Federal Reports

We found that DOI ensured that grant funds and license revenue were used for allowable activities and complied with applicable laws and requirements. 

VBA has long-standing challenges processing military sexual trauma claims and centralizing the expertise of this work. The OIG conducted this review to assess VBA’s planning and implementation of the Military Sexual Trauma Operations Center and its governance structure for processing claims.

The OIG found the center struggled to hire and retain experienced claims processors and to recruit processors with expertise in military sexual trauma claims. The center’s turnover rate in fiscal year (FY) 2024 was 22.6 percent; the nationwide rate at VA regional offices was 7.5 percent.

Although the center implemented some quality assurance processes, improvements are still needed. From FY 2019 to FY 2024, military sexual trauma claims accuracy dropped almost 10 percentage points; in response, VBA’s Compensation Service began quarterly quality spot checks. The results of the checks showed improvement in denials, but accuracy was still below the 96 percent goal. Errors included failing to get all records, insufficient medical opinions due to missed evidence, and not ordering necessary medical exams.

Further, the center’s two-signature process is not sufficient to evaluate the competency of claims processors or the competency of designated reviewers. The OIG found that about 34 percent of denied claims had errors despite a designated reviewer agreeing with the original decision. Because reviewers grant claims more often than they deny them, fewer denials than grants were reviewed in the two-signature process even though OIG and VBA quality reviews showed denied claims had more errors.

VBA concurred with the OIG’s three recommendations to adjust statistics reporting for the center, update the two-signature process to include more denials, and develop a process to assess designated reviewers’ competency.

This Office of Inspector General (OIG) Care in the Community healthcare inspection program report describes the results of a focused evaluation of community care processes at eight Veterans Integrated Service Network (VISN) 4: VA Healthcare medical facilities with a community care program. 

This evaluation focused on five domains:
   •    Leadership and Administration of Community Care
   •    Administratively Closed Community Care Consults
   •    Community Care Provider Requests for Additional Services
   •    Care Coordination Activities for Patients Referred for Community Care
   •    Community Urgent Care Coordination and Management

The OIG issued 13 recommendations for VA to correct identified deficiencies in the five domains:
   •    Leadership and Administration of Community Care
     o    Community care oversight councils
     o    Staffing tool reassessments
     o    Patient safety events
     o    Patient safety trends, lessons learned, and corrective actions
     o    Community care document importing
   •    Administratively Closed Community Care Consults
     o    Community care appointment confirmation
     o    Medical documents
   •    Community Care Provider Requests for Additional Services
     o    Request processing
     o    Approval and denial letters for community providers and patients
   •    Care Coordination Activities for Patients Referred for Community Care
     o    Community Care–Care Coordination Plan note use to document care coordination activities
     o    Appointment confirmation
   •    Community Urgent Care Coordination and Management
     o    Community Care–Urgent Care Record note creation