All Reports

Better Coordination Needed to Negotiate Consistent Prices for Prescription Eyeglasses
|
21-02984-179
|
Topics: Care Coordination,Community Care,Contract Integrity,Patient Care Services Operations

Open Recommendation Image, SquareOpenClosed and Implemented Recommendation Image, CheckmarkClosed-ImplementedNot Implemented Recommendation Image, X character'Closed-Not Implemented
No. 1
Open Recommendation Image, Square
to Veterans Health Administration (VHA)

Coordinate with the executive director of the Prosthetic and Sensory Aids Service and officials from the Veterans Health Administration’s Procurement and Logistics Office and the VA Office of Acquisition, Logistics, and Construction to develop and implement a sourcing strategy, such as national contracts or a pricing catalog across all contracts by vendor for eyeglasses prescribed by a VA provider.

No. 2
Open Recommendation Image, Square
to Veterans Health Administration (VHA)

Coordinate with the executive directors of the Prosthetic and Sensory Aids Service and the Veterans Health Administration’s Office of Procurement to implement a process to ensure contracting officers coordinate before awarding any Veterans Integrated Service Network–level contracts for eyeglasses to make sure these vendors offer the Veterans Health Administration the best pricing that is also consistent for the same or similar items to the extent possible.

Total Monetary Impact of All Recommendations
Open: $ 6,500,000.00
Closed: $ 0.00
Improvements Needed for VBA’s Claims Automation Project
|
22-02936-175

Open Recommendation Image, SquareOpenClosed and Implemented Recommendation Image, CheckmarkClosed-ImplementedNot Implemented Recommendation Image, X character'Closed-Not Implemented
No. 1
Open Recommendation Image, Square
to Veterans Benefits Administration (VBA)
Implement technology improvements and demonstrate progress to ensure the accuracy and completeness of information on the hypertension summary sheet.
No. 2
Open Recommendation Image, Square
to Veterans Benefits Administration (VBA)
Implement a process to communicate any change in policy, procedure, or the claims processing manual associated with all automated diagnostic codes between the Office of Automated Benefits Delivery, the Office of Policy and Oversight, the Office of Field Operations, and Compensation Service to ensure guidance is clear and consistent for all claims processors.
No. 3
Open Recommendation Image, Square
to Veterans Benefits Administration (VBA)
Implement an improved quality assurance process and monitor the results to ensure the accuracy of hypertension summary sheets and final decisions.
No. 4
Open Recommendation Image, Square
to Veterans Benefits Administration (VBA)
Create or amend metrics to compare the timeliness of claims processing using automation tools versus the traditional process.
Manufacturers Failed to Make Some Drugs Available to Government Agencies at a Discount as Required
|
22-01624-143

Open Recommendation Image, SquareOpenClosed and Implemented Recommendation Image, CheckmarkClosed-ImplementedNot Implemented Recommendation Image, X character'Closed-Not Implemented
No. 1
Open Recommendation Image, Square
to Acquisitions, Logistics, and Construction (OALC),Veterans Health Administration (VHA)
Issue guidance clarifying that allergens are exempt from the public law and include how the determination was reached.
No. 2
Open Recommendation Image, Square
to Acquisitions, Logistics, and Construction (OALC),Veterans Health Administration (VHA)
Formalize and communicate the process for manufacturers to request exemptions.
No. 3
Open Recommendation Image, Square
to Acquisitions, Logistics, and Construction (OALC),Veterans Health Administration (VHA)
Formalize the internal process for granting exemptions.
No. 4
Open Recommendation Image, Square
to Acquisitions, Logistics, and Construction (OALC),Veterans Health Administration (VHA)
Establish a procedure for monitoring covered drugs identified in this report as not commercially sold.
No. 5
Open Recommendation Image, Square
to Acquisitions, Logistics, and Construction (OALC),Veterans Health Administration (VHA)
Develop a procedure to monitor covered drugs identified in this report as newly launched to ensure they have an established ceiling price, and make certain they are made available on the Federal Supply Schedule at the end of the 75-day period.
No. 6
Open Recommendation Image, Square
to Acquisitions, Logistics, and Construction (OALC),Veterans Health Administration (VHA)
Request that noncompliant manufacturers identified by the Office of Inspector General conduct a self-audit and submit their findings for remediation.
No. 7
Open Recommendation Image, Square
to Acquisitions, Logistics, and Construction (OALC),Veterans Health Administration (VHA)
Engage with the Food and Drug Administration to ensure that when manufacturers request new national drug codes, they are made aware of the public law requirements.
No. 8
Open Recommendation Image, Square
to Acquisitions, Logistics, and Construction (OALC)
Require contracting staff at the National Acquisition Center to conduct a covered drug check for all of a manufacturer’s drugs when any pharmaceutical Federal Supply Schedule proposal or product addition modification is submitted.
Total Monetary Impact of All Recommendations
Open: $ 28,100,000.00
Closed: $ 0.00
Inconsistent Guidance and Limited Oversight Contributed to Inaccurate Community Care Wait-Time Eligibility Calculations at the C.W. Bill Young VA Medical Center in Bay Pines, Florida
|
23-01011-148

