Faster claims processing, new policies expose VA to fraud, abuse

Faster claims processing coupled with expanded coverage requirements have left disability payments to ex-military members vulnerable to fraud and abuse, according to the Wall Street Journal.

Disability payments made by the Department of Veterans Affairs have soared over the last 15 years from nearly $15 billion in 2000 to $60.2 billion last year, according to the WSJ. Meanwhile, the VA processed twice as many claims for post-traumatic stress disorder (PTSD) between 2011 and 2015 as it did in the previous five-year period. Last year, a senior VA official said the agency’s $6 billion medical supply budget is susceptible to fraud, waste and abuse.

Former physicians and psychiatrists tell the newspaper that a new policy instituted by the VA in 2010 that limits PTSD documentation requirements opens the door for abuse. Disability payments for illnesses like Parkinson’s disease and heart disease have also expanded. Likewise, veterans relayed stories in which they were told by clinic staffers to appear homeless and disheveled to receive a higher monthly payment or get an appointment faster.

Pressure to speed up claims processing to cut down on the VA’s infamous backlog and care delays has made the program even more susceptible to fraud and overpayments. Physicians told the WSJ they are limited in the amount of time they spend evaluating patients and are encouraged to restrict their documentation in order to get through claims at a faster rate. A new computer system implemented in 2012 relies on self-reported health issues rather than medical history, leaving clinicians unable to verify illnesses. 

- read the WSJ article

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