“The Veterans Benefits Administration’s (VBA) Compensation Service oversees the delivery of disability compensation benefits for veterans. Within the Compensation Service, the quality assurance program helps ensure veterans receive the benefits they deserve in an accurate and timely manner.”
“This review focused on the quality review team (QRT) program, a component of VBA’s quality assurance program for veterans’ disability compensation benefits. QRT specialists perform quality reviews on employees responsible for processing disability compensation claims.1This important function exists to ensure the accuracy with which VBA staff process compensation claims, identify any trends in errors committed by claims processors, provide training and mentoring on error trends, and review the performance of individual employees. Without accurate quality reviews, the risk increases that claims will be adjudicated with less accuracy and VBA will lack adequate information about staff performance levels or improvements needed…”
What the Review Found
“The OIG found that QRT specialists did not identify a significant number of claims-processing errors that should have been identified. Based on a statistical sample, the OIG estimated that 9,900 of the 28,400 quality reviews (35 percent) completed during the review period contained missed claims-processing errors that should have been identified. Quality reviews with identified errors are routed to another QRT specialist for peer review to help ensure the cited errors are appropriate. The OIG determined that the current peer review process was not adequate to identify errors missed during the initial quality review. In addition, performance reviews of QRT specialists did not promote competency, resulting in missed claims-processing errors…”
What the OIG Recommended
“The OIG recommended the undersecretary for benefits assess the current peer review process and determine whether a more in-depth review should be required to ensure all claims-processing errors are identified, revise the QRT specialist performance review process to promote competency, revise the error reconsideration process to promote objectivity and adherence to current VBA procedures, and improve oversight of the error correction process…”
Source: Deficiencies in the Quality Review Team Program – July 22, 2020. VA OIG.