Open Recommendation Image, SquareOpenClosed and Implemented Recommendation Image, CheckmarkClosed-ImplementedNot Implemented Recommendation Image, X character'Closed-Not Implemented
No. 1
Open Recommendation Image, Square
to Veterans Health Administration (VHA)
The under secretary for health to make sure all scheduling guidance and other materials correctly refer to the date that should be used to determine wait-time eligibility for community care.
No. 2
Open Recommendation Image, Square
to Veterans Health Administration (VHA)
The under secretary for health to make sure the Office of Integrated Veteran Care provides ongoing oversight to ensure all facilities are using nationally approved scheduling tools.
No. 3
Open Recommendation Image, Square
to Veterans Health Administration (VHA)
The under secretary for health to develop an oversight process to verify that schedulers are using the correct dates to calculate wait-time eligibility for community care.
No. 4
Open Recommendation Image, Square
to Veterans Health Administration (VHA)
The under secretary for health to develop a mechanism to notify schedulers when it is appropriate to consider wait-time eligibility for community care regardless of which scheduling system schedulers are using.
VHA Faces Challenges Implementing the Appeals Modernization Act
|
22-02064-155

Open Recommendation Image, SquareOpenClosed and Implemented Recommendation Image, CheckmarkClosed-ImplementedNot Implemented Recommendation Image, X character'Closed-Not Implemented
No. 1
Open Recommendation Image, Square
to Veterans Health Administration (VHA)
Require the Office of Regulations, Appeals, and Policy, in coordination with the Office of General Counsel, to determine whether the Office of Dentistry and the Consolidated Patient Account Center Program have appealable benefits decisions governed by the AMA, and if so, to update program policies, processes, and procedures accordingly, including ensuring that claimants receive written decision notices that meet all act requirements.
No. 2
Open Recommendation Image, Square
to Veterans Health Administration (VHA)
Require the Office of Regulations, Appeals, and Policy to evaluate the program offices’ barriers to including all required elements in decision notices and take corrective action, seeking congressional relief if needed.
No. 3
Open Recommendation Image, Square
to Veterans Health Administration (VHA)
Using the evaluation findings from recommendation 2, require Payment Operations to update its systems to generate AMA-compliant decision notices to the extent possible.
No. 4
Open Recommendation Image, Square
to Veterans Health Administration (VHA)
Using the same evaluation findings, require the Veteran and Family Member Programs to update its systems to generate AMA-compliant decision notices to the extent possible.
No. 5
Open Recommendation Image, Square
to Veterans Health Administration (VHA)
Require the Office of Regulations, Appeals, and Policy and the program office for Member Services’ Eligibility and Enrollment Division to ensure that priority group assignment decision notices are provided with enrollment handbooks given to veterans.
No. 6
Open Recommendation Image, Square
to Veterans Health Administration (VHA)
Identify resources and assign duties to conduct quality control reviews of decision letters with program offices to remediate deficiencies.
No. 7
Open Recommendation Image, Square
to Veterans Health Administration (VHA)
Work with the Office of Information and Technology to update Caseflow to address identified VHA system requirements within specified deadlines, including adding a program identifier and facilitating entries for individuals and entities that are not veterans.
No. 8
Open Recommendation Image, Square
to Veterans Health Administration (VHA)
Establish interim tracking procedures with the program offices until Caseflow can be considered a reliable system for VHA oversight.
No. 9
Open Recommendation Image, Square
to Veterans Health Administration (VHA)
In coordination with the Office of General Counsel, seek clarification on how the reporting metrics sections of the Appeals Modernization Act apply to VHA, and then develop those measures.
No. 10
Open Recommendation Image, Square
to Veterans Health Administration (VHA)
Issue policy and other clear guidance that includes standard tracking processes and procedures, and oversight of that tracking.
No. 11
Open Recommendation Image, Square
to Veterans Health Administration (VHA)
Work with VBA and others to allow access to all VHA program offices, and ensure that those offices in turn require that staff use the Centralized Mail Portal for all decision reviews or establish another mechanism that ensures all decision reviews are tracked from request receipt through routing and processing.
No. 12
Open Recommendation Image, Square
to Veterans Health Administration (VHA)
Work with the Office of Information and Technology to determine the best way to create a central repository and identify the necessary resources to implement and maintain it.
No. 13
Open Recommendation Image, Square
to Veterans Health Administration (VHA)
Develop decision review retention standards and communicate to the relevant programs what types of claims and appeals documentation should be stored, for how long, and where.
No. 14
Open Recommendation Image, Square
to Veterans Health Administration (VHA)
Implement training on processing and tracking appeals that is mandatory for VHA staff who process decision reviews.
Nonadherence to Requirements for Processing Gulf War Illness Claims Led to Premature Decisions
|
22-02194-152

