Additionally, VHA has identified the Beneficiary Travel Program as being  susceptible to significant improper payments. For VA’s 2012 Performance and Accountability  Report, VHA estimated that the Beneficiary Travel Program had   $71 million in improper payments. VHA Has Developed Efforts to Improve the Beneficiary Travel Program, but Lack of Internal Controls May Impede Their Effectiveness

VHA has developed multiple efforts to improve the management and  oversight of its process for reimbursing veterans’ travel expenses for  medical appointments. VHA Has Developed Efforts That Aim to Improve the Management and Oversight of the Beneficiary Travel Program

VHA has developed multiple efforts to improve the management and  oversight of the Beneficiary Travel Program, as well as the timeliness and  accuracy of payments. These efforts—many of which  medical centers are or will be required to implement—are expected to  increase the consistency of how the program is administered. For  example, the Dashboard, a Web-based software, provides a standardized  process that medical centers are required to use to determine a veteran’s  eligibility for travel reimbursement, the amount of any deductibles, and the  number of miles from the veteran’s residence to the closest VA medical  facility where care could be provided. For example, in the fall of 2012, VHA piloted the Electronic Funds  Transfer (EFT) effort—a process for transferring travel reimbursement  funds electronically into veterans’ bank accounts—in medical centers in 2  of the 21 VISNs. The EFT effort—along with VHA’s Debit Card effort, a  VHA-wide card that veterans can use to receive travel reimbursement  electronically—implements a Department of the Treasury requirement for  federal agencies to convert cash payments to electronic funds payments  by March 1, 2013. Without  these internal controls in place, VHA cannot ensure that the efforts will  meet its goals, such as improved management and oversight. The Web-based Beneficiary Travel Analytics Tool,  implemented March 31, 2013, generates travel reimbursement pattern  reports—reports identifying questionable veteran reimbursement patterns  that may indicate improper payments, such as frequently changing  addresses on reimbursement claims, which may be done to  inappropriately increase travel reimbursement amounts. VHA also did not provide a communication  plan for sharing information on EFT with medical centers and veterans in  a timely manner, as would have been consistent with internal control  standards. VHA has not developed a plan to  ensure medical centers’ compliance with the efforts or its existing policies,  as would be consistent with internal control standards. However, VHA  officials told us they do not have a plan in place to ensure that each  medical center is using this new software. In the past 5 years, spending under the program has more  than doubled, from about $370 million in fiscal year 2008 to about   $860 million in fiscal year 2012. Specifically,  VHA has not developed a plan for evaluating VHA-wide performance  indicators for the Beneficiary Travel Analytics Tool; provided timely  guidance and effective communication tools to medical centers for EFT;  ensured compliance with Dashboard and other efforts; and routinely  collected information on medical centers’ local procedures to identify and  share best practices. Recommendation for Executive Action

To improve the management and oversight of the Beneficiary Travel  Program, we recommend that the Secretary of Veterans Affairs direct the  Under Secretary for Health to ensure appropriate internal controls have  been identified and applied in the development and implementation of all  of VHA’s efforts aimed at improving the program, including developing and implementing a plan to evaluate performance  indicators for the Beneficiary Travel Analytics Tool, providing timely guidance and effective communication tools to  medical centers as VHA completes its implementation of EFT, ensuring medical centers’ compliance with Dashboard and other  routinely collecting information to identify and share best practices  across medical centers. VA generally  agreed with our conclusions and concurred with our recommendation.
Why GAO Did This Study

VHA's Beneficiary Travel Program is designed to encourage eligible veterans to seek medical care by reducing travel costs to medical appointments. Veterans are eligible to receive reimbursement for some travel expenses, such as mileage, through the program that is administered by VA medical centers. In February 2013, the VA Office of Inspector General identified issues with inadequate management and oversight. VHA has identified the program as susceptible to significant improper payments and has estimated $71 million in improper payments for fiscal year 2012.
GAO was asked to examine VHA's Beneficiary Travel Program. In this report, GAO examined recent efforts VHA has developed or implemented to improve the program. GAO reviewed documents and interviewed VHA officials about these efforts; and determined whether VHA applied the appropriate internal controls. GAO also reviewed documents and interviewed officials from six VA medical centers, which vary on the basis of fiscal year 2012 mileage reimbursement spending, geographic location, and other factors.

What GAO Found

The Department of Veterans Affairs' (VA) Veterans Health Administration (VHA) has developed efforts to improve the Beneficiary Travel Program, but lack of internal controls may impede their effectiveness. Specifically, VHA has developed multiple efforts to improve the management and oversight of its process for reimbursing veterans' travel expenses for medical appointments, as well as the timeliness and accuracy of payments, including the following:
Dashboard . Web-based software that determines a veteran's eligibility for travel reimbursement, the amount of any deductibles, and the number of miles from the veteran's residence to the closest VA medical facility. The software is designed to enable VA medical center staff to quickly and consistently calculate veterans' mileage reimbursement.
Beneficiary Travel Analytics Tool . Tool that provides each medical center with reports identifying questionable veteran reimbursement patterns, such as frequently changing addresses on reimbursement claims, which may be done to inappropriately increase travel reimbursement amounts. The reports are intended to help medical centers define and implement facility-level internal controls to reduce improper payments.
Electronic Funds Transfer (EFT) . Process to transfer travel reimbursement funds electronically into veterans' bank accounts. This effort implements a Department of the Treasury requirement for federal agencies to convert cash payments to electronic funds payments, and aims to improve efficiency, increase oversight, and reduce the amount of cash on hand.
These efforts are expected to increase the consistency of how the program is administered by medical centers. However, GAO found that internal controls were lacking for some of the efforts, including the following:
Monitoring Compliance . VHA has not developed a plan to ensure medical centers' compliance with the efforts or existing policies. For example, although medical centers are required to use the Dashboard, VHA officials told us they do not have a plan in place to ensure that each medical center is using this new software.
Evaluating Performance Indicators . VHA has not developed a plan for evaluating VHA-wide performance indicators for at least one of its efforts, the Beneficiary Travel Analytics Tool.
Providing Effective Communication . VHA did not provide a communication plan for sharing information on EFT with medical centers and veterans in a timely manner.
Without necessary internal controls in place, VHA cannot ensure that its new efforts will meet its goals, such as improved management and oversight, or that the Beneficiary Travel Program, which has seen spending more than double in the past 5 years--approaching $1 billion annually--is operating effectively.

What GAO Recommends

GAO recommends that VA identify and apply internal controls in its efforts to improve management and oversight of the Beneficiary Travel Program, including ensuring compliance with the Dashboard, evaluating performance indicators for the Beneficiary Travel Analytics Tool, and providing effective communication tools to medical centers for EFT. VA generally agreed with GAO's conclusions and concurred with the recommendation.