Beneficiary Travel

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Program level Payment Integrity results

Sponsoring agency: Department of Veterans Affairs

PROGRAM METRICS

$883 M

in FY 2021 outlays, with a

86.1%

payment accuracy rate

PROGRAM METRICS

$1,254 M

in FY 2022 outlays, with a

92.1%

payment accuracy rate

PROGRAM METRICS

$1,757 M

in FY 2023 outlays, with a

93.2%

payment accuracy rate

PROGRAM METRICS

$1,849 M

in FY 2024 outlays, with a

91.9%

payment accuracy rate

PROGRAM METRICS

$2,053 M

in FY 2025 outlays, with a

92.4%

payment accuracy rate

  • Improper payment estimates over time
    View as:

    Chart toggle amounts:
    Proper payments
    Overpayment
    Underpayment
    Technically improper
    Unknown

Payment Integrity results

  • FY 2021 improper payment estimates

    Chart legend and breakdown

    Payment accuracy rate

    Improper payment rate

    Unknown payment rate


    Sampling & estimation methodology details

    Sampling timeframe:

    10/2019 - 09/2020


    Confidence interval:

    >90%


    Margin of error:

    +/-3.72

Overpayments

Overpayment root cause Overpayment amount
Amount of overpayments within the agency's control $80.75 M
Amount of overpayments that occurred because the data/information needed to validate payment accuracy prior to making a payment does not exist $0.0 M
The amount of overpayments that occurred because of an inability to access the data/information needed to validate payment accuracy prior to making a payment $0.0 M
The amount of overpayments that occurred because of a failure to access data/information needed to validate payment accuracy prior to making a payment $80.75 M

Overpayment root cause Overpayment amount
Amount of overpayments outside the agency's control $0.0 M

Underpayments

Underpayment root cause Underpayment amount
Amount of underpayments $0.56 M
The amount of underpayments that occurred because the data/information needed to validate payment accuracy prior to making a payment does not exist $0.0 M
The amount of underpayments that occurred because of an inability to access the data/information needed to validate payment accuracy prior to making a payment $0.0 M
The amount of underpayments that occurred because of a failure to access data/information needed to validate payment accuracy prior to making a payment $0.56 M

Technically improper payments

The amount of improper payments that were paid to the right recipient for the correct amount but were considered technically improper because of failure to follow statute or regulation $5.02 M

Additional information

$5.58 M

Unknown Payment Details

VA had lacking or insufficient documentation to validate whether a payment was proper or not.

The amount of payments that could either be proper or improper but the agency is unable to determine whether they were proper or improper as a result of insufficient or lack of documentation is $36.73 M


Cause of insufficient or lack of documentation & why the documentation is needed for determination of payment type
Payment cause Amount Description of the documentation that was not provided and explanation of why the program is unable to conclude whether the payment is proper or improper without that documentation

Evaluation of corrective actions

VA continues to prioritize and implement effective corrective actions and mitigation strategies that reduce improper payments agency-wide as evidenced by its third consecutive and largest year of reductions. Specifically, from FY20 to FY21, the Beneficiary Travel program decreased its error rate from 16.42 percent to 13.93 percent (2.49% reduction) and improper payments from $167.59 million to $123.06 million ($44.53 million reduction).

Future payment integrity outlook

Beneficiary Travel has established a baseline.

Out-Year improper payment and unknown payment projections and target
Current year +1 estimated future outlays $1,253.65 M
Current year +1 estimated future improper payments $93.93 M
Current year +1 estimated future unknown payments $31.31 M
Current year +1 estimated future improper payment and unknown payment rate 9.99 %

The program's current year improper payment and unknown payment rate of 13.93 % has not been achieved with a balance of payment integrity risk and controls and does not represent the lowest rate that can be achieved without disproportionally increasing another risk, therefore it is not the tolerable rate.

VA does not have additional program needs.

Additional programmatic information

  • FY 2022 improper payment estimates

    Chart legend and breakdown

    Payment accuracy rate

    Improper payment rate

    Unknown payment rate


    Sampling & estimation methodology details

    Sampling timeframe:

    10/2020 - 09/2021


    Confidence interval:

    95% to <100%


    Margin of error:

    +/-2.94

Overpayments

The agency has the direct ability to prevent Beneficiary Travel program overpayments from occurring. As VA modernizes agency-wide systems of record and decommissions outdated, legacy technology, VA will gain the capability to integrate transportation claims’ processing systems, improving, monitoring and internal controls. VA seeks to fully implement standardized payment processing tools to streamline claims, automate eligibility determinations, detect and prevent improper payments, and enhance reporting and auditing capabilities. Further, as the agency moves toward a centralized operating environment, the Beneficiary Travel program will establish direct lines of authority and standard processes and procedures based on transportation regulatory requirements.
Overpayment root cause Overpayment amount
Amount of overpayments within the agency's control $58.48 M
Amount of overpayments that occurred because the data/information needed to validate payment accuracy prior to making a payment does not exist $0.0 M
The amount of overpayments that occurred because of an inability to access the data/information needed to validate payment accuracy prior to making a payment $0.0 M
The amount of overpayments that occurred because of a failure to access data/information needed to validate payment accuracy prior to making a payment $58.48 M

Overpayment root cause Overpayment amount
Amount of overpayments outside the agency's control $0.0 M

Underpayments

Underpayment root cause Underpayment amount
Amount of underpayments $0.47 M
The amount of underpayments that occurred because the data/information needed to validate payment accuracy prior to making a payment does not exist $0.0 M
The amount of underpayments that occurred because of an inability to access the data/information needed to validate payment accuracy prior to making a payment $0.0 M
The amount of underpayments that occurred because of a failure to access data/information needed to validate payment accuracy prior to making a payment $0.47 M

Technically improper payments

While VA confirmed the payment was paid to the right person in the right amount, VA lacked proper approval on medical qualification. Specifically, where clinical documentation for special mode travel was not properly approved by a VA clinician. This resulted in a technically improper payment.
The amount of improper payments that were paid to the right recipient for the correct amount but were considered technically improper because of failure to follow statute or regulation $16.09 M

Additional information

$16.56 M

Unknown Payment Details

VA had lacking or insufficient documentation related to authorization, receiving or payment documentation that was required to validate whether a payment was proper or not. The agency was missing documentation which contained key information that would have enabled the agency's ability to discern whether the payment was proper or improper. The missing documentation contained information such as the special mode transportation preauthorization, authorization for common carrier, consultation, proof of care, and claim form for reimbursement.

