VA to begin independent review of disability claims accuracy

The accuracy rate of all disability claims processed by the Veterans Benefits Administration (VBA) will be independently reviewed beginning Oct. 1, according to the General Accounting Office. The VBA's Compensation and Pension Service will review the claims processing accuracy rates submitted by each of the VBA's regional offices to prevent bias in the department's statistics and to ensure that employees involved in processing claims do not review their own work. The Compensation and Pension Service pays monthly benefits to disabled and low-income veterans. Currently, VBA's regional offices process claims and regional staff are responsible for reviewing the accuracy of their own work. In an August letter to Rep. Lane Evans, D-Ill., on the status of VBA's disability claims processing, GAO praised the department for its decision to independently review the accuracy rates for all its offices. GAO said the current system is unacceptable because "both reviewers and their managers have an inherent self-interest in having as high an accuracy rate as possible, which potentially could bias the reviewers and influence them to overlook or conceal errors." The VBA currently does not use self-reported accuracy rates submitted by its regional offices in those offices' individual accuracy scorecards because the data is unreliable. Rather, VBA inserts the overall accuracy rate of its service delivery network, which is determined by the Compensation and Pension Service, to assess the performance of a specific office. Since October 1998, the Compensation and Pension Service has performed quality reviews on claims processing data to determine the accuracy rates for the nation and each of the VBA's nine service delivery networks, but not for each of its 57 individual regional offices. VBA thought the Compensation and Pension Service would be too overwhelmed if it reviewed the accuracy rate of processed claims submitted by the regional offices, GAO said. The Compensation and Pension Service currently reviews a total of about 7,000 cases a year for the nation and each delivery network. That number will grow to about 18,000 a year when it starts reviewing the rates submitted by the regional offices. VBA will add 10 new full-time employees to handle the extra work and hopes to produce an annual claims processing accuracy rate of about 95 percent for each regional office, the GAO report said. In March 1999, GAO released a report that recommended that VBA independently review the accuracy rates of claims processing submitted by each of its regional offices. The 1999 Veterans Millennium Health Care and Benefits Act also directed VBA to develop a quality assurance program that meets internal control and review standards. The VBA's claims processing system has been repeatedly criticized in recent years as slow and inefficient. The agency has tried to improve its claims processing accuracy by using case management techniques and by reorganizing its field offices into clusters meant to collaborate with one another. Despite VBA's attempts at reform, its claims processing system is still error-prone. According to a June report from the General Accounting Office, VBA reported errors in 41 percent of the claims it processed overall during fiscal 2000. As one of its strategic goals, the agency is trying to achieve a 96 percent accuracy rating in claims processing for the nation as a whole by fiscal 2006.