Federal Reports

In April 2017, we evaluated the VA Regional Office (VARO) in Detroit, Michigan, to determine how well Veterans Service Center (VSC) staff processed disability claims, processed proposed rating reductions, entered claims-related information, and responded to special controlled correspondence. Staff improved the accuracy of processing traumatic brain injury (TBI) claims but inaccurately processed a significant number of claims for special monthly compensation (SMC). We reviewed 30 of 679 veterans’ TBI claims and found Rating Veterans Service Representatives (RVSRs) accurately processed 28 cases. RVSRs did not always process entitlement to SMC and ancillary benefits consistently with Veterans Benefits Administration policy. We reviewed 30 of 52 SMC claims and found RVSRs inaccurately processed 5 cases due to ineffective second-signature reviews for higher-level SMC cases completed by VSC managers. Four errors resulted in 43 improper monthly payments totaling approximately $32,800. We sampled claims we considered at increased risk of processing errors, thus these results do not represent the overall accuracy of disability claims processing at this VARO. Staff generally processed proposed rating reductions accurately but needed better oversight to ensure timely actions. We reviewed 30 of 268 benefits reduction cases and found that RVSRs and Veterans Service Representatives delayed or inaccurately processed 8 cases. Delays occurred because management prioritized other workload higher to meet established performance goals related to processing disability claims. These delays and processing inaccuracies resulted in 66 improper monthly payments to 8 veterans, totaling approximately $48,000. Staff needed to improve the accuracy of data input into the electronic systems at the time of claims establishment. We reviewed 30 of 1,982 newly established claims and found Claims Assistants did not correctly input claim information in 20 cases due to inexperience and ineffective quality reviews. These inaccuracies may result in misrouted claims and delays in claims processing. Staff generally processed special controlled correspondence timely. We reviewed 30 of 173 special correspondences and found staff and management did not accurately control 21 inquiries due to insufficient oversight to ensure inquiries were properly established with the correct dates of claim. We recommended the VARO Director implement a plan to ensure the accuracy of reviews of higher-level SMC cases; implement a plan to ensure Claims Assistants receive comprehensive training on claims establishment; and improve the quality review process for claims establishment. The Director should ensure staff use the correct dates of claim for end product 500s to improve the management of special controlled correspondence. The Director concurred with our recommendations. Management’s planned actions are responsive. We will follow up as required.

The California Department of Social Services (Social Services), Community Care Licensing Division (licensing division), did not (1) accurately record or investigate one complaint, (2) complete investigations in a timely manner, (3) refer priority I and II complaints (the most serious) to the Investigations Branch, (4) adequately cross-report complaints to the Children and Family Services Division and to law enforcement, (5) conduct onsite inspections within 10 days, (6) associate an employee of a community care facility with the facility, and (7) adequately clear plan-of-correction deficiencies.

Wisconsin Physicians Service Insurance Corporation (WPS) claimed $1.2 million in unallowable administrative costs on its Medicare Part A final administrative cost proposals (FACPs) for fiscal year 2012. We recommended that WPS reduce its FACPs by $1.2 million to eliminate the unallowable costs identified and improve procedures to identify allowable and unallowable costs in accordance with the applicable Medicare contract, Cost Accounting Standards (CAS), and FAR provisions. In written comments on our draft report, WPS did not concur with $1.2 million in recommended reductions related to unallowable residual home office expenses, employee incentive program bonuses and related taxes, and salary allocations. WPS provided limited comments on our recommendation for procedural improvements. We maintain that all of our findings and recommendations are valid.

Wisconsin Physicians Service Insurance Corporation (WPS) claimed $1.3 million in unallowable administrative costs on its Medicare Part B final administrative cost proposals (FACPs) for fiscal year 2012.

In March 2015, February and October 2016, the Postal Service administered Postal Pulse surveys to evaluate employee engagement. Results indicated postal employee engagement improved slightly over the course of the three surveys. However, the Postal Service ranked in the bottom one percent of scores for all organizations Gallup surveyed in each of the three survey administrations. In January 2016, management created an employee engagement team within the Human Resources function, which subsequently developed eight engagement activities. Our objective was to assess Postal Service Human Resources’ employee engagement activities to determine whether they are effective in enhancing employee engagement. We also reviewed employee comments on social media sites to gauge employee sentiments.

In 2016, the Postal Service managed 31,585 retail offices serving 877 million customers. To reduce wait-time-in-line and expedite customer transactions, the Postal Service developed the mobile Point-of-Sale (mPOS) system, which allows retail associates to accept credit card and non-PIN debit card payments for customers’ retail transactions. Our objective was to determine if the mPOS devices and application are managed in accordance with Postal Service policy and best practices.