The amount of payments that could either be proper or improper but the agency is unable to determine whether they were proper or improper as a result of insufficient or lack of documentation is $24.04 M


Cause of insufficient or lack of documentation & why the documentation is needed for determination of payment type
Payment cause Amount Description of the documentation that was not provided and explanation of why the program is unable to conclude whether the payment is proper or improper without that documentation

Evaluation of corrective actions

VA performed an effectiveness review in FY 2022 of the actions implemented in FY 2021. The purpose of this review was to assess the appropriateness of corrective actions or mitigation strategies and whether the actions were effectively implemented and prioritized within the agency. The results for the Beneficiary Travel program indicated that of the nine actions assessed, four were open and determined to be correctly designed to mitigate the root cause, and five were open and determined that improvements could be made to effectively mitigate the root cause. If improvements could be made, VA conducted a root cause analysis to refine the program's mitigation strategies to ensure they address and reduce root cause(s) of error.

For errors tied to failure to access data/information, associated corrective actions or mitigation strategies did not reduce the improper payment amount from FY 2020 to FY 2021. For errors tied to statutory requirements of program were not met, associated corrective actions or mitigation strategies contributed to a total reduction in the improper payment amount from $42.96 million in FY 2020 to $5.02 million in FY 2021, or an 88% reduction. For errors tied to unable to determine whether proper or improper, associated corrective actions or mitigation strategies contributed to a total reduction in the unknown payment amount from $54.84 million in FY 2020 to $36.73 million in FY 2021, or a 33% reduction.

VA will perform an effectiveness review in FY 2023 of the corrective action plans implemented in FY 2022 due to the time needed to implement actions as well as to impact the payment process. Results of this review will be reported in FY 2023.

Future payment integrity outlook

Beneficiary Travel has established a baseline.

The Beneficiary Travel reduction target is equal to the estimated future improper payment and unknown payment rate. VA establishes reduction targets by setting them lower than the current year improper payment estimates. Reduction targets are a balance between being aggressive and realistic. One thing VA has learned from the many years it has been working to comply with improper payments legislation is that it can take three years from the point an error cause is isolated during testing to develop a corrective action, implement it, and then wait for payments to be made that can then be tested the following year since VA tests and reports improper payments one year in arrears.

Out-Year improper payment and unknown payment projections and target
Current year +1 estimated future outlays $1,703.71 M
Current year +1 estimated future improper payments $95.83 M
Current year +1 estimated future unknown payments $31.94 M
Current year +1 estimated future improper payment and unknown payment rate 7.5 %
Current year +1 estimated future improper payment and unknown payment reduction target 7.5 %

The program's current year improper payment and unknown payment rate of 7.9 % may or may not be the tolerable rate. The agency has not yet determined the tolerable rate for this program.

VA has not determined a tolerable rate due to all requirements for establishing a tolerable rate not yet being met. VA continues to prioritize implementing appropriate corrective actions and mitigation strategies to reduce improper and unknown payments. The program plans to be compliant with the Payment Integrity Information Act of 2019 for FY 2022.

VA has not yet determined the tolerable rate. VA is working to determine all requirements for establishing a tolerable rate per Office of Management and Budget guidance before attempting to establish tolerable rates. At this time, VA is not aware of additional program needs.

VA is still working to determine all requirements for establishing a tolerable rate per Office of Management and Budget guidance before attempting to establish a tolerable rate. At this time, VA is not aware of additional program needs.

Additional programmatic information

The Beneficiary Travel program continues to prioritize and implement effective corrective actions and mitigation strategies that reduce improper and unknown payments as evidenced by its fifth consecutive year of reductions and is expected to achieve compliance with the Payment Integrity Information Act of 2019 for FY 2022. Specifically, from FY 2021 to FY 2022, the Beneficiary Travel program decreased its improper and unknown error rate from 13.93% to 7.90% (6.03% reduction) and improper and unknown payments from $123.06 million to $99.08 million ($23.98 million reduction).

  • FY 2023 improper payment estimates

    Chart legend and breakdown

    Payment accuracy rate

    Improper payment rate

    Unknown payment rate


    Sampling & estimation methodology details

    Sampling timeframe:

    10/2021 - 09/2022


    Confidence interval:

    95% to <100%


    Margin of error:

    +/-2.33

  • Actions taken & planned to mitigate improper payments

    Mitigation strategy Description of the corrective action Completion date Status
    Automation
    Actions taken regarding automation included continuing to implement new software that will provide a customized and enhanced tool to streamline claims, automate eligibility determinations, payment processing, detection and prevention of improper payments, and enhance reporting and auditing capabilities. Additionally, VA continued with the post-implementation modernization of the beneficiary travel claims processing software and other systems.
    The corrective action was not fully completed this reporting period
    Not Completed
    Automation
    Actions planned regarding automation include continuing to implement new software that will provide a customized and enhanced tool to streamline claims, automate eligibility determinations, payment processing, detection and prevention of improper payments, and enhance reporting and auditing capabilities. Additionally, VA will continue with the post-implementation modernization of the beneficiary travel claims processing software and other systems. In addition, VA will continue planning for the Electronic Claims Adjudication Management System for invoice payment processing nationwide, which is expected to improve the timeliness and accuracy of ambulance claims processing. These actions are designed to address overpayments and underpayments attributed to failure to access data/information, technically improper payments attributed to statutory requirements of program not met, and unknown payments attributed to being unable to determine whether proper or improper. Automation was the best mitigation strategy because improper and unknown payments resulted from manual processes and human error.
    FY2024
    Planned
    Change Process
    Actions planned regarding change process include the Beneficiary Travel program office will submit proposed enterprise-wide infrastructure solutions to address staffing requirements, training, standardized business processes, program-level monitoring, and quality assurance reporting. These actions are designed to reduce improper and unknown payments errors associated with failure to access data/information needed to ensure proper payment amounts. Change process was the best mitigation strategy in order to develop stronger internal controls and mitigate risks within existing payment processes.
    FY2024
    Planned

