timeliness. However, VBA has not documented how it will ensure the data are accurate or how it will use the data to track the timeliness and billing of corrected exam reports. VBA also has no plans to use the new system to analyze performance data to identify trends or other program-wide issues. Without such plans, VBA may miss opportunities to improve contractor oversight and the program overall.

A third-party auditor verifies that contracted examiners have valid medical licenses, but VBA does not verify if examiners have completed training nor does it collect information to assess training effectiveness in preparing examiners. While VBA plans to improve monitoring of training, it has not documented plans for tracking or collecting information to assess training. These actions could help ensure that VBA contractors provide veterans with high-quality exams and help VBA determine if additional training is needed.

Why GAO Did This Study

This testimony summarizes the information contained in GAO's October 2018 report, entitled VA Disability Exams: Improved Performance Analysis and Training Oversight Needed for Contracted Exams (GAO-19-13).

For more information, contact Elizabeth Curda at (202) 512-7215 or curdae@gao.gov.

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