The Department of Veterans Affairs clarified plans for deploying a data tool to assist staff in identifying suspected fraud in claims. The focus of the tool will be on third-party for-profit companies — known as claims sharks — that try to take advantage of veterans and the benefits system, the agency said. (Stars and Stripes)
WASHINGTON — The Department of Veterans Affairs announced Monday that it is dropping plans to scan 1 million old disability benefits questionnaires dating to 2010 to identify possible signs of fraud.
The VA, however, will still deploy a “data collection tool,” which is under development, to look for false or exaggerated medical evidence in newly submitted DBQs that are part of a veteran’s claim for benefits, the agency said.
“This tool is forward-looking only. VA will not use the tool to revisit previously finalized and…
MANAGEMENT & CULTURE (THE “TONE AT THE TOP”)
Fraud thrives in “sloppy” environments where leadership ignores the rules.
- The Fraud Triangle: For fraud to occur, three elements must be present: Pressure (the need for money), Rationalization (thinking “I deserve this”), and Opportunity (weak controls). You can only control the Opportunity.
- Whistleblower Hotline: Provide an anonymous way for staff to report “odd behavior.” Most internal frauds are caught via tips, not audits.
- Background Checks: Conduct credit and criminal record checks for all employees in financial or data-sensitive roles.
- Annual Ethics Training: Make sure every staff member knows that the company has a Zero Tolerance policy toward “borrowing” from petty cash or fudging overtime.