Overpayments

VA overpayments are within the agency's control and occur when the program failed to access the data/information needed to validate the closest facility that could provide the Veteran's treatment was utilized, special mode transportation rates were correctly paid according to contract, if applicable, services were received, beneficiary met administrative and medical qualification, or claim payments were calculated according to mileage and deductibles, if applicable. The agency has the direct ability to prevent overpayments from occurring by improving processes and controls surrounding administrative and medical qualifications, and simplifying contract pricing, when applicable, to include valid claim mileage calculations. Additionally, system improvements will allow for automation of the authorizations and will ensure services are rendered, decreasing human error. These improvements will allow for more accurate payment validation.
Overpayment root cause Overpayment amount
Amount of overpayments within the agency's control $88.5 M
Amount of overpayments that occurred because the data/information needed to validate payment accuracy prior to making a payment does not exist $0.0 M
The amount of overpayments that occurred because of an inability to access the data/information needed to validate payment accuracy prior to making a payment $0.0 M
The amount of overpayments that occurred because of a failure to access data/information needed to validate payment accuracy prior to making a payment $88.5 M

Overpayment root cause Overpayment amount
Amount of overpayments outside the agency's control $0.0 M

Overpayment type Eligibility element/information needed Eligibility amount
Overpayments Within Agency Control Address/Location $5.58 M
Overpayments Within Agency Control Contractor or Provider Status $2.64 M
Overpayments Within Agency Control Financial $80.29 M

Overpayment type Mitigation strategies taken Mitigation strategies planned
Overpayments within the agency’s control Automation Automation

Underpayments

Underpayment root cause Underpayment amount
Amount of underpayments $0.56 M
The amount of underpayments that occurred because the data/information needed to validate payment accuracy prior to making a payment does not exist $0.0 M
The amount of underpayments that occurred because of an inability to access the data/information needed to validate payment accuracy prior to making a payment $0.0 M
The amount of underpayments that occurred because of a failure to access data/information needed to validate payment accuracy prior to making a payment $0.56 M

Eligibility element/information needed Eligibility amount
Contractor or Provider Status $0.56 M

Mitigation strategies taken Mitigation strategies planned
Automation Automation

Technically improper payments

VA payments are considered technically improper when the payment was paid to the right person in the right amount but the payment failed to meet all regulatory and/or statutory requirements. While VA confirmed the payment was paid to the right person in the right amount, VA lacked proper approval on medical qualification. Specifically, where clinical documentation for special mode travel was not properly and timely approved by a VA clinician, or a request was not sent to procurement to create a contract modification. These resulted in technically improper payments for failing to comply with 38 Code of Federal Regulations - Applications (Part 70.20), 38 Code of Federal Regulations - Criteria for approval (Part 70.4), and Federal Acquisition Regulation sections General (Part 1.601) and Policy (Part 43.102).
The amount of improper payments that were paid to the right recipient for the correct amount but were considered technically improper because of failure to follow statute or regulation $13.86 M

Mitigation strategies taken Mitigation strategies planned
Automation Automation

Additional information

$14.42 M

Unknown Payment Details

The payments are considered unknown payments when VA had lacking or insufficient documentation related to authorization, receiving, or eligibility documentation that was required to validate whether a payment was proper or improper. Specifically, these unknown payments occur when the agency was unable to determine the Veteran's eligibility due to missing annual income documentation, the special mode transportation was not medically necessary or approved by a VA clinician before transportation occurred, and the stations did not provide proof of receipt. Without annual income eligibility, receiving supporting documentation and special mode transportation or common carrier preauthorization and/or proof of care, if applicable, the program is unable to determine whether the amount paid is proper or improper.

The amount of payments that could either be proper or improper but the agency is unable to determine whether they were proper or improper as a result of insufficient or lack of documentation is $17.03 M


Cause of insufficient or lack of documentation & why the documentation is needed for determination of payment type
Payment cause Amount Description of the documentation that was not provided and explanation of why the program is unable to conclude whether the payment is proper or improper without that documentation
Applicants $7.45 M VA is required to validate an applicant's eligibility documentation such as income or interfacility (transfer between VA facilities) verification. VA uses projected gross household income and deductible expenses to validate that the applicant is eligible based on income. VA uses the non-VA care authorizations and medical records to verify eligibility to transfer between VA facilities. When review of the payments reveals that the station failed to obtain the eligibility documentation, the payment is considered an unknown payment because the reviewer is unable to discern whether the payment was a proper payment or an improper payment.
Other $9.58 M VA is required to validate authorization of transport and care. However, the agency currently does not have the documentation necessary to determine if the payment is proper or not. Local VA Medical Centers failed to provide authorization and receiving documentation. Specifically, authorization documentation such as the non-VA care authorization or special mode travel or emergent ambulance document was not obtained. The missing documentation needed will assist VA in determining the clinical need for transport. Centralized documentation retention for each claim is not currently possible within the agency’s current systems of record environment. Hard copy evidence can be maintained at local VA Medical Centers responsible for claims processing. For this reason, we are unable to conclude whether the payment is proper or improper at time of payment without that documentation.

Mitigation strategies taken Mitigation strategies planned
Automation Automation,Change Process

Evaluation of corrective actions

The Beneficiary Travel program continues to prioritize and implement effective corrective actions and mitigation strategies that reduce improper and unknown payments as evidenced by its sixth consecutive year of rate reductions. In FY 2023, VA performed an effectiveness review of actions developed and implemented in FY 2022. The purpose of this review was to assess the appropriateness of corrective actions and mitigation strategies and whether the actions were effectively implemented and prioritized within the agency. The results for the Beneficiary Travel program indicated that of the four actions assessed, three were open and determined to be correctly designed to mitigate the root cause, and one was open and determined that improvements could be made to effectively mitigate the root cause. If improvements could be made, VA conducted a root cause analysis to refine the program's mitigation strategies to ensure they address and reduce root cause(s) of error.

