VBA  awarded 12 contracts to five contractors to begin providing exams in  2016. VBA Reported Contractors Missed Exam Quality Targets, and VBA Could Not Accurately Measure Performance On Timeliness Targets

		Contractors Missed Quality Targets in First Half of 2017; More Recent Data Are Not Yet Available for Most Districts

VBA reported that almost all contractors missed VBA’s quality target of 92  percent in the first half of calendar year 2017, and more recent data are  not yet available for most districts. Alternatively, a contractor may have conducted an exam with the  veteran, but not yet sent the exam report to VBA. Delayed Quality Reviews and Performance Reports, and Data Limitations, Hinder VBA’s Monitoring of Contractors

		VBA Identified Some Contractor Performance Problems but Was Delayed in Completing Quality Reviews and Performance Reports

			VBA Identification of Performance Problems

VBA’s contract exam program office, primarily through its Contracting  Officer’s Representatives (COR), has identified some contractor  performance problems, such as delays in completing specific exams,  through its oversight of contractor performance. VBA officials also indicated that they were unable to fully assess  individual contractor timeliness against VBA’s performance targets  because the exam management system did not include the date the initial  exam report was submitted to VBA, which is needed to calculate  timeliness as outlined in the contracts. As a result, VBA officials  said the agency still did not have complete data in the new system that  would allow it to track insufficient exams. Auditor Verifies Contracted Examiner Licenses, but VBA Does Not Verify Training Completion or Collect Information on Training Effectiveness

		VBA Uses a Third-Party Auditor to Verify Contracted Examiner Licenses

VBA has a third-party auditor who verifies that all active contracted  examiners have a current, valid, and unrestricted medical license in the  state where they examined a veteran. However, VBA has not provided details or documentation on  these planned checks, such as how it will determine which records to  review or the steps it will take to verify the accuracy of training records. VBA officials also said they are planning to develop an online system that  would allow VBA to certify that examiners have completed required  training, rather than relying on contractors for this information. VBA Does Not Collect Information to Determine if Training Effectively Prepares Examiners

VBA does not collect information from contractors or examiners to help  determine if required training effectively prepares examiners to conduct  high quality exams and complete exam reports. These improvements  might be limited, however, without a plan to use the data to produce the  quality information needed by VBA to monitor insufficient exams, ensure it  pays contractors the correct amount for those exams, and help it  accurately calculate contractor timeliness. Without  doing so, the agency may miss opportunities to improve the program and,  ultimately, its service to veterans. The Under Secretary for Benefits should develop and implement a plan  for how VBA will use data from the new exam management system to  oversee contractors, including how it will capture accurate data on the  status of exams and use it to (1) assess contractor timeliness, (2) monitor  time spent correcting inadequate and insufficient exams, and (3) verify  proper exam invoicing. (Recommendation 2)
The Under Secretary for Benefits should document and implement a plan  and processes to verify that contracted examiners have completed  required training. VA concurred with all our  recommendations and described the Veterans Benefits Administration’s  (VBA) plans for taking action to address them. Appendix I: Additional Information on Selected Methodologies

	Review of VBA Contracts

To evaluate VBA monitoring of contractor performance and VBA  oversight of contracted examiners’ qualifications and training, we  reviewed relevant federal laws, regulations, and VA guidance on the use  of contracted examiners for disability compensation exams. Analysis of VBA Data on the Timeliness of Contracted Exams

To answer what is known about the timeliness of VBA contracted exams,  we analyzed VBA data on disability compensation exams completed by  five contractors between February 2017 and January 2018. While VBA officials acknowledged that this data limitation  affects the agency’s ability to assess individual contractor timeliness on  VBA’s performance targets outlined in the contracts, the limitation did not  prevent us from analyzing the timeliness of contracted exams overall.
Why GAO Did This Study

In 2016, VBA awarded 12 contracts to five private firms for up to $6.8 billion lasting up to 5 years to conduct veterans' disability medical exams. Both VBA contracted medical examiners and medical providers from the Veterans Health Administration perform these exams, with a growing number of exams being completed by contractors. Starting in 2017, VBA contracted examiners conducted about half of all exams. GAO was asked to review the performance and oversight of VBA's disability medical exam contractors.
This report examines (1) what is known about the quality and timeliness of VBA contracted exams; (2) the extent to which VBA monitors contractors' performance; and (3) how VBA ensures that its contractors provide qualified and well-trained examiners. GAO analyzed the most recent reliable data available on the quality and timeliness of exams (January 2017 to February 2018), reviewed VBA and selected contract documents and relevant federal laws and regulations, and interviewed agency officials, exam contractors, an audit firm that checks examiners' licenses, and selected veterans service organizations.

What GAO Found

The Veterans Benefits Administration (VBA) has limited information on whether contractors who conduct disability compensation medical exams are meeting the agency's quality and timeliness targets. VBA contracted examiners have completed a growing number of exams in recent years (see figure). VBA uses completed exam reports to help determine if a veteran should receive disability benefits. VBA reported that the vast majority of contractors' quality scores fell well below VBA's target—92 percent of exam reports with no errors—for the first half of 2017. Since then, VBA has not completed all its quality reviews, but has hired more staff to do them. VBA officials acknowledged that VBA also does not have accurate information on contractor timeliness. VBA officials said the exam management system used until spring 2018 did not always retain the initial exam report completion date, which is used to calculate timeliness. In spring 2018, VBA implemented a new system designed to capture this information.
VBA monitoring has addressed some problems with contractors, such as reassigning exams from contractors that did not have enough examiners to those that did. However, the issues GAO identified with VBA's quality and timeliness information limit VBA's ability to effectively oversee contractors. For example, VBA officials said they were unable to track the timeliness of exam reports sent back to contractors for corrections, which is needed to determine if VBA should reduce payment to a contractor. The new system implemented in spring 2018 tracks more detailed data on exam timeliness. However, VBA has not documented how it will ensure the data are accurate or how it will use the data to track the timeliness and billing of corrected exam reports. VBA also has no plans to use the new system to analyze performance data to identify trends or other program-wide issues. Without such plans, VBA may miss opportunities to improve contractor oversight and the program overall.
A third-party auditor verifies that contracted examiners have valid medical licenses, but VBA does not verify if examiners have completed training nor does it collect information to assess training effectiveness in preparing examiners. While VBA plans to improve monitoring of training, it has not documented plans for tracking or collecting information to assess training. These actions could help ensure that VBA contractors provide veterans with high-quality exams and help VBA determine if additional training is needed.

What GAO Recommends

GAO recommends VBA (1) develop a plan for using its new data system to monitor contractors' quality and timeliness performance, (2) analyze overall program performance, (3) verify that contracted examiners complete required training, and (4) collect information to assess the effectiveness of that training. The Department of Veterans Affairs agreed with GAO's recommendations.