Veterans Health Administration: Further Improvements Needed to Manage Fraud Risks in Beneficiary Travel Program
Fast Facts
The Veterans Health Administration reimburses eligible veterans and other beneficiaries' costs for travel to receive medical care. However, VA found this program made $1 billion in payment errors during FYs 2018-2024.
Our own testing found that:
- VA paid beneficiaries who provided ineligible departure addresses for reimbursement
- VA made duplicate payments to transportation vendors
- Staff modified claim amounts during manual reviews, causing beneficiaries and vendors to receive more than the claimed amount
We made 9 recommendations, including monitoring and evaluating the agency's processes for ensuring claims and payments are correct.
Ambulance, stethoscope, and bold red question mark overlaid on cash.
Highlights
What GAO Found
The Department of Veterans Affairs (VA) reported approximately $1 billion in cumulative estimated improper payments—including overpayments, underpayments, and unknown payments—across the Beneficiary Travel (BT) Program from fiscal years 2018 through 2024. During that period, 10 cases of fraud related to the BT Program were adjudicated. The cases involved at least 892 fraudulent claims and totaled at least $219,000. Most of the cases involved beneficiaries that fraudulently reported addresses.
VA has implemented data systems partly to mitigate fraud and improper payment risks in the BT Program. Examples include automatically verifying certain claim information before claims can be processed and flagging claims for further review if information is missing or does not appear to meet eligibility requirements.
GAO tested specific areas of risk for improper payments or fraud and found VA potentially made improper payments from fiscal years 2018 through 2023 totaling over $10 million in these areas. Specifically, GAO found instances in which
- VA potentially improperly paid beneficiaries who provided ineligible departure addresses, such as post office boxes rather than residential addresses;
- VA potentially made duplicate payments to special mode transportation (SMT) vendors for the same invoice; and
- VA staff manually modified BT claims, resulting in potentially improper payments to beneficiaries and SMT vendors, such as instances in which SMT vendors were paid amounts that exceeded the claimed amount.
Ineligible Departure Addresses May Result in Improper Payments
Since GAO’s analysis, VA has made changes to prevent potential duplicate and improper payments. For example, VA began transitioning to a new system for processing certain SMT invoices and implemented new controls to prevent overpayments. However, VA has not ensured that existing controls have been implemented effectively, such as ensuring that staff use acceptable documentation to verify residential addresses to reduce the risk of improper payments. VA also has not monitored and evaluated its new controls to ensure they are operating effectively to reduce the risk of improper payments.
Why GAO Did This Study
VA reported spending over $2.3 billion in fiscal year 2025 to reimburse eligible veterans and others for certain necessary transportation costs associated with veteran health care through the BT Program.
The Consolidated Appropriations Act, 2023, includes a provision for GAO to examine potential fraud and improper payments in this program. Among other things, this report examines VA’s reported improper payments and adjudicated fraud in the BT Program and indicators of potential improper payments or fraud in the BT Program identified from selected data sources and VA’s controls to mitigate related risks.
GAO reviewed relevant VA documents and adjudicated fraud cases and interviewed knowledgeable officials. To identify instances of potential improper payments, GAO analyzed information from VA’s data systems used to process BT claims from fiscal years 2018 through 2023, the most recent full fiscal year for which data were available at the time of GAO’s analysis.
Further, GAO compared VA’s efforts against leading practices from GAO’s Fraud Risk Framework, BT Program requirements, and VA’s financial policies.
Recommendations
GAO is making nine recommendations to VA, including that VA provide guidance to staff on acceptable documentation for verifying residential addresses and monitor and evaluate its controls for SMT claims and invoices. VA concurred with all nine recommendations and indicated that it will take actions to implement them.
Recommendations for Executive Action
| Agency Affected | Recommendation | Status |
|---|---|---|
| Department of Veterans Affairs | The Under Secretary for Health should develop guidance for BT Program staff on acceptable documentation for verifying residential addresses when claims do not meet BTSSS rules related to addresses or distance traveled. (Recommendation 1) |
When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
|
| Department of Veterans Affairs | The Under Secretary for Health should communicate to staff responsible for processing invoices in IPPS the importance of adequately reviewing BT invoices to ensure they are not duplicates before certifying the invoices for payment. (Recommendation 2) |
When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
|
| Department of Veterans Affairs | The Under Secretary for Health should regularly monitor and evaluate whether existing controls for preventing payment of potentially duplicate BT SMT claims and invoices between IPPS and eCAMS and within eCAMS are implemented as intended and are operating effectively to prevent payment of potentially duplicate SMT claims and, if necessary, revise controls. (Recommendation 3) |
When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
|
| Department of Veterans Affairs | The Under Secretary for Health should regularly monitor and evaluate whether controls used to validate payment amounts that are manually overridden in BTSSS are implemented and operating as intended to prevent potential overpayments. (Recommendation 4) |
When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
|
| Department of Veterans Affairs | The Under Secretary for Health should regularly monitor and evaluate whether controls to prevent potential BT overpayments resulting from staff manually pricing claims in eCAMS, including controls that automatically set the paid amount to the billed amount, are implemented as intended and are operating effectively and, if necessary, revise controls. (Recommendation 5) |
When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
|
| Department of Veterans Affairs | The Under Secretary for Health should clearly define and document the responsible and necessary authority to lead fraud risk management activities in the BT Program. This could include revising the BT Program directive to clarify the BT Program's designee for leading fraud risk management activities and completing and implementing revisions to VHA-wide guidance to include a requirement for program offices to have a designee for fraud risk management activities. (Recommendation 6) |
When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
|
| Department of Veterans Affairs | The Under Secretary for Health should update and enhance its fraud risk assessment for the BT Program to comprehensively identify and assess known fraud risks to the BT Program. This process should involve relevant stakeholders and sources of information on fraud risks. (Recommendation 7) |
When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
|
| Department of Veterans Affairs | The Under Secretary for Health should establish fraud risk tolerance as part of its BT fraud risk assessment and consider risk tolerance in assessing whether controls sufficiently address known risks, or whether VA needs to implement additional mitigating actions to address known risks. (Recommendation 8) |
When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
|
| Department of Veterans Affairs | The Under Secretary for Health should implement required initial and ongoing fraud-awareness training relevant to risks facing the BT Program for VA employees and contractors that handle BT claims. For example, information on known fraud risks could be incorporated into required training for BT Program staff that process claims through specific systems. This training should include information on the highest fraud risks to the BT Program, including both GHCT and SMT, such as risks related to eligibility, duplicate claims, and other risks that VHA identifies through fraud risk assessments. (Recommendation 9) |
When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
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