For errors tied to failure to access data/information, associated corrective actions or mitigation strategies contributed to a reduction in the improper payment amount from $81.31 million in FY 2021 to $58.95 million in FY 2022, or a 28% reduction. For errors tied to unable to determine whether proper or improper, associated corrective actions or mitigation strategies contributed to a reduction in the unknown payment amount from $36.73 million in FY 2021 to $24.04 million in FY 2022, or a 35% reduction. For errors tied to statutory requirements of program not met, associated corrective actions or mitigation strategies did not reduce the improper payment amount from FY 2021 to FY 2022.

VA will perform an effectiveness review in FY 2024 of the corrective action plans developed and implemented in FY 2023 due to the time needed to develop and implement actions as well as to impact the payment process. Results of this review will be reported in FY 2024.

Future payment integrity outlook

Beneficiary Travel has established a baseline.

The Beneficiary Travel reduction target is equal to the estimated future improper payment and unknown payment rate. VA establishes reduction targets by setting them lower than the current year improper payment estimates. Reduction targets are a balance between being aggressive and realistic. One thing VA has learned from the many years it has been working to comply with improper payments legislation is that it can take three years from the point an error cause is isolated during testing to develop a corrective action, implement it, and then wait for payments to be made that can then be tested the following year since VA tests and reports improper payments one year in arrears.

Out-Year improper payment and unknown payment projections and target
Current year +1 estimated future outlays $1,793.62 M
Current year +1 estimated future improper payments $103.67 M
Current year +1 estimated future unknown payments $18.29 M
Current year +1 estimated future improper payment and unknown payment rate 6.8 %
Current year +1 estimated future improper payment and unknown payment reduction target 6.8 %

The program's current year improper payment and unknown payment rate of 6.83 % may or may not be the tolerable rate. The agency has not yet determined the tolerable rate for this program.

VA has not determined a tolerable rate due to all requirements for establishing a tolerable rate not yet being met. VA continues to prioritize implementing appropriate corrective actions and mitigation strategies to reduce improper and unknown payments. The program plans to maintain compliance with the Payment Integrity Information Act of 2019 for FY 2023.

VA has not determined a tolerable rate due to all requirements for establishing a tolerable rate not yet being met. In March 2023, GAO acknowledged VA’s substantial reduction in improper and unknown payments using effective mitigation strategies and corrective actions (GAO-23-106285, IMPROPER PAYMENTS: Fiscal Year 2022 Estimates and Opportunities for Improvement). VA continues to prioritize implementing appropriate corrective actions and mitigation strategies and has adequate funding to implement improvements planned to internal controls, human capital, information systems and other infrastructure, as needed, over VA’s payment processing and procurement systems to continue reducing improper and unknown payments. VA will establish a tolerable rate if all applicable requirements are met.

At this time, VA is not aware of additional program needs. Therefore, VA has not requested additional resources to establish and maintain internal controls to reduce improper and unknown payments to a tolerable rate.

Additional programmatic information

The Beneficiary Travel program continues to prioritize and implement effective corrective actions and mitigation strategies that reduce improper and unknown payments as evidenced by its sixth consecutive year of reductions and is expected to achieve compliance with the Payment Integrity Information Act of 2019 for FY 2023. Specifically, from FY 2022 to FY 2023, the Beneficiary Travel program decreased its improper and unknown error rate from 7.90% to 6.83% (1.07% reduction). Due to beneficiary needs and increased costs, the program did see an increase in outlays of 40%; therefore, although the program did successfully reduce its rate of improper and unknown payments, its overall reported improper and unknown payments increased. Given the time it takes to implement corrective actions and mitigation strategies, the program expects the continued positive impact of these actions on its FY 2024 improper and unknown payment rate.

  • FY 2024 improper payment estimates

    Chart legend and breakdown

    Payment accuracy rate

    Improper payment rate

    Unknown payment rate


    Sampling & estimation methodology details

    Sampling timeframe:

    10/2022 - 09/2023


    Confidence interval:

    95% to <100%


    Margin of error:

    +/-2.41

  • Actions taken & planned to mitigate improper payments

    Mitigation strategy Description of the corrective action Completion date Status
    Change Process
    Actions taken included establishing and deploying enterprise-wide infrastructure solutions to include quality assurance monitoring processes for mileage reimbursement and special mode transportation. These actions were designed to address unknown payments attributed to being unable to determine whether proper or improper. Change process was the best mitigation strategy in order to develop stronger internal controls and mitigate risks within existing payment processes.
    FY2024 Q4
    Completed
    Automation
    Actions taken included continuing to implement new software that provides a customized and enhanced tool to streamline claims, automate eligibility determinations, payment processing, detection and prevention of improper payments, and enhance reporting and auditing capabilities. In addition, VA continued with the post-implementation modernization of the beneficiary travel claims processing software and other systems. Further,VA continued planning for invoice payment processing nationwide, which is expected to improve the timeliness and accuracy of ambulance claims processing. Finally, VA transitioned from a legacy system to a new beneficiary travel claims processing system. Although the overall corrective actions were not fully implemented/completed during FY 2024, tasks within the actions were completed to move the overall action implementation forward. These actions were designed to address overpayments and underpayments attributed to failure to access data/information, technically improper payments attributed to statutory requirements of program not met, and unknown payments attributed to being unable to determine whether proper or improper. Automation was the best mitigation strategy because improper and unknown payments resulted from manual processes and human error.
    The corrective action was not fully completed this reporting period
    Not Completed
    Automation
    Actions planned include continuing with the post-implementation modernization of beneficiary travel claims processing systems. VA enhanced automation action plans to expand use of transportation modalities that will streamline third-party preauthorized claims processing, integrate medical qualifications, and automate contract execution. These actions were designed to address overpayments and underpayments attributed to failure to access data/information, and technically improper payments attributed to statutory requirements of program not met. Automation was the best mitigation strategy because improper and unknown payments resulted from manual processes and human error.
    FY2025
    Planned
    Training
    Actions planned include developing new and enhanced claims' processing training and deploying training resources across various stakeholder groups to ensure more effective communication across target audiences. Additionally, VA will continue establishing and deploying enterprise-wide infrastructure solutions including reviewing the effectiveness of quality assurance and monitoring reporting processes and developing and implementing effective standardized processes. These actions were designed to reduce improper and unknown payment errors associated with statutory requirements of program were not met and unable to determine whether proper or improper. Training was the best mitigation strategy to communicate the importance of consistencies in standard operating procedures.
    FY2025
    Planned

