Home Improvements and Structural Alterations Program Needs Greater Oversight

The VA Office of Inspector General (OIG) conducted an audit to assess if the Veterans Health Administration (VHA) effectively managed the Home Improvements and Structural Alterations (HISA) Program to provide benefits to eligible veterans.The HISA program provides payments for certain medically necessary improvements and alterations to primary residences. Generally, veterans with qualifying service-connected disabilities, or qualifying exceptions, are eligible for a lifetime benefit of $6,800, and veterans with qualifying non-service-connected disabilities are eligible for $2,000. The OIG audit team looked at VHA spending on the program from fiscal year (FY) 2017 through FY 2021.The audit team determined the HISA program overpaid roughly 2,600 veterans by an estimated $10.6 million out of $206 million total (about 5 percent). In addition, the team determined the program paid approximately $935,000 for improvements that were not supported by diagnostic or medical justification. These errors in payments occurred because eligibility requirements for the $6,800 lifetime benefit were not always followed or the disability was not documented correctly. In some cases, eligibility information for the full service-connected benefit is confusing. For example, VHA’s Rehabilitation and Prosthetic Services public website states that some non-service-connected disabilities may be rated as service-connected, which is incorrect. VHA also did not create procedures to effectively monitor medical facilities’ adherence to program timelines to ensure veterans received final payments on schedule.The OIG made five recommendations to the under secretary for health to improve oversight of this program by issuing guidance on eligibility requirements; updating eligibility information on the public website; and creating procedures to ensure medical facility staff correctly approve, justify, and document improvements and alterations.