Open Recommendation Image, SquareOpenClosed and Implemented Recommendation Image, CheckmarkClosed-ImplementedNot Implemented Recommendation Image, X character'Closed-Not Implemented
No. 1
Open Recommendation Image, Square
to Veterans Benefits Administration (VBA)
The under secretary for benefits update the instructions provided to examiners for completing Gulf War general medical examinations to add the definitional requirements for medically unexplained illness as outlined in 38 C.F.R.§ 3.317 and clarify the instructions and related procedures to reflect that an examiner’s determination that a disability pattern is an undiagnosed illness or a medically unexplained illness requires a written explanation.
No. 2
Open Recommendation Image, Square
to Veterans Benefits Administration (VBA)
The under secretary for benefits implement a plan to update the Gulf War general medical examination disability benefits questionnaire to add the definitional requirements for medically unexplained illness as outlined in 38 C.F.R.§ 3.317.
No. 3
Open Recommendation Image, Square
to Veterans Benefits Administration (VBA)
The under secretary for benefits implement a plan to incorporate into the Gulf War general medical disability benefits questionnaires the clinical requirements listed in 38 C.F.R.§ 3.317 for an undiagnosed illness and a medically unexplained illness.
No. 4
Open Recommendation Image, Square
to Veterans Benefits Administration (VBA)
The under secretary for benefits implement a plan to incorporate into the appropriate medical disability benefits questionnaires the diagnostic criteria for functional gastrointestinal disorders from 38 C.F.R.§ 3.317 and require examiners to provide an explanation of whether the disorder is functional or structural. This should include a requirement that any necessary testing has been completed before examiners diagnose specific functional gastrointestinal disorders.
No. 5
Open Recommendation Image, Square
to Veterans Benefits Administration (VBA)
The under secretary for benefits update VA’s Adjudication Procedures Manual to clearly state that all the requirements of 38 C.F.R.§ 3.317 must be met to award benefits. Clarify and reiterate instructions to claims processors that benefits should only be awarded after taking into consideration the overall evidence of record.
Total Monetary Impact of All Recommendations
Open: $ 25,600,000.00
Closed: $ 0.00
VA Should Ensure Veterans’ Records in the New Electronic Health System Are Reviewed before Deciding Benefits Claims
|
22-03806-162

