Military News

VA audit: Seattle office overpays some claims because of slow corrections to cases

Delays in processing claims at the Department of Veterans Affairs benefits office in Seattle are causing the agency to overpay patients after they recover from surgeries, according to a VA Inspector General report released Thursday.

The report says the VA Regional Office “did not accurately process” 24 percent of the 90 disability claims that auditors reviewed in a March site visit. The errors in the sample group cost the agency more than $168,000.

In most of the cases, inspectors found the claims processors did not move quickly enough to revise benefits after a patient’s recovery.

“Taking timely and appropriate action on benefits reductions is necessary to ensure financial stewardship and minimize improper benefits payments,” the report says in urging the regional office to create a plan to provide oversight of temporary claims.

The Seattle VA office handles cases for veterans all over Washington, including those who receive care at the American Lake hospital in Lakewood.

The report opens a window on the choices VA offices have to make when they move cases though a backlogged benefits system straining with hundreds of thousands of delayed claims throughout the country.

Managers at the VA Regional Office agreed with the investigators’ recommendations, but challenged the characterization of the delays as “errors.”

Instead, the managers said the claims processing staff is overworked and following priorities set by the agency to work through the most severely delayed claims before turning attention to newer ones.

The VA aims to process all benefits claims within six months. Nationwide, about 252,000 claims are currently considered delayed by that standard, down from 611,000 in June 2013.

The Inspector General report focused mostly on short-term adjustments to disability claims that can arise when a veteran receives a surgery or treatment for a temporary medical ailment.

In one case, auditors found that the Seattle claims office did not adjust a veteran’s disability rating for 10 months after it received evidence that his condition had improved after receiving treatment for prostate cancer. The slow action cost the VA $14,155.

Other errors occurred when the claims staff did not schedule medical re-examinations or when they did not take timely action to address a patient’s appeal.

In a different group of claims, auditors found that the VA regional office overpaid veterans who should have certain benefits discontinued because of delays in processing those cases. That overpayment totaled about $171,000.

The Inspector General report focused on the Veterans Benefits Administration. In recent months, the Veterans Health Administration — the branch of the VA that manages its hospitals — has come under fire for delays in providing care to patients. The two branches are distinct, but patients often feel frustrated by both when they feel they’re not receiving care in a timely manner.

  Comments