Overpayments

VA overpayments are within the agency's control and occur when the program failed to access the data/information needed to validate the closest facility that could provide the Veteran's treatment was utilized, special mode transportation rates were correctly paid according to contract, if applicable, services were received, beneficiary met administrative and medical qualification, claim was timely submitted, claim was not a duplicate, or claim payments were calculated according to mileage and deductibles, if applicable. The agency has the direct ability to prevent overpayments from occurring by improving processes and controls surrounding administrative and medical qualifications, and simplifying contract pricing, when applicable, to include valid claim mileage calculations. Additionally, system improvements will allow for automation of the authorizations, closest facility, and will ensure services are rendered, decreasing human error. These improvements will allow for more accurate payment validation.
Overpayment root cause Overpayment amount
Amount of overpayments within the agency's control $86.22 M
Amount of overpayments that occurred because the data/information needed to validate payment accuracy prior to making a payment does not exist $0.0 M
The amount of overpayments that occurred because of an inability to access the data/information needed to validate payment accuracy prior to making a payment $0.0 M
The amount of overpayments that occurred because of a failure to access data/information needed to validate payment accuracy prior to making a payment $86.22 M

Overpayment root cause Overpayment amount
Amount of overpayments outside the agency's control $0.0 M

Overpayment type Eligibility element/information needed Eligibility amount
Overpayments Within Agency Control Address/Location $1.49 M
Overpayments Within Agency Control Contractor or Provider Status $6.12 M
Overpayments Within Agency Control Financial $78.61 M

Overpayment type Mitigation strategies taken Mitigation strategies planned
Overpayments within the agency’s control Automation Automation

Underpayments

Underpayment root cause Underpayment amount
Amount of underpayments $3.59 M
The amount of underpayments that occurred because the data/information needed to validate payment accuracy prior to making a payment does not exist $0.0 M
The amount of underpayments that occurred because of an inability to access the data/information needed to validate payment accuracy prior to making a payment $0.0 M
The amount of underpayments that occurred because of a failure to access data/information needed to validate payment accuracy prior to making a payment $3.59 M

Eligibility element/information needed Eligibility amount
Contractor or Provider Status $2.41 M
Financial $1.18 M

Mitigation strategies taken Mitigation strategies planned
Automation Automation

Technically improper payments

VA payments are considered technically improper when the payment was paid to the right person in the right amount but the payment failed to meet all regulatory and/or statutory requirements. While VA confirmed the payment was paid to the right person in the right amount, VA lacked proper approval on medical qualification. Specifically, where clinical documentation for special mode travel was not properly and timely approved by a VA clinician. Most improper payments resulted from delinquent authorizations and lack of proper approval on medical qualification. These resulted in technically improper payments for failing to comply with 38 Code of Federal Regulations - Applications (Part 70.20), 38 Code of Federal Regulations - Criteria for approval (Part 70.4), and Federal Acquisition Regulation sections General (Part 1.601) and Policy (Part 43.102).
The amount of improper payments that were paid to the right recipient for the correct amount but were considered technically improper because of failure to follow statute or regulation $42.23 M

Mitigation strategies taken Mitigation strategies planned
Automation Automation, Training

Additional information

$45.82 M

Unknown Payment Details

The payments are considered unknown payments when VA had missing or insufficient documentation related to authorization, receiving, eligibility, or pricing documentation that was required to validate whether a payment was proper or improper. Specifically, these unknown payments occur when the agency was unable to determine the Veteran's eligibility due to missing annual income documentation, medical authorization documentation, or incomplete contract price schedules. Without annual income eligibility, contract price schedules, receiving supporting documentation and special mode transportation or common carrier preauthorization documentation, if applicable, the program is unable to determine whether the amount paid is proper or improper.

The amount of payments that could either be proper or improper but the agency is unable to determine whether they were proper or improper as a result of insufficient or lack of documentation is $17.53 M


Cause of insufficient or lack of documentation & why the documentation is needed for determination of payment type
Payment cause Amount Description of the documentation that was not provided and explanation of why the program is unable to conclude whether the payment is proper or improper without that documentation
Other $17.53 M VA is required to validate authorization of transport and care as well as contract pricing. However, the agency currently does not have the documentation necessary to determine if the payment is proper or not. VA was unable to locate authorization and receiving documentation, or complete contract rate schedules. Specifically, authorization documentation such as the non-VA care authorization or special mode travel or emergent ambulance document was not obtained. The missing documentation needed will assist VA in determining the clinical need for transport. Centralized documentation retention for each claim is not currently possible within the agency’s current systems of record environment. Hard copy evidence is often maintained locally for claims processing purposes. For this reason, we are unable to conclude whether the payment is proper or improper at time of payment without that documentation.

Mitigation strategies taken Mitigation strategies planned
Automation,Change Process Training

Evaluation of corrective actions

The Beneficiary Travel program continues to prioritize and implement corrective actions and mitigation strategies designed to reduce improper and unknown payments. In FY 2024, VA performed an effectiveness review of actions developed and implemented in FY 2023. The purpose of this review was to assess the appropriateness of corrective actions and mitigation strategies and whether the actions were effectively implemented and prioritized within the agency. The results for the Beneficiary Travel program indicated that of the four actions assessed, three were designed effectively and one was designed ineffectively. If improvements could be made, VA conducted a root cause analysis to refine the program's mitigation strategies to ensure they address and reduce root cause(s) of error.