Open Recommendation Image, SquareOpenClosed and Implemented Recommendation Image, CheckmarkClosed-ImplementedNot Implemented Recommendation Image, X character'Closed-Not Implemented
No. 1
Open Recommendation Image, Square
to Veterans Benefits Administration (VBA)
Conduct national refresher training on the Electronic Health Record Modernization National Process Memorandum and assess training effectiveness
No. 2
Open Recommendation Image, Square
to Veterans Benefits Administration (VBA)
Consider updating VA Manual 21-4 to reflect that quality assurance measures include addressing failures to consider all Veterans Health Administration records as directed in the Adjudication Procedures Manual that are subject to an enterprise-wide search in the Compensation and Pension Records Interchange system whether or not directed to those records by the claimant and ensure staff are advised of the changes.
The Fiduciary Program Needs to Verify the Prompt Return of Deceased Beneficiaries’ Funds to VA
|
22-03543-151

Open Recommendation Image, SquareOpenClosed and Implemented Recommendation Image, CheckmarkClosed-ImplementedNot Implemented Recommendation Image, X character'Closed-Not Implemented
No. 1
Open Recommendation Image, Square
to Veterans Benefits Administration (VBA)
The Pension and Fiduciary Service clarifies procedural requirements to fiduciary hub staff on how to verify whether VA-derived funds of deceased beneficiaries must be returned to VA, including whether the fiduciary identified any valid will or heir to whom the funds are otherwise due.
No. 2
Closed and Implemented Recommendation Image, Checkmark
to Veterans Benefits Administration (VBA)
The Pension and Fiduciary Service considers reimplementing the procedural requirement to verify the disbursement of VA-derived funds to deceased beneficiaries’ estates when a valid will or heir exists.
No. 3
Open Recommendation Image, Square
to Veterans Benefits Administration (VBA)
The Pension and Fiduciary Service identifies existing or implements new electronic controls that allow VBA staff to track Fiduciary Program tasks, timeliness, and workload related to the return of deceased beneficiaries’ VA-derived funds to VA that would otherwise escheat to a state if not disbursed to heirs.
No. 4
Open Recommendation Image, Square
to Veterans Benefits Administration (VBA)
The Pension and Fiduciary Service and the Office of Field Operations establish a methodology and monitor workload to ensure the prompt return of deceased beneficiaries’ VA-derived funds.
VA Developed Reporting Metrics for Appeals Modernization Act Decision Reviews but Could Be Clearer on Some Veterans’ Wait Times
|
22-00488-81
|
Topics: Claims and Appeals,Appointment Scheduling and Wait Times

Open Recommendation Image, SquareOpenClosed and Implemented Recommendation Image, CheckmarkClosed-ImplementedNot Implemented Recommendation Image, X character'Closed-Not Implemented
No. 1
Open Recommendation Image, Square
to Veterans Benefits Administration (VBA)
Update the reporting methodology used in public reports to reflect the total time veterans wait for a final claims decision when their higher level reviews require a supplemental claim be established and completed due to an error.
No. 2
Open Recommendation Image, Square
to Veterans Benefits Administration (VBA)
Revise and clearly state the measures used for calculating and reporting the average duration, from the filing of an initial claim until the claim is resolved and claimants no longer take any action under the Appeals Modernization Act claim, and ensure consistency with subsection M of the act.
Review of VA’s Compliance with the Payment Integrity Information Act for Fiscal Year 2022
|
23-00237-124
|
Topics: Financial Management

Open Recommendation Image, SquareOpenClosed and Implemented Recommendation Image, CheckmarkClosed-ImplementedNot Implemented Recommendation Image, X character'Closed-Not Implemented
No. 1
Open Recommendation Image, Square
to Veterans Benefits Administration (VBA)
The under secretary for benefits reduces improper and unknown payments to below 10 percent for the Pension Program.
No. 2
Open Recommendation Image, Square
to Veterans Health Administration (VHA)
The under secretary for health reduces improper and unknown payments to below 10 percent for the Purchased Long-Term Services and Supports Program.
Goals Not Met for Implementation of the Beneficiary Travel Self-Service System
|
21-03598-92
|
Topics: System Development and Implementation

