Federal Reports

Pension Management Centers (PMCs) provide benefits and services to some of the most vulnerable veterans and survivors. OIG’s review focused on rating decisions that addressed original pension benefits and claims processing actions related to Medicaid-covered nursing homes. OIG found St. Paul PMC staff failed to order general medical examinations to support veterans’ pension claims—denying 88 percent of those requiring rating decisions in 2015. St. Paul management and staff misinterpreted Veterans Benefits Administration's (VBA’s) guidance on requesting general medical examinations to support pension claims, and VBA lacked oversight for identifying inconsistent rating practices among PMCs. Consequently, claims processed by the St. Paul PMC were denied more frequently when compared to the Milwaukee and Philadelphia PMCs. Claims processors at the PMCs also delayed and inaccurately processed pension benefits reduction cases whenever beneficiaries resided in Medicaid-covered nursing care facilities. Delays and inaccuracies found in 1,900 of 2,800 Medicaid benefits reduction cases completed in 2015 resulted in an estimated $6.9 million in improper benefits payments. If the PMCs continue to delay and inaccurately process these adjustments, VBA will pay approximately $34.5 million in improper benefits from Calendar Year (CY) 2016 through CY 2020. Generally, VBA did not prioritize this workload, performance measures for Medicaid-covered nursing home care reduction cases were lacking, and PMCs did not provide training specific to Medicaid-covered cases. OIG recommended that VBA clarify guidance and provide training on ordering general medical examinations to support original pension claims, review denied pension claims to determine whether examinations were required, and implement a plan to ensure rating consistency. We also recommended that VBA prioritize benefit reduction actions and develop workload performance measures for benefits reduction cases associated with Medicaid-covered nursing homes.

This audit sought to determine whether the National Pension Call Center (NPCC) is providing timely and quality assistance to veterans and their families. OIG found Veterans Benefits Administration (VBA) management needed to improve the NPCC’s oversight of quality review and training processes. Specifically, NPCC supervisors did not review or take corrective actions for calls evaluated by quality-review specialists. Calls in Spanish were not included in Benefits Assistance Service (BAS) quality-review monitoring, and NPCC management and call agents did not complete or properly record all required training. VBA management lacked reasonable assurance that the NPCC’s hours of operation provided sufficient availability for pension recipients to speak with agents. Also, the Philadelphia VA Regional Office (VARO) staff mailed documentation that included personally identifiable information (PII) to incorrect addresses. This occurred because the NPCC coach did not implement a process requiring corrective actions to address low-scoring quality review results. BAS has never had a quality-review specialist fluent in Spanish to evaluate calls. The NPCC and BAS management provided inadequate oversight to ensure staff received or completed the required training. VBA management did not analyze the available call data to determine the number of calls that go unanswered after the close of NPCC’s business day. The Philadelphia VARO’s controls for outgoing mail processes needed strengthening. OIG recommended VBA implement controls to ensure callers receive accurate and complete responses to pension inquiries, BAS has qualified staff to evaluate the quality of Spanish-speaking calls, and required training is completed and recorded timely and to continuously evaluate data for calls made outside of normal business hours. OIG also recommended the Philadelphia VARO Director strengthen controls at the VARO to ensure documents that include PII are mailed to the intended veteran. The Acting Under Secretary for Benefits concurred with our findings and recommendations. We considered the corrective action plans acceptable and will follow up on their implementation.

On November 1, 2017, the Pennsylvania Court of Common Pleas of Bucks County sentenced an Amtrak B&B Mechanic Foreman to 6-23 months of confinement and 36 months’ probation for the Manufacture, Delivery, or Possession with the Intent to Manufacture or Deliver narcotics.

RSVP of Tulsa demonstrated a lack of due diligence in ensuring the RSVP grant was properly administered.

The Minnesota Elderly Waiver program (the program) funds home- and community-based services for people aged 65 and older who are eligible for medical assistance and require the level of care provided in a nursing home but choose to live in the community, such as at a licensed family adult foster care home (home). Minnesota operates the program under a Federal waiver to its Medicaid State plan. We have conducted health and safety reviews of Head Start grantees and of regulated childcare facilities and wanted to determine whether there may be similar health and safety risks for vulnerable adults living in homes.