Through implementation of effective corrective actions and mitigation strategies, Beneficiary Travel reduced overpayments from $88.50 million in FY 2023 to $86.22 million in FY 2024, or a $2.28 million reduction. Additionally, Beneficiary Travel experienced a $91.78 million increase in outlays, specifically in program areas where errors tend to occur. VA has increased the sample size in this program area to gain additional insight into the root error cause(s) occurring and plans to expand and enhance FY 2024 corrective actions related to these high-risk program areas. For errors tied to failure to access data/information, errors tied to statutory requirements of program not met, and errors tied to errors tied to unable to determine whether proper or improper, associated corrective actions or mitigation strategies did not reduce the improper payment amount from FY 2023 to FY 2024.

VA will perform an effectiveness review in FY 2025 of the corrective action plans developed and implemented in FY 2024 due to the time needed to develop and implement actions as well as to impact the payment process. Results of this review will be reported in FY 2025.

Actions taken regarding automation included continuing to implement new software that will provide a customized and enhanced tool to streamline claims, automate eligibility determinations, payment processing, detection and prevention of improper payments, and enhance reporting and auditing capabilities. Additionally, VA continued with the post-implementation modernization of the beneficiary travel claims processing software and other systems. In addition, VA continued with the planning for utlizing an automated system to process invoice payments nationwide, which is expected to improve the timeliness and accuracy of ambulance claims processing. Finally, VA transitioned from a legacy system to a new beneficiary travel claims processing sytem. Actions taken regarding change process included establishing and deploying enterprise-wide infrastructure solutions to include quality assurance monitoring processes for mileage reimbursement and special mode transportation. Actions planned regarding training include developing new and enhanced claims processing trainings and deploying training resources across various stakeholder groups impacted to ensure more effective communication across target audiences. Additionally, VA will continue establishing and deploying enterprise-wide infrastructure solutions including reviewing the effectiveness of quality assurance and monitoring reporting processes and developing and implementing effective standardized processes. Actions planned regarding automation include VA will continue with the post-implementation modernization of beneficiary travel claims processing systems. VA enhanced automation action plans to expand use of transportation modalities that will streamline third-party preauthorized claims processing, integrate medical qualifications, and automate contract execution.

VA has identified root causes for improper and unknown payments and developed effective corrective actions and mitigation strategies. The cause of overpayments and underpayments were attributed to failure to access data/information, the cause of technically improper payments were attributed to statutory requirements of the program not met, and the cause of unknown payments were attributed to unable to determine whether proper or improper. In particular, the majority of overpayments occurred due to claim payments being calculated incorrectly. The majority of underpayments occurred because the claim was not paid according to contract terms. The majority of technically improper payments occurred because clinical documentation for special mode travel was not properly and timely approved by a VA clinician. The majority of unknown payments occurred because authorization documentation such as the non-VA care authorization or special mode travel or emergent ambulance document was not obtained. Automation was the best mitigation strategy because overpayments resulted from manual processes and human error. Change process was the best mitigation strategy in order to develop stronger internal controls and mitigate risks within existing payment processes. Training was the best mitigation strategy to communicate the importance of consistencies in standard operating procedures.

VA updates corrective action plans annually based on testing results, and no less than quarterly throughout the fiscal year, to ensure actions planned or taken are appropriately prioritized and designed to mitigate risks of improper and unknown payments. VA monitors progress and results of implementation on a quarterly basis. Additionally, an effectiveness review is performed annually to measure if an action planned has reduced or is properly designed to reduce improper and unknown payments for a specific root cause based on a set benchmark. The annual effectiveness review process allows VA to create or update actions as necessary to ensure continued progress in the remediation of improper and unknown payments. If areas for improvement are identified, VA conducts a root cause analysis to refine the program's mitigation strategies to ensure they addressed and reduced root cause(s) of error.

Through implementation of effective corrective actions and mitigation strategies, Beneficiary Travel reduced overpayments from $88.50 million in FY 2023 to $86.22 million in FY 2024, or a $2.28 million reduction despite a $91.78 million increase in outlays. VA has increased the sample size in this program area to gain additional insight into the root error causes occurring and plans to expand and enhance FY 2024 corrective actions related to these high-risk program areas. As part of the established corrective action process, the program reported improved corrective action and mitigation strategies planned for FY 2025.

Future payment integrity outlook

Beneficiary Travel has established a baseline.

The Beneficiary Travel reduction target is equal to the estimated future improper payment and unknown payment rate. VA establishes reduction targets by setting them lower than the current year improper and unknown payment estimates. Reduction targets are a balance between being aggressive and realistic. One thing VA has learned from the many years it has been working to comply with improper payments legislation is that it can take three to five years from the point an error cause is isolated during testing to develop a corrective action, implement it, and then wait for payments to be made that can then be tested the following year since VA tests and reports improper payments one year in arrears.

Out-Year improper payment and unknown payment projections and target
Current year +1 estimated future outlays $2,003.28 M
Current year +1 estimated future improper payments $139.73 M
Current year +1 estimated future unknown payments $15.53 M
Current year +1 estimated future improper payment and unknown payment rate 7.75 %
Current year +1 estimated future improper payment and unknown payment reduction target 7.75 %

The program's current year improper payment and unknown payment rate of 8.09 % may or may not be the tolerable rate. The agency has not yet determined the tolerable rate for this program.

VA has not determined a tolerable rate due to all requirements for establishing a tolerable rate not yet being met. VA continues to identify and implement appropriate corrective actions and mitigation strategies to further reduce the improper and unknown payment rate. VA has determined these corrective actions and mitigation strategies do not impede the mission and can be implemented cost-effectively within existing budget authority.

VA has not determined a tolerable rate due to all requirements for establishing a tolerable rate not yet being met. In March 2023, the Government Accountability Office acknowledged VA’s substantial reduction in improper and unknown payments using effective mitigation strategies and corrective actions (GAO-23-106285, IMPROPER PAYMENTS: Fiscal Year 2022 Estimates and Opportunities for Improvement). VA continues to prioritize implementing appropriate corrective actions and mitigation strategies and has adequate funding to implement improvements planned to internal controls, human capital, information systems and other infrastructure, as needed, over VA’s payment processing and procurement systems to continue reducing improper and unknown payments. VA is still actively reducing improper and unknown payments within its existing budget authority. VA considers the reduction of improper and unknown payments a critical part of its financial stewardship efforts.

