A recent report from the VA Office of the Inspector General (OIG) has revealed that an automated benefits delivery system implemented by the Veterans Affairs (VA) has resulted in wrongful claims decisions for veterans filing high blood pressure claims. The system, introduced in December 2021, was meant to expedite claims decisions but instead led to inaccurate ratings on 27% of the reviewed high blood pressure claims.
The VA implemented the automated system in anticipation of a surge in disability applications following the passage of the PACT Act. Vietnam-era veterans who were exposed to Agent Orange, a substance linked to hypertension, were filing high blood pressure claims under the act. The system was designed to extract blood pressure readings and other relevant data from VA treatment records and create a summary for review by VA staff, who would then make the final decision on the claim.
However, the OIG report found that incomplete data compiled by the system resulted in several incorrect decisions. The report recommended that the VA make improvements to both the technology and the quality assurance process to prevent further errors. Larry Reinkemeyer, the VA assistant inspector general for audits and evaluation, emphasized the importance of improving oversight to ensure eligible veterans receive the benefits they are entitled to.
Experts in the field of artificial intelligence (AI) caution against relying solely on AI tools without proper understanding of their limitations. They emphasize the need for human oversight in reviewing data entering the system and the analysis generated by the AI. The errors in the automated system highlight the dangers of human error and poor quality control in data collection and entry.
While VA officials agreed with most of the recommendations in the report, they clarified that the automated system did not make final claims decisions during the inspection period. They stated that the system was still in the early stages of implementation and development at the time of the review.
In response to the findings, the VA has taken steps to improve the automation process. These include creating a repeatable process to ensure quality and effectiveness on a small scale before expanding nationwide, implementing a dedicated quality review process using independent reviewers, and collaborating with tech industry leaders for insights on improvement. The VA has also developed a new dashboard to closely monitor trends and enhance communication with veterans, family members, caregivers, and survivors.
While the automated system has shown promise in expediting claims processing, the VA acknowledges the need for continuous modernization and improvement. The goal is to ensure that veterans receive the benefits they deserve as quickly as possible. With these improvements, veterans can expect faster initial decisions and a more efficient claims process.
