Kansas VA office mishandled benefit appeals data


April 28, 2016 | By

Managers at a regional Veterans Affairs office in Kansas directed staff to enter incorrect information in the appeals records of 36 veterans, though an audit was unable to determine whether this was a move to speed up the review process, according to a report from the VA Office of Inspector General.

Staff were told to enter the same “placeholder” diagnostic code for the bone infection osteomyelitis on all 36 claims, though none of those patients actually had that condition.

When claims assistants were unable to accurately diagnose patient conditions, they entered the same incorrect code on all similar appeals, figuring it would be corrected later. It was corrected in some cases later on, but not others.

The audit also found that 28 of the 36 cases did not comply with agency policy for processing appealed claims, and some cases included multiple errors.

Various issues of timely action were discovered, including:

  • In 13 of 28 cases, the dates entered into the records system differed on average by 204 days–more than six months from the actual dates on the decision notification letters.
  • In five of 28 cases, staff did not record the correct date for receipt of the appeal.

Staff from the VA OIG arrived unannounced on June 16, 2015, to investigate an allegation that managers gave orders to enter inaccurate data to improve timeliness measures.

Falsified records were central to the scandal over wait times for patients seeking care from the VA.

To learn more:
– read the report (.pdf)

Leave a Reply