VA Leaves 13,000+ Appeals in Boxes Unprocessed

An Office of the Inspector General (IG) audit of the Veterans Health Administration (VHA) Office of Community Care revealed that some VA disability claim offices were not processing a large number of appeals for years.

In a November 21, 2019 report the IG audit showed that leading up to the implementation of the Appeals Modernization Act the VHA was not prepared. More specifically, the audit revealed that a large majority of claims were going unprocessed for years at a time.

If a veteran receives medical care at a non-VA hospital, that veteran can file a claim with the VA to be reimbursed for that care. If the claims processors are not able to properly process or fail to process those claims and appeals then veterans can be left with financial liability for the care.

The leaders at the VHA Community Care Offices had little oversight or structure within the appeals process and were unaware of the backlog of unprocessed claims and appeals. The audit revealed that appeals and claims were being mailed to offices that did not have any staff assigned to process them, and so, the claims and appeals were left sitting unprocessed in boxes, cabinets, and offices. When the audit team visited 10 of the 80 offices they found more than 8,800 appeal documents sitting unprocessed. It was also discovered that there was no system in place to track, record, or monitor any of the appeals until July 2018. As of February 2019, the Offices said they have 13,935 appeals and the audit showed that more than 12,000 of those were pending for an average of two years.

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