Telehealth Public-Use Questionnaires Were Used Improperly to Determine Disability Benefits

The VA Office of Inspector General (OIG) conducted this review in response to veterans’ benefits claims identified and referred by the Veterans Benefits Administration (VBA) as being potentially fraudulent. It also addressed whether allegations to the OIG hotline that telehealth questionnaires (without in-person examinations) were being improperly used for benefits determinations. VBA prohibits the use of telehealth for benefit rating purposes. The OIG had previously found problems with the use of disability benefits questionnaires and recommended VBA improve controls on the use of publicly available forms that could be altered to support baseless or exaggerated disability claims. The OIG found claims processors improperly used questionnaires completed by private care providers to determine benefit entitlements without ensuring the examination was done in person. For example, VBA made improper determinations in 41 of the 81 claims the OIG reviewed, amounting to about $613,000 in benefit payments. Many other claims were likely submitted with telehealth examinations. VBA cannot easily identify those examinations improperly used to provide benefits nor correct related claims. VBA did not provide consistent staff guidance, adequately monitor use of telehealth questionnaires, or modify forms to reflect prohibited uses. VBA’s internal controls are inadequate to prevent the use of publicly available questionnaires, which contain an inherent risk of fraud, despite VBA’s risk-mitigation efforts. The OIG recommended the under secretary for benefits consider whether to discontinue using publicly available questionnaires for supporting benefit claims. If use is continued, VBA should update procedures so claims processors know how to handle questionnaires they suspect were completed via telehealth. The OIG also recommended adding to questionnaires whether they were completed in person or through telehealth, and publicly noting that telehealth examinations are not acceptable for determining benefit entitlements.