At this time, VA is not aware of additional program needs. Therefore, VA has not requested additional resources to establish and maintain internal controls to reduce improper and unknown payments to a tolerable rate.

Additional programmatic information

The Beneficiary Travel program continues to prioritize and implement corrective actions and mitigation strategies that reduce improper and unknown payments. Although Beneficiary Travel reported an increase in overall improper and unknown payments, projected improper and unknown payments remain under the 10% compliance threshold established by the Payment Integrity Information Act of 2019 for the fifth consecutive year. Further, the program underwent improvements in FY 2024 that will increase its ability to reduce improper payments in the future. Through implementation of effective corrective actions and mitigation strategies, Beneficiary Travel reduced overpayments from $88.50 million in FY 2023 to $86.22 million in FY 2024, or a $2.28 million reduction despite a $91.78 million increase in outlays. VA plans to expand and enhance FY 2024 corrective actions related to high-risk areas as well as increase the FY 2025 sample size to gain additional insight into the root cause errors occurring.

Accountability for detecting, preventing, and recovering improper payments

This program was determined compliant in FY 2024 by the Office of Inspector General and reported improper and unknown payments below required thresholds for a compliance determination in FY 2025. In FY 2025, VA executive managers and program personnel will be focused on prevention and recovery of overpayments as appropriate. This will include various mitigation strategies such as automation and training. These actions address the root causes of errors found in FY 2024 payment integrity testing. VA’s executive managers to include the Deputy Executive Director for Member Services and program personnel will be held accountable through annual performance criteria contained within their performance plans. Performance criteria will be unique to and inclusive of all their duties. Depending on each employees’ responsibilities, duties can include preventing improper and unknown payments through effective internal controls, recovering overpayments if appropriate, and implementing remediation efforts for known causes of improper and unknown payments. State and local governments are not involved in the execution of this program.

  • FY 2025 improper payment estimates

    Chart legend and breakdown

    Payment accuracy rate

    Improper payment rate

    Unknown payment rate


    Sampling & estimation methodology details

    Sampling timeframe:

    10/2023 - 09/2024


    Confidence interval:

    95% to <100%


    Margin of error:

    +/-2.44

Causes

VA overpayments are within the agency's control and occurred when the program failed to access the data/information needed to validate the closest facility that could provide the Veteran's treatment was utilized, special mode transportation rates were incorrectly paid according to the contract, services were not received, beneficiary did not meet administrative and/or medical qualification, claim was not submitted timely, claim was duplicative, or claim payments were incorrectly calculated according to mileage, deductibles, and/or meals and lodging. VA underpayments occurred when the program failed to access the data/information needed to validate claim payments were calculated correctly according to deductibles. VA technically improper payments occurred when the payment was paid to the right person in the right amount but failed to meet all regulatory and/or statutory requirements. While VA confirmed the payment was paid to the right person in the right amount, VA lacked proper approval of medical qualification. Specifically, where clinical documentation for special mode travel was not properly and timely approved by a VA clinician. Most technically improper payments resulted from delinquent authorizations and lack of proper approval on medical qualification. These resulted in technically improper payments for failing to comply with 38 Code of Federal Regulations - Applications (Part 70.20), 38 Code of Federal Regulations - Criteria for approval (Part 70.4), and Federal Acquisition Regulation sections General (Part 1.601) and Policy (Part 43.101). VA unknown payments occurred when VA had missing or insufficient documentation related to authorization, receiving, eligibility, or pricing documentation that was required to validate whether a payment was proper or improper. Specifically, these unknown payments occurred when the agency was unable to determine the Veterans' eligibility due to missing annual income documentation, medical authorization documentation, or incomplete contract price schedules. Without annual income eligibility, contract price schedules, receiving supporting documentation and special mode transportation or common carrier preauthorization documentation, if applicable, the program is unable to determine whether the amount paid is proper or improper.

Overpayment root cause Overpayment amount
Amount of overpayments within the agency's control $96.39 M
Amount of overpayments outside the agency's control $0.0 M
Amount of overpayments that occurred because the data/information needed to validate payment accuracy prior to making a payment does not exist $0.0 M
Amount of overpayments that occurred because of an inability to access the data/information needed to validate payment accuracy prior to making a payment $0.0 M
Amount of overpayments that occurred because of a failure to access data/information needed to validate payment accuracy prior to making a payment $96.39 M

Underpayment root cause Underpayment amount
Amount of underpayments $0.53 M
The amount of underpayments that occurred because the data/information needed to validate payment accuracy prior to making a payment does not exist $0.0 M
The amount of underpayments that occurred because of an inability to access the data/information needed to validate payment accuracy prior to making a payment $0.0 M
The amount of underpayments that occurred because of a failure to access data/information needed to validate payment accuracy prior to making a payment $0.53 M

The amount of improper payments that were paid to the right recipient for the correct amount but were considered technically improper because of failure to follow statute or regulation $25.32 M

The amount that could either be proper or improper but the agency is unable to determine whether it was proper or improper as a result of insufficient or lack of documentation $33.44 M