Open Recommendation Image, SquareOpenClosed and Implemented Recommendation Image, CheckmarkClosed-ImplementedNot Implemented Recommendation Image, X character'Closed-Not Implemented
No. 1
Open Recommendation Image, Square
to Veterans Health Administration (VHA)
Director of the Veterans Transportation Program determines what system changes are needed to meet auto-adjudication goals and implement these changes.
No. 2
Open Recommendation Image, Square
to Veterans Health Administration (VHA)
Director of the Veterans Transportation Program conducts outreach to users, solicits feedback, and considers whether system changes are needed based on feedback, to increase self-service portal usage.
No. 3
Open Recommendation Image, Square
to Veterans Health Administration (VHA)
Assistant Under Secretary for Health for Operations create an action plan to phase out continued use of the VistA beneficiary travel function.
No. 4
Open Recommendation Image, Square
to Veterans Health Administration (VHA)
Assistant Under Secretary for Health for Operations coordinates with the veteran’s health administration office of finance and assess whether duplicate payments were made to veterans requesting travel reimbursement since the new system went live.
The Medical Disability Examination Office Needs to Better Monitor Mileage Requirements for Contract Exams
|
22-02067-82

Open Recommendation Image, SquareOpenClosed and Implemented Recommendation Image, CheckmarkClosed-ImplementedNot Implemented Recommendation Image, X character'Closed-Not Implemented
No. 1
Closed and Implemented Recommendation Image, Checkmark
to Veterans Benefits Administration (VBA)
Implement a process to monitor and demonstrate progress to assess vendors’ compliance with contractual mileage and travel reimbursement requirements.
No. 2
Closed and Implemented Recommendation Image, Checkmark
to Veterans Benefits Administration (VBA)
Collaborate with vendors to ensure portals include proper documentation of express consent.
No. 3
Closed and Implemented Recommendation Image, Checkmark
to Veterans Benefits Administration (VBA)
Collaborate with vendors to ensure mileage reimbursement information is available in vendor portals.
Audie L. Murphy Memorial Veterans’ Hospital Missed Opportunities to Distribute Excess Ventilators during the COVID-19 Pandemic
|
22-02604-74

Open Recommendation Image, SquareOpenClosed and Implemented Recommendation Image, CheckmarkClosed-ImplementedNot Implemented Recommendation Image, X character'Closed-Not Implemented
No. 1
Closed and Implemented Recommendation Image, Checkmark
to Veterans Health Administration (VHA)
Document a methodology for determining the number of ventilators required by the Audie L. Murphy Memorial Veterans’ Hospital to fulfill its mission and provide care during routine and emergency operations.
No. 2
Closed and Implemented Recommendation Image, Checkmark
to Veterans Health Administration (VHA)
Determine whether the remaining ventilators are required to support the hospital’s mission. If excess ventilators are identified, perform procedures to turn them in for reassignment, reutilization, or disposal in accordance with VA Handbook 7002.
Total Monetary Impact of All Recommendations
Open: $ 0.00
Closed: $ 2,500,000.00
Veterans Are Still Being Required to Attend Unwarranted Medical Reexaminations for Disability Benefits
|
22-01503-65

Open Recommendation Image, SquareOpenClosed and Implemented Recommendation Image, CheckmarkClosed-ImplementedNot Implemented Recommendation Image, X character'Closed-Not Implemented
No. 1
Open Recommendation Image, Square
to Veterans Benefits Administration (VBA)
Take action to help reduce unwarranted reexaminations by updating guidance and enhancing information systems to require rating specialists to cite objective evidence and provide justification for establishing reexamination controls.
No. 2
Open Recommendation Image, Square
to Veterans Benefits Administration (VBA)
Consider establishing criteria to define a “locally-designated claims processor with expertise in review examination ordering” and ensure these claims processors meet all training requirements related to establishing and ordering medical reexaminations.
No. 3
Open Recommendation Image, Square
to Veterans Benefits Administration (VBA)
Update training materials to include the guidance from VBA Policy Letter 21-01, “Updated Guidance on Routine Future Examination Requests” and ensure these claims processors meet all training requirements related to establishing and ordering medical reexaminations
Displaying 1 - 20 of 273