The Railroad Retirement Board Should Strengthen Controls and Contractor Oversight of the Medical Opinion and Disability Determination Process

Submitting OIG:

Report Description:

Date Issued:

Wednesday, May 15, 2024

Agency Reviewed / Investigated:

Railroad Retirement Board

Submitting OIG-Specific Report Number:

24-06

Location(s):

Agency-Wide

Type of Report:

Audit

Questioned Costs:

$42,443

Funds for Better Use:

$59,493

Number of Recommendations:

Report updated under NDAA 5274:

View Document:

Attachment	Size
Audit-Report-24-06.pdf	1.21 MB

Recommendation Number	Recommendation Status	Significant Recommendation
1	Open	No
The Office of Programs should create a cover sheet with a checklist that allows the Contracting Officer’s Representative to verify that the following requirements have been met: The claims examiner signed and dated form G-137 SUP, via a written/electronic signature or a “sticky note;” and Current medical evidence is included in each medical opinion.
2	Open	No
The Office of Programs should require a secondary authorizer to review each medical opinion.
3	Open	No
The Office of Programs should create controls that require the Contracting Officer’s Representative to sample medical opinions and review them for acceptability on a routine basis.
4	Open	No
The Office of Programs should retrain the examiners to sign each medical opinion they review and ensure that current medical evidence is included.
5	Open	No
The Office of Programs should work with the RRB’s Executive Committee to determine which RRB employees should be provided annual training regarding the review and acceptance of medical opinions to ensure RRB’s internal controls for the usage of medical opinions in the disability determination process are designed and operating effectively.
6	Open	No
The Office of Programs should work with the RRB’s Executive Committee to retrain applicable employees regarding the medical opinion approval process and document retention requirements to ensure the evaluation of medical opinions follows RRB’s internal controls.
7	Open	No
The Office of Programs should review the 11 incomplete medical opinions to determine if the missing information from the medical opinion would change the disability determination and expand the review of medical opinions if disability determinations are found to be impacted.
8	Open	No
The Office of Programs should work with Office of Administration to determine if additional Contracting Officer’s Representatives are required to ensure proper contractual and technical oversight and monitoring of the medical opinions contract.
9	Open	No
The Office of Programs should work with Office of Administration to revise the approval process in the Disability Claims Manual so that claims examiners do not approve payment for medical opinions and develop a new process for the Contracting Officer’s Representative or the Alternate Contracting Officer’s Representatives to review and approve payment for medical opinions.
10	Open	No
The Office of Programs should work with Acquisition Management to include language in the next medical services contract requiring that if consultation sessions with the consultants occur online, payments are in 30-minute increments in which consultation occurs, instead of the entire 4-hour window.

Recommendation Number

Recommendation Status

Significant Recommendation

Additional Details

Open

The Office of Programs should create a cover sheet with a checklist that allows the Contracting Officer’s Representative to verify that the following requirements have been met: The claims examiner signed and dated form G-137 SUP, via a written/electronic signature or a “sticky note;” and Current medical evidence is included in each medical opinion.

Open

The Office of Programs should require a secondary authorizer to review each medical opinion.

Open

The Office of Programs should create controls that require the Contracting Officer’s Representative to sample medical opinions and review them for acceptability on a routine basis.

Open

The Office of Programs should retrain the examiners to sign each medical opinion they review and ensure that current medical evidence is included.