GAO: Applications for VHA Healthcare Benefits Frequently Mishandled

by Sandra Basu

October 16, 2017

By Sandra Basu

Wilmington, DE, VAMC and Philadelphia and Wilmington Veterans Benefits Administration office jointly held a Benefits Claims Workshop and Town Hall meeting last year to help work through obstacles or explain benefits of which they might have been previously unaware. VA photo.

WASHINGTON VHA does not have the right protocols in place to ensure applications for enrollment are processed in a timely manner or that enrollment determinations are accurate, according to a new report.

“Timely and accurate processing of veterans’ enrollment applications is critical to ensuring that eligible veterans obtain needed health care,” the Government Accountability Office (GAO) explained. “Without efficient and effective enrollment processes, veterans may be delayed in obtaining needed services or incorrectly denied benefits.”

The oversight group examined to what extent VHA has implemented better processes for enrolling veterans for healthcare benefits.

“We and others have expressed concerns about VA’s inability to effectively provide and oversee timely access to health care, which, in some cases, reportedly has resulted in harm to veterans,” the report stated.

Veterans seeking to enroll for healthcare benefits must submit an application to either VA’s Health Eligibility Center (HEC) or a VAMC. Applications are required to be processed within five days of receipt.

The problem, GAO noted, is that VHA enrollment staff, both from HEC and VAMCs, “frequently did not process enrollment applications in accordance with VHA’s timeliness standards and made incorrect enrollment determinations.”

GAO reviewed six VAMCs and found that, as of March and April 2017, VAMC enrollment staff had not resolved 31 of the 56 pending applications included in its random, nongeneralizable sample of pending applications.

            “Specifically we found that for 22 (71%) of the 31 unresolved applications, there was no evidence that VAMC enrollment staff had attempted to contact the veterans to obtain missing military service or financial information, and that 18 of these 22 applications had been in a pending status for three months or longer at the time of our review,” according to the report. “VAMC officials told us they were not aware that some of the unresolved were in a pending status prior to our review.”

The GAO pointed out that prior studies found that VHA enrollment staffers, whether from HEC or VAMCs, “frequently did not process enrollment applications within five business days in accordance with VHA timeliness standards.”

 “A June 2016 VHA audit found that HEC staff did not process 143 of 253 applications reviewed (57%) within VHA’s timeliness standard,” the document stated. “The audit found that this occurred, in part, because HEC enrollment staff were not prioritizing workload to focus on processing applications that were approaching the timeliness standard.”

A VHA Chief Business Office analysis showed that VAMCs also did not consistently process online applications within five days, noting that “only 35% of online applications were processed by VAMCs within five business days in fiscal year 2012 and 65% through the first 7 months of fiscal year 2016.”

In a September 2015 report, VA’s Office of Inspector General found that, as of September 2014, the enrollment system contained nearly 870,000 pending applications, many of which had been pending for more than five years. According to that report, 72% of those applications were pending because additional financial information was needed from veterans.

“According to HEC officials, as of May 2017, they were able to resolve about 30% of the applications (about 255,000 applications). This included enrolling approximately 88,000 veterans, as well as removing from pending status applications for which HEC officials said veterans were no longer living,” according to the report.

The GAO investigators said that HEC officials and VAMC staff told them in the recent audit that pending applications were difficult to resolve because they were generally several years old and lacked accurate contact information. In addition, discussion with enrollment staff found that none of the VAMCs in its review had a specific policy or procedure for how to resolve pending applications.

“In the absence of a standard procedure for VAMCs to use to resolve pending applications, veterans are at risk for experiencing unnecessary delays while waiting for their applications to be processed,” the report explained.

When it comes to correct enrollment determinations, two VHA audits in 2016 found that VHA enrollment staff members, including those from HEC and VAMCs, frequently erred in their responses.

“In some cases, veterans were rejected for healthcare benefits when those veterans should have been enrolled, and in other cases veterans were enrolled when they were ineligible for benefits, according to these audits,” the GAO emphasized.

VA concurred with GAO’s four recommendations to address these issues:

    • Define the responsibilities of VAMCs in resolving pending enrollment applications;
    • Define oversight responsibilities to help ensure timely application processing and accurate enrollment determinations;
    • Develop procedures for collecting reliable data system-wide to evaluate the timeliness of application processing; and
    • Clarify its five-day timeliness standard.

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