Inadequate Oversight Allowed a Senior Benefits Representative to Inaccurately Authorize Thousands of Decisions

The OIG received a hotline allegation that the Veterans Service Center manager at the Philadelphia VA Regional Benefit Office permitted a senior veterans service representative (VSR) to “blindly” approve hundreds of rating decisions for disability benefits claims each day without conducting the required reviews. The OIG team substantiated the allegation. From at least fiscal year 2022 through 2024, this senior VSR authorized about 85,300 claims—about 19 times the national average. The senior VSR spent an average of 4.7 minutes reviewing each claim authorized during this three-year period, versus a national average of about 21 minutes. The OIG obtained data showing that the senior VSR rarely opened necessary documents to verify claim information prior to authorization. The senior VSR contributed more than 35 percent each year toward the regional office’s claims completions goal, a metric that is part of regional office executive directors’ performance standards.

Based on the results of a statistical sample of 32 rating decisions that the senior VSR authorized from January 1, 2024, through June 30, 2024, the team estimated that approximately 13,200 decisions (84 percent) had at least one error. Some of the errors likely occurred because the senior VSR did not open and review the necessary documents. Monetary impact errors resulted in an estimated $2.2 million in improper payments during this period.

Officials from the regional office, the Northeast District, and the central office were aware of the Philadelphia senior VSR’s unusually high authorization rate. However, they overlooked opportunities to strengthen internal controls and effectively respond to the associated risks. The OIG recommended the under secretary for benefits review the errors the OIG team identified, correct these errors, and evaluate the effectiveness of controls for authorization rate outliers.