Submitting OIG:
Report Description:
The Appeals Modernization Act (AMA) of 2017 charged VA with establishing a new process for more quickly and transparently reviewing benefit claims decisions with which veterans disagree.
VA implemented the AMA in 2019, and though it largely focuses on Veterans Benefits Administration benefits decisions, it also applies to those made by the Veterans Health Administration (VHA), such as clothing allowances related to prosthetics use and reimbursement of non-VA emergency care. The VA Office of Inspector General (OIG) previously reported on difficulties with the appeals modernization rollout. Additional concerns prompted this review to determine whether VHA processed and tracked appeals of benefits decisions in accordance with the AMA’s requirements and two VHA interim policy notices.
Based on a nonstatistical sample of 180 decision reviews initiated between February 19, 2019, and June 27, 2022, the OIG found
• VHA program offices did not give claimants the information needed to initiate higher-level reviews and supplemental claims regarding benefits decisions. Before VHA can process decision reviews, both the AMA and VHA’s interim policy notices require that claimants receive an explanation as to why a claim was denied, steps for seeking further review of a denied benefit, and other information.
• VHA did not accurately track reviews because it did not implement effective systems, sufficient policies, or adequate training. VHA’s many programs were operating independently, and most did not have effective tracking systems. VHA’s two interim policy notices required tracking but lacked specificity and were in effect for only one year each. By not effectively tracking reviews, VHA risks not processing reviews or not granting veterans the benefits to which they are entitled.
The OIG made 14 recommendations to the under secretary for health to improve information given to claimants, centralize intake, and better track and standardize retention of decision reviews.
Date Issued:
Thursday, September 7, 2023
Agency Reviewed / Investigated:
Submitting OIG-Specific Report Number:
22-02064-155
Component, if applicable:
Veterans Health Administration
Location(s):
Agency-Wide
Type of Report:
Review
Questioned Costs:
$0
Funds for Better Use:
$0
Number of Recommendations:
14
Report updated under NDAA 5274:
No
View Document:
Attachment | Size |
---|---|
VAOIG-22-02064-155.pdf | 4.02 MB |
Additional Details Link: