Federal Reports

OIG administers the Medicaid Fraud Control Unit (MFCU or Unit) grant awards, annually recertifies the Units, and oversees the Units' performance in accordance with the requirements of the grant. As part of this oversight, OIG conducts periodic reviews of all Units and prepares public reports based on these reviews.

The OIG substantiated an anonymous allegation that an employee at the VA Regional Office (VARO) in Little Rock, Arkansas, established and decided claims for disability benefits inaccurately. The review team found that 11 of 19 claims and decisions were in error because the employee granted benefits that were not warranted, the required forms were not provided to establish a claim, or both. Furthermore, the employee should only have decided on claims, not established them, in his position as a rating veterans service representative. As a result, the Veterans Benefits Administration made nearly $311,000 in improper payments to beneficiaries. The team did not find that the employee benefited financially from the inaccurate processing. The review team noted that the erroneous decisions might have been prevented if staff had followed the required internal controls to ensure the accuracy of decisions. These controls include second signature reviews, informal quality assessments, and third signature reviews for certain types of decisions. The allegation also mentioned a possible conflict of interest in the employee’s website for his nonprofit organization. The site provided information about the VA disability claims process, and the review team found that it created the appearance of and potential for ethics violations. However, the team determined that the employee did not use the site to assist veterans on claims that he processed. Following the team’s review, the employee resigned from his VA position to work in a different field, thereby reducing the potential for conflict of interest. The OIG recommended that the director of the Little Rock VARO review and correct the employee’s rating decisions. The director should also ensure that the proper authority approves rating decisions that are intended to resolve clear and unmistakable errors, and that rating veterans service representatives cannot establish claims in VA’s electronic system.