VA Contracted C&P Exams Not Meeting Quality, Timeliness Standards: GAO

A report from the Government Accountability Office has revealed that private sector medical providers contracted by the Department of Veterans Affairs to conduct Compensation and Pension examinations are not meeting the accuracy and timeliness standards set forth by VA. Additionally, the report found that VA did not have the tools it needed to adequately track these contractors’ performance during the time period in question.

Compensation and pension examinations fulfill essential functions for VA disability claims, such as establishing service connection for a disability and assessing its severity for VA disability compensation. Since legislation passed in 2014 allowing VA to outsource more services to the private sector, there has been a substantial hike in the number of exams conducted by those contracted by VA. For example, private contractors performed about 60% of the 1.4 million exam requests completed in FY 2018.

Upon awarding contracts to five private firms, VA put quality and timeliness standards in place. The first of these provisions requires that 92 percent of the contractors’ reports contain no errors. The majority of these contractors’ performance fell into the “unsatisfactory” category, which means that 10 percent or more of their reports contained errors. One contractor who performed the worst had errors in 38 percent of their reports, meaning that only 62 percent of their reports were satisfactory.

A timeliness standard set by VA requires that disability exam contractors submit their reports to the department within 20 days of accepting a veteran’s exam request. GAO investigators used VA data to analyze the timeliness of VA exams performed by contractors between February 2017 and January 2018. Results show that just about half of these exams met VA’s standard, whereas 12 percent of them took 40 or more days—double VA’s targeted time.

VA had included timeliness and accuracy standards within the contracts awarded to five vendors in 2016, worth $6.8 billion over the course of five years, but lacked the proper IT systems to track these metrics at the time. Since the IT systems were not in place, metrics were not tracked. Therefore, VA did not impose any penalties upon low-performing contractors as was stipulated within their contracts.

Some contractors were found unable to meet the capacity needed to complete the exams assigned to them. These exams were then reassigned to other vendors, which potentially presented unnecessary delay to veterans’ claims.

Training practices of these examiners were also called into question. Although VA has systems in place to ensure that examiners are medically licensed, there is no way to verify that contractors are completing required training as the verifications are currently self-reported.

What did the Government Accountability Office Recommend?

GAO had a number of recommendations for VA. One was that VA fully implement its computer system with auditing capability to hold these contractors accountable. Another was to conduct an analysis of program-wide challenges and high-level trends, so these systemwide situations do not reoccur. GAO also recommended that VA implement a way to verify that contracted examiners have completed required trainings, and to assess the effectiveness of this training to make improvements as needed.

Has VA fixed any of these issues?

The Department of Veterans Affairs has already taken some action to remedy some of the shortcomings noted in the report:

• One nonperforming vendor is no longer contracted with VA;
• The Exam Management System (EMS) is now fully operational. VA does not expect to incur any technical issues in tracking these metrics moving forward, as it includes a built-in auditing system;
• Current contracts with vendors have been modified to include “lessons learned” provisions and update current business needs;
• Additional staff have been hired to conduct quality reviews;