VA HEALTH CARE

Additional Steps 

Needed to Strengthen 

Beneficiary Travel 

Program Management 

and Oversight

Report to Congressional Requesters

July 2013

GAO-13-632

United States Government Accountability Office
United States Government Accountability Office

Highlights of GAO-13-632, a report to 

congressional requesters

July 2013

VA HEALTH CARE

Additional Steps Needed to Strengthen Beneficiary 

Travel Program Management and Oversight

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 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. 

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.

View GAO-13-632. For more information, 

contact Debra A. Draper at (202) 512-7114 or 

draperd@gao.gov.
Page i GAO-13-632 VA Travel Reimbursement

Letter 1 

Background 3

VHA Has Developed Efforts to Improve the Beneficiary Travel 

Program, but Lack of Internal Controls May Impede Their 

Effectiveness 8

Conclusions 15

Recommendation for Executive Action 16

Agency Comments and Our Evaluation 16

Appendix I Examples of VA Medical Center Procedures for 

Administering the Beneficiary Travel Program 20

Appendix II Comments from the Department of Veterans Affairs 21

Appendix III GAO Contact and Staff Acknowledgments 24

Table

Table 1: VHA-Identified Efforts to Improve the Management and 

Oversight of the Beneficiary Travel Program 10

Figure

Figure 1: Spending for VHA’s Beneficiary Travel Program, Fiscal 

Year 2008 through Fiscal Year 2012 5

Contents 
Page ii GAO-13-632 VA Travel Reimbursement

Abbreviations

EFT electronic funds transfer

IPERA Improper Payments Elimination and Recovery Act of 2010

OIG Office of Inspector General

VA Department of Veterans Affairs

VHA Veterans Health Administration

VISN Veterans Integrated Service Network

This is a work of the U.S. government and is not subject to copyright protection in the 

United States. The published product may be reproduced and distributed in its entirety 

without further permission from GAO. However, because this work may contain 

copyrighted images or other material, permission from the copyright holder may be 

necessary if you wish to reproduce this material separately.
Page 1 GAO-13-632 VA Travel Reimbursement

441 G St. N.W.

Washington, DC 20548

July 15, 2013

Congressional Requesters

The Department of Veterans Affairs’ (VA) Veterans Health Administration 

(VHA) Beneficiary Travel Program is designed to encourage eligible 

veterans to seek needed medical care by reducing travel costs to medical 

appointments. Veterans are eligible to receive reimbursement for some 

travel expenses associated with medical appointments, such as mileage, 

if they meet certain criteria, generally related to whether they have a 

service-connected disability or low income level.

Concerns have been raised about the program’s efficacy and 

management, including VHA’s oversight of VA medical centers that are 

responsible for implementing the program at the local level. Specifically, 

findings from a recent audit conducted by the VA Office of Inspector 

General (OIG) identified problems with the Beneficiary Travel Program, 

including inadequate management and oversight, and inaccurate 

payments to veterans.1 Members of Congress also have raised concerns 

about the program, particularly regarding veterans’ difficulties receiving 

travel reimbursement, including reports of veterans waiting in long lines to 

receive cash reimbursement for travel expenses, or facing delays 

receiving reimbursement checks by mail. Furthermore, VHA has identified 

the Beneficiary Travel Program as a program that is susceptible to 

significant improper payments, and has estimated $71 million in improper 

payments for fiscal year 2012.2 Spending for the Beneficiary Travel 

Program comes out of individual medical center medical care funds—the 

same funds that are used for patient care—and has increased from about 

$370 million in fiscal year 2008 to about $860 million in fiscal year 2012.

 

1

See Department of Veterans Affairs, Office of Inspector General, Veterans Health 

Administration: Audit of the Beneficiary Travel Program, 11-00336-292 (Washington, D.C.: 

Feb. 6, 2013). 

2

See Department of Veterans Affairs, Department of Veterans Affairs (VA) 2012 

Performance and Accountability Report (Washington, D.C.: Nov. 15, 2012).

 
 

Page 2 GAO-13-632 VA Travel Reimbursement

Congressional requesters expressed interest in obtaining information on 

VHA’s Beneficiary Travel Program. In this report, we examine the efforts, 

if any, VHA has identified to improve the process for reimbursement of 

veterans’ travel expenses to medical appointments within the Beneficiary 

Travel Program.

