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The Systematic Technical Accuracy Review Program Has Not Adequately Identified and Corrected Claims-Processing Deficiencies

Report Information

Issue Date
Closure Date
Report Number
19-07059-169
VA Office
Veterans Benefits Administration (VBA)
Report Author
Office of Audits and Evaluations
Report Type
Review
Report Topic
Claims and Medical Exams
Major Management Challenges
Benefits for Veterans
Recommendations
6
Questioned Costs
$0
Better Use of Funds
$0
Congressionally Mandated
No

Summary

Summary
The VA Office of Inspector General (OIG) reviewed the Systematic Technical Accuracy Review (STAR) program, which helps the Veterans Benefits Administration (VBA) provide timely and accurate disability compensation benefits to veterans and their beneficiaries. VBA’s STAR analysts perform quality reviews on randomly selected claims for disability compensation to identify errors and deficiencies in how claims were processed and to provide feedback to personnel to improve decision-making. The OIG review team examined whether STAR staff conducted accurate quality reviews of claims decisions, had adequate procedures to ensure corrective actions were timely and correct, and provided feedback to managers and staff to improve decision-making. The OIG found that STAR analysts were generally identifying benefit entitlement errors but not placing as much emphasis on finding procedural deficiencies. The OIG team determined there was no formal secondary review process for procedural deficiencies. An estimated 55 percent of claims had deficiencies (including benefit entitlement errors that could affect veterans’ disability compensation payments) and procedural deficiencies (such as veterans having to report for an unnecessary medical examination). Problems were also noted with the process for correcting errors that resulted in untimely and inaccurate actions, as well as with outdated or inaccessible feedback from reviews that did not enhance the quality of claims decisions. The OIG made six recommendations for ensuring STAR analysts follow the quality review checklist. Improvements to the second senior review process were also recommended for both analyst-identified deficiencies and to scan for errors missed by analysts, as well as advancing the processes to correct errors. In addition, VBA was called on to assess the training requirements for STAR staff; establish adequate policies, procedures, and monitoring to ensure corrections are completed timely and accurately; and to develop a plan to provide quality review data and feedback to assist managers in improving decision-making on claims.

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: 9/7/2021
Improve the current second-review process for quality reviews when STAR analysts identify claims-processing deficiencies and consider requiring senior reviewers to conduct a comprehensive review of all issues assessed by the analyst.
No. 2
Closed and Implemented Recommendation Image, Checkmark
to Veterans Benefits Administration (VBA)
Closure Date: 9/7/2021
Establish a formal second-review process for quality reviews when STAR analysts do not identify claims-processing deficiencies.
No. 3
Closed and Implemented Recommendation Image, Checkmark
to Veterans Benefits Administration (VBA)
Closure Date: 1/5/2021
Assess the current training requirements for STAR staff and establish a formal training plan that promotes claims-processing expertise and accuracy.
No. 4
Closed and Implemented Recommendation Image, Checkmark
to Veterans Benefits Administration (VBA)
Closure Date: 3/30/2022
Implement a plan to ensure STAR analysts place more emphasis on and assess all procedural deficiency elements included on the quality review checklist.
No. 5
Closed and Implemented Recommendation Image, Checkmark
to Veterans Benefits Administration (VBA)
Closure Date: 6/25/2021
Establish adequate policies, procedures, and monitoring to ensure corrections are completed timely and accurately.
No. 6
Closed and Implemented Recommendation Image, Checkmark
to Veterans Benefits Administration (VBA)
Closure Date: 6/25/2021
Ensure STAR develops a plan to provide usable data and meaningful feedback to assist regional offices in improving the quality of decision-making.