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Office of the Inspector General Reports on the VA’s Inability to Provide Quality Coverage for Veterans

Monday, August 26, 2019

According to a recent report conducted by the Office of the Inspector General, the VA denied coverage for 17,400 veterans in a six-month period in 2017. These claims totaled to $53.3 million and should have been covered by the government.

It appears the environment at the VA contributed to the inaccuracy of approval decisions for medical claims. The findings state that there was “systemic pressure to favor speed over accuracy” when it came to reviewing claims. “Overall, the responses showed that the claims-processing environment focused on production and prioritized quantity over quality,” the report states.

The report elaborates further on factors that contributed to an environment that allowed for this much inaccuracy. It notes that examiners of medical claims must hit target numbers in order to receive a performance rating of “fully successful.” In addition, as the number of an examiner’s reviewed claims goes up, so does their performance rating. These ratings play an important role in determining bonuses for the examiners at the VA. Similarly, the quantity of reviewed claims also contributed to opportunities for examiners to work remotely.

As a result of these practices, the VA has “placed more emphasis on the number of claims processed than the accuracy of the claims decisions.”

The chairs of the House and Senate Veterans Affairs Committees, along with other members of Congress, sent a letter to the VA early last week demanding answers. Chris Pappas D-N.H., U.S. Representative of New Hampshire’s 1st Congressional District, was among those who signed the letter. He also stated to reporters that “No veteran should be afraid to seek care in an emergency room. Clearly the bureaucracy is favoring speed over accuracy, it’s favoring efficiency over the health of our veterans.”

The Inspector General concluded that a staggering 31 percent of rejected emergency care claims had been inappropriately processed. Additionally, it reported on an enormous backlog in sending out patient bills, even time-sensitive ones which makes filing appeals in time extremely difficult. This leads to the conclusion that not only was coverage wrongly denied for so many, but in many cases their ability to appeal was hampered by delayed bills.

Since the six-month period on which the Inspector General reports, there have been many changes in leadership, specifically in the directors of the office that processes emergency claims. The IG reports that this instability has allowed for these practices to continue. The VA issued a statement to NBC News stating that it is reviewing the claims in the Inspector General’s report for possibly payment to veterans.

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