Prevention

Actions taken regarding change process included VA establishing and deploying enterprise-wide infrastructure solutions, including reviewing the effectiveness of quality assurance and monitoring reporting processes and developing and implementing effective standardized processes. These actions were designed to reduce unknown payments attributed to being unable to determine whether proper or improper. Change process was the best mitigation strategy in order to develop stronger internal controls and mitigate risks within existing payment processes. The completion date was June 25, 2025. Actions taken regarding training included VA developing new and enhanced claims processing training and deploying training resources across various stakeholder groups to ensure more effective communication across target audiences. These actions were designed to reduce technically improper payments attributed to statutory requirements of program not met and unknown payments attributed to being unable to determine whether proper or improper. Training was the best mitigation strategy to communicate the importance of consistencies in standard operating procedures within a decentralized program. The completion date was June 25, 2025. Actions planned regarding automation include VA continuing with the post-implementation modernization of beneficiary travel claims processing systems. These actions are designed to address overpayments and underpayments attributed to failure to access data/information. Automation is the best mitigation strategy because improper and unknown payments resulted from manual processes and human error. The estimated completion date is May 31, 2026. Actions planned regarding change process include VA leveraging integrations of transportation and medical record systems, targeted enhancements of general and application controls, and transportation scheduling that will streamline third-party preauthorized ordering, integrate medical qualifications, and increase efficiency in claims adjudication. VA is also consolidating beneficiary travel claims processing through standardized reimbursement processes by centralizing the workload. A central processing office can focus on timely, proper payments to Veterans. Finally, VA is reviewing and updating payment processes regarding paper checks, which is in alignment with Executive Order 14247: Modernizing Payments To and From Americas Bank Account. These actions are designed to address overpayments attributed to failure to access data/information, technically improper payment errors attributed to statutory requirements of the program were not met, and unknown payments attributed to being unable to determine whether proper or improper. Change process is the best mitigation strategy in order to develop stronger internal controls and mitigate risks within existing payment processes. The estimated completion date is December 31, 2026.
The Beneficiary Travel program continues to prioritize and implement corrective actions and mitigation strategies designed to reduce improper and unknown payments. In FY 2025, VA performed an effectiveness review of actions developed and implemented in FY 2024. The purpose of this review was to assess the appropriateness of corrective actions and mitigation strategies and whether the actions were effectively implemented and prioritized within the agency. The results for the Beneficiary Travel program indicated that of the four actions assessed, two were designed effectively and two were designed ineffectively. If improvements could be made, VA conducted a root cause analysis to refine the program’s mitigation strategies to ensure they address and reduce root cause(s) of error. For FY 2025, Beneficiary Travel reduced the improper and unknown payment rate from 8.09% in FY 2024 to 7.58% in FY 2025, or a 0.51% reduction, despite a $204.24 million increase in outlays. For errors tied to statutory requirements of program were not met, associated corrective actions or mitigation strategies contributed to a total reduction in the improper payment amount from $42.23 million in FY 2024 to $25.32 million in FY 2025, or a 40.04% reduction. VA will perform an effectiveness review in FY 2026 of the corrective action plans developed and implemented in FY 2025 due to the time needed to develop and implement actions as well as to impact the payment process. Results of this review will be reported in FY 2026.

VA updates corrective action plans annually based on testing results, and no less than quarterly throughout the fiscal year, to ensure actions planned or taken are appropriately prioritized and designed to mitigate risks of improper and unknown payments. VA monitors progress and results of implementation on a quarterly basis. Additionally, an effectiveness review is performed annually to measure if an action planned has reduced or is properly designed to reduce improper and unknown payments for a specific root cause based on a set benchmark. The annual effectiveness review process allows VA to create or update actions as necessary to ensure continued progress in the remediation of improper and unknown payments. If areas for improvement are identified, VA conducts a root cause analysis to refine the program’s mitigation strategies to ensure they addressed and reduced root cause(s) of error. VA’s process for development of corrective actions and mitigation strategies ensures the severity of the error is considered and the action is adequate. VA’s corrective actions and mitigation strategies were evaluated by the Office of Inspector General during their FY 2025 annual audit and determined reasonable with no recommendations for improvement. Through implementation of effective corrective actions and mitigation strategies, Beneficiary Travel reduced the improper and unknown payment rate from 8.09% in FY 2024 to 7.58% in FY 2025, or a .51% reduction despite a $204.24 million increase in outlays. VA increased the sample size in this program to gain additional insight into the root error causes occurring and will expand and enhance future corrective actions related to these high-risk program areas.

Payment type Mitigation strategies taken Mitigation strategies planned
Overpayments Automation Automation, Change Process
Underpayments Automation Automation
Technically improper payments Training Change Process
Unknown payments Change Process Change Process

Eligibility element/information needed Description of the eligbility element/information
Address/location Information regarding where the applicant/recipient lived, owned property, or was physically present in a specific location
Contractor or Provider Status Status or standing of contractor or provider, including recipient eligibility to provide medical services
Financial The financial position or status of a beneficiary, recipient, or their family

Additional information

The Beneficiary Travel program continues to prioritize and implement corrective actions and mitigation strategies that reduce improper and unknown payments. Beneficiary Travel reported a decrease in the improper and unknown payment rate in FY 2025. The program remains under the 10% compliance threshold established by the Payment Integrity Information Act of 2019 for the fourth consecutive year. Through implementation of effective corrective actions and mitigation strategies, Beneficiary Travel reduced the improper and unknown payments rate from 8.09% in FY 2024 to 7.58% in FY 2025, or a .51% reduction despite a $204.24 million increase in outlays.

Reduction target

7.5 %

VA continues to prioritize implementing appropriate corrective actions and mitigation strategies and has adequate funding to implement improvements planned to internal controls, human capital, information systems and other infrastructure, as needed, over VA’s payment processing and procurement systems to continue reducing improper and unknown payments. VA is still actively reducing improper and unknown payments within its existing budget authority. VA considers the reduction of improper and unknown payments a critical part of its financial stewardship efforts.

At this time, VA is not aware of additional program needs. Therefore, VA has not requested additional resources to establish and maintain payment integrity.

This program was determined compliant in FY 2025 by the Office of Inspector General and has reported improper and unknown payments below required thresholds for a compliance determination in FY 2026. In FY 2026, VA executive managers and program personnel will be focused on prevention and recovery of overpayments as appropriate. This will include various mitigation strategies such as automation and change process. These actions address the root causes of errors found in FY 2025 payment integrity testing. VA’s executive managers to include the Deputy Executive Director for Member Services and program personnel will be held accountable through annual performance criteria contained within their performance plans. Performance criteria will be unique to and inclusive of all their duties. Depending on each employees’ responsibilities, duties can include preventing improper and unknown payments through effective internal controls, recovering overpayments if appropriate, and implementing remediation efforts for known causes of improper and unknown payments. State and local governments are not involved in the execution of this program.

$25.85 M