Manipulation of Claims Files Data Found in VA Review of LR Office

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LITTLE ROCK, AR - A review of the Little Rock Veterans Administration Regional Office (VARO) has turned up manipulation of data involving benefits claims files.

The review was conducted by the VA's Office of Audits and Evaluations which operates under the Office of Inspector General (OIG).

A report released on Thursday explained in detail how the review got started in July after the agency received an anonymous allegation claiming that staff at the Little Rock VARO applied the Veterans Benefits Administration’s (VBA) Fast Letter (FL) 13-10, “Guidance on Date of Claim Issues,” dated May 20, 2013, inappropriately to adjust dates of claims for unadjudicated claims discovered in the files.

The report states that the complainant alleged that adjusting the dates of claims was done to give the appearance that VBA was making more progress than it actually had in eliminating its backlog of disability claims. 

The report states that agency policy changes were ordered effective June 27 of last year but action was not taken by the Little Rock office until nearly six months later.

Highlights from the report:
  • The review included interviews with managers and staff responsible for implementing and following the guidance outline. The panel also examined a VARO spreadsheet of 48 unadjudicated claims that staff identified in claims folders from May 22, 2013, through June 20, 2014 which showed staff adjusted the dates of claim for all 48 cases. This resulted in the claims having more current dates than the dates they were initially received within VA. However, staff did so as VBA directed in the Fast Letter guidance, the report stated. 
  • Of the 48 cases, 43 were rating-related, involving disability determinations. An average of 1 year and 8 months elapsed between the initial dates VA received the claims until the dates that staff discovered the unadjudicated claims in the files. Among the 43 rating-related claims, 1 claim was 20 years old, but the date of claim had been adjusted to make the claim appear 14 days old.
  • The five remaining claims were non-rating related, involving issues such as additional monthly allowances for veterans’ dependents. An average of 5 years and 9 months elapsed between the initial dates VA received the claims until the dates staff discovered the claims in the files. Among these five non-rating related claims, one claim was over 16 years old, but the date of claim had been adjusted to make the claim appear 6 days old. 
  • In a memo, received January 8, 2015, the Under Secretary for Benefits (USB) advised OIG that VBA terminated the use of FL 13-10, Guidance on Date of Claim Issues, effective June 27, 2014. The memo further indicated all VARO staff were instructed to immediately follow the permanent procedural guidance found in VBA’s governing directives for all claims, to include “found” claims. 
  • The report explains that the VBA uses dates of claims to control and manage claims workloads within the electronic processing environment. VBA policy states that the date of claim is the earliest date a claim is received at a VA facility. VBA staff typically process claims in their workloads by claim type and age—generally working the oldest claims first. However, according to the Fast Letter 13-10 guidance, VARO staff could adjust dates of claims for unadjudicated claims to the dates they were discovered in claims folders. 
The panel says it remains "concerned that VBA’s permanent guidance related to dates of claims continues to provide for an exception that allows VARO staff to use a later date of claim, despite having evidence that an earlier date of claim exists."

Click here to read the full report.

Update:

The Little Rock VA Regional Office issued the following response Friday:


"The Department of Veterans Affairs (VA) strives to provide Veterans with the care and benefits they have earned and deserve.  The VA Regional Office at Little Rock takes this mission very seriously.  Arkansas Veterans receive over $66 million in disability benefits monthly.


In May 2013, VA issued guidance to all regional offices that was designed to ensure there was no disincentive in its processing procedures for taking action on any previously undecided claim.   The VA Regional Office at Little Rock applied the guidance as directed.  There are over a quarter million Veterans in the State of Arkansas.  Of those, 45,000 receive disability benefits.  This guidance was applied to 48 cases.


Upon learning the Office of Inspector General (OIG) received a complaint one of the nation’s 56 regional offices was not properly following this guidance, VA suspended the guidance on June 27, 2014.   VARO Little Rock discontinued using the guidance immediately upon notice of the suspension.  The guidance has not been used in Little Rock since June 27, 2014.


There is no indication that the VARO Little Rock applied the guidance improperly.  In fact, the OIG Report specifically highlights that VARO Little Rock took an extra step by keeping a spreadsheet of the cases so that they were addressed quickly upon discovery.  Managers at the office chose to “do the right thing” for Arkansas Veterans."


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