Audit of VA’s Internal Controls Over the Use of Disability Benefits Questionnaires

Report Information

Issue Date
Report Number
11-00733-95
VA Office
Veterans Health Administration (VHA)
Veterans Benefits Administration (VBA)
Report Author
Office of Audits and Evaluations
Report Type
Audit
Recommendations
9
Questioned Costs
$0
Better Use of Funds
$0
Congressionally Mandated
No

Summary

Summary
The OIG conducted this audit to provide an early assessment of VA’s internal controls over the use of disability benefits questionnaires (DBQ). We wanted to determine whether adequate front-end controls to identify and minimize risks were in place before benefit payments were initiated. VA implemented the new DBQ process to reduce the claims backlog by changing the way VA collects medical evidence to support claims. VA expects DBQs to replace the current need for C&P medical exams, by relying on information from veterans and private physicians. We expect the volume of claims processed using DBQs to increase significantly. Our review found VA has a quality assurance review process, but it verifies only a limited number of DBQs and does so after claims are awarded. These quality assurance reviews do not provide reasonable assurance that fraud will be detected in the DBQ program as it accepts claims. The Under Secretary for Benefits and Under Secretary for Health generally concurred with our report recommendations. We will follow up on the implementation of corrective actions.

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)
We recommend the Under Secretary for Benefits develop internal controls within the disability benefits questionnaire process that will reduce the risk of fraud, such as notifying veterans and physicians that submitted information is subject to verification.
No. 2
Closed and Implemented Recommendation Image, Checkmark
to Veterans Health Administration (VHA)
We recommend the Under Secretary for Benefits develop front-end controls for the disability benefits questionnaire process to verify the identity and credentials of private physicians who submit completed disability benefits questionnaires, including those entered into the Fast Track Claims Processing System.
No. 3
Closed and Implemented Recommendation Image, Checkmark
to Veterans Health Administration (VHA)
We recommend the Under Secretary for Benefits develop a plan to measure compliance with the guidance contained in Fast Letter 11-36 pertaining to tracking claims where a disability benefits questionnaire was received as medical evidence.
No. 4
Closed and Implemented Recommendation Image, Checkmark
to Veterans Health Administration (VHA)
We recommend the Under Secretary for Benefits develop controls to electronically capture information contained on completed disability benefits questionnaires.
No. 5
Closed and Implemented Recommendation Image, Checkmark
to Veterans Health Administration (VHA)
We recommend the Under Secretary for Benefits update the policy manual with information on the disability benefits questionnaire process, to include procedures for verifying information on completed disability benefits questionnaires and tracking and monitoring completed disability benefits questionnaires.
No. 6
Closed and Implemented Recommendation Image, Checkmark
to Veterans Health Administration (VHA)
We recommend the Under Secretary for Benefits take steps to improve quality assurance reviews by focusing reviews on disability benefits questionnaires that pose an increased risk of fraud.
No. 7
Closed and Implemented Recommendation Image, Checkmark
to Veterans Health Administration (VHA)
We recommend the Under Secretary for Benefits establish control mechanisms to ensure that potential cases of fraud identified during the quality assurance review process are immediately forwarded to the Office of Inspector General.
No. 8
Closed and Implemented Recommendation Image, Checkmark
to Veterans Health Administration (VHA)
We recommend the Under Secretary for Health identify key components of disability benefits questionnaires that should be reviewed as part of the Disability Examination Management Office’s quality assurance review process.
No. 9
Closed and Implemented Recommendation Image, Checkmark
to Veterans Health Administration (VHA)
We recommend the Under Secretary for Health modify the process used to select claims reviewed by the Disability Examination Management Office’s quality assurance staff.