Control Weaknesses Diminish the Value of Medical Opinions in the Railroad Retirement Board Disability Determination Process

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Date Issued

Wednesday, March 9, 2016

Submitting OIG

Railroad Retirement Board OIG

Other Participating OIGs

Railroad Retirement Board OIG

Agencies Reviewed/Investigated

Railroad Retirement Board

Report Number

16-05

Report Type

Audit

Agency Wide

Yes

Number of Recommendations

Questioned Costs

Funds for Better Use

Open Recommendations

This report has 7 open recommendations.

Recommendation Number	Significant Recommendation	Recommended Questioned Costs	Recommended Funds for Better Use	Additional Details
16-051	No	$0	$0	Management does not concur with this recommendation. This recommendation remains open because the Office of Inspector General for the Railroad Retirement Board continues to see the need for the recommended corrective action.
The Office of Programs should modify the medical opinion form to require the doctor to provide a documented conclusion on the medical severity of the claimant’s medical ailments.
16-053	No	$0	$0	Management does not concur with this recommendation. This recommendation remains open because the Office of Inspector General for the Railroad Retirement Board continues to see the need for the recommended corrective action.
The Office of Programs should ensure that medical opinions resolve all conflicting medical evidence.
16-0518	No	$0	$0
The Office of Administration should develop effective contract ramifications for instances where timeliness standards are not met.
16-055	No	$0	$0	Management does not concur with this recommendation. This recommendation remains open because the Office of Inspector General for the Railroad Retirement Board continues to see the need for the recommended corrective action.
The Office of Programs should modify the medical opinion form to elicit required information from the medical doctors.
16-057	No	$0	$0	Management does not concur with this recommendation. This recommendation remains open because the Office of Inspector General for the Railroad Retirement Board continues to see the need for the recommended corrective action.
The Office of Programs should update procedures for Railroad Retirement Board claims examiners to ensure that all current applicable medical evidence, that has been received in support of the disability based claim, is referenced by the doctor in the medical opinion, before they accept the medical opinion for payment.
16-058	No	$0	$0	Management does not concur with this recommendation. This recommendation remains open because the Office of Inspector General for the Railroad Retirement Board continues to see the need for the recommended corrective action.
The Office of Programs should update Railroad Retirement Board procedures to instruct the Railroad Retirement Board claims examiner to meet with the doctor when onsite if the Railroad Retirement Board claims examiner is not certain that enough medical evidence is in file.
16-0512	No	$0	$0	Management does not concur with this recommendation. This recommendation remains open because the Office of Inspector General for the Railroad Retirement Board continues to see the need for the recommended corrective action.
The Office of Programs should take action to recover amounts improperly paid for medical opinions that did not meet the contract requirements for the term of the medical services contract.