Deficiencies in the Quality Review Team Program

Report Information

Issue Date
Closure Date
Report Number
19-07054-174
VA Office
Veterans Benefits Administration (VBA)
Report Author
Office of Audits and Evaluations
Report Type
Review
Major Management Challenges
Benefits for Veterans
Recommendations
5
Questioned Costs
$0
Better Use of Funds
$0
Congressionally Mandated
No

Summary

Summary
Quality review team (QRT) program specialists oversee employees in the Veterans Benefits Administration (VBA) who process disability compensation claims. The VA Office of Inspector General (OIG) examined whether QRT specialists conducted accurate quality reviews; regional office managers decided employee requests for reconsideration of errors appropriately; and employees corrected claims-processing errors based on established standards. The OIG found that QRT specialists, who are supposed to identify claims-processing errors made by employees, missed errors in approximately 9,900 of the 28,400 quality reviews (35 percent) completed during the review period. Furthermore, the process in which QRT specialists review one another’s work was inadequate to identify errors missed during the initial quality review. Performance reviews of QRT specialists also did not ensure competency for identifying errors. Regional office managers did not follow VBA procedures by overturning errors identified by QRT specialists. The OIG estimated that during the review period, regional office managers inappropriately overturned errors in 430 of 870 quality reviews (about 50 percent) where claims processors requested a reconsideration of QRT specialist- identified errors. Finally, VBA has not established adequate oversight or accountability to ensure the timeliness of error corrections. The OIG estimated that during the review period 2,000 of 4,400 identified errors (45 percent) were not corrected in a timely manner and 810 of 4,400 identified errors (18 percent) were not corrected at all. The OIG recommended the under secretary for benefits (1) revise the current peer review process to make certain all errors are identified during quality reviews, (2) revise the QRT specialist performance review process to promote competency in identifying errors, (3) revise the error reconsideration process to adhere to VBA procedures and promote objectivity, and (4) improve oversight of the error correction process.

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)
Closure Date: 6/4/2021
The OIG recommends that the under secretary for benefits assess the current peer review process and determine whether a more in depth review should be required to ensure claims processing errors are identified.
No. 2
Closed and Implemented Recommendation Image, Checkmark
to Veterans Benefits Administration (VBA)
Closure Date: 6/4/2021
The OIG recommends that the under secretary for benefits establish a process where a sampling of non error quality reviews undergo peer review to ensure claims processing errors are identified.
No. 3
Closed and Implemented Recommendation Image, Checkmark
to Veterans Benefits Administration (VBA)
Closure Date: 6/4/2021
The OIG recommends that the under secretary for benefits revise the QRT specialist performance review process to include more objectivity to ensure constructive feedback is provided to promote competency.
No. 4
Closed and Implemented Recommendation Image, Checkmark
to Veterans Benefits Administration (VBA)
Closure Date: 12/12/2022
The OIG recommends that the under secretary for benefits revise the error reconsideration process to ensure objectivity and adherence to current VBA procedures.
No. 5
Closed and Implemented Recommendation Image, Checkmark
to Veterans Benefits Administration (VBA)
Closure Date: 6/4/2021
The OIG recommends that the under secretary for benefits improve oversight procedures for monitoring the timeliness of error corrections.