To determine whether VHA has developed efforts to improve the 

Beneficiary Travel Program, we asked officials from VHA’s Chief 

Business Office and Office of Finance—the offices that have 

responsibility for setting policies and procedures related to the Beneficiary 

Travel Program—to identify national efforts to improve the program. We 

focused on efforts, including policies, processes, and initiatives, that were 

developed or implemented from October 2011 to May 2013. For each 

effort VHA identified, we reviewed VHA documentation describing its 

purpose, development or implementation status, and any issues 

encountered in the development and implementation of the effort. We 

also collected documentation and interviewed officials from VHA about 

any communication VHA provided for veterans about the effort. To 

identify local perspectives on any efforts VHA is deploying nationally and 

local officials’ experiences with the program generally, we reviewed 

documents and interviewed officials from six VA medical centers: 

(1) Kansas City VA Medical Center (Mo.); (2) Malcolm Randall VA 

Medical Center (Gainesville, Fla.); (3) Minneapolis VA Health Care 

System (Minn.); (4) Maine VA Medical Center (Augusta, Maine); 

(5) Veterans Health Care System of the Ozarks (Fayetteville, Ark.); and 

(6) West Los Angeles VA Medical Center (Calif.). These medical centers 

vary in terms of fiscal year 2012 total mileage reimbursement spending; 

participation as a pilot or early implementation site for any of VHA’s 

efforts to improve its travel reimbursement program; VA region; 

rural/urban location; and VA-assigned facility complexity level.3

 

3

VA assigns each medical center a complexity score derived from multiple variables to 

measure facility complexity arrayed along four categories, namely patient population 

served, clinical services offered, education and research complexity, and administrative 

complexity.

We also 

interviewed officials from selected veteran service organizations—Blinded 

Veterans Association, Disabled American Veterans, and Paralyzed 

Veterans of America—to get their perspectives on VHA’s Beneficiary 

Travel Program, including challenges veterans may face in seeking 

reimbursement, and VHA’s efforts to improve the program. Using 

strategic planning and performance measures consistent with the 
 

Page 3 GAO-13-632 VA Travel Reimbursement

Government Performance and Results Act and GAO’s related internal 

control standards,4

We conducted this performance audit from December 2012 to July 2013 

in accordance with generally accepted government auditing standards. 

Those standards require that we plan and perform the audit to obtain 

sufficient, appropriate evidence to provide a reasonable basis for our 

findings and conclusions based on our audit objectives. We believe that 

the evidence obtained provides a reasonable basis for our findings and 

conclusions based on our audit objectives.

we determined whether VHA applied appropriate 

internal controls in the development and implementation of the efforts.

Under authority first provided by Congress in 1940, VA reimburses 

eligible veterans for travel expenses associated with medical 

appointments through VHA’s Beneficiary Travel Program.5

Veterans are eligible for travel reimbursement if they have 30 percent or

more service-connected disability ratings; are receiving care related to 

their service-connected disability if their service-connected disability 

Specifically, 

travel expenses eligible for reimbursement include mileage, tolls, meals, 

and lodging. Through the program, VA may also pay for special mode 

transportation—such as ambulances and wheelchair vans.

 

4

GAO, Results-Oriented Government: Practices That Can Help Enhance and Sustain 

Collaboration among Federal Agencies, GAO-06-15 (Washington, D.C.: Oct. 21, 2005); 

Managing for Results: Key Considerations for Implementing Interagency Collaborative 

Mechanisms, GAO-12-1022 (Washington, D.C.: Sept. 27, 2012); Executive Guide: 

Effectively Implementing the Government Performance and Results Act, 

GAO/GGD-96-118 (Washington, D.C.: June 1996); Agencies’ Strategic Plans Under 

GPRA: Key Questions to Facilitate Congressional Review, GAO/GGD-10.1.16

(Washington, D.C.: May 1997); Standards for Internal Control in the Federal Government, 

GAO/AIMD-00-21.3.1 (Washington, D.C.: November 1999).

5

See 38 U.S.C. § 111. Under the statute, VA is authorized but not required to reimburse 

travel expenses for veterans. However, if VA exercises its authority to reimburse travel 

expenses, VA must pay travel expenses for specified categories of veterans and may 

reimburse travel expenses for any other veterans receiving medical care in accordance 

with regulations. In general, VA's regulations for the Beneficiary Travel Program currently

designate as eligible the categories of veterans specifically mentioned in 38 U.S.C. § 111. 

Persons specifically mentioned in other VA statutes as eligible for payment for beneficiary 

travel are also eligible, such as certain family members of veterans. See 38 C.F.R. § 

70.10. Veterans traveling for certain emergency situations may be eligible for travel 

reimbursement under separate authority. See 38 U.S.C. § 1725; 38 C.F.R. §§ 17.1000–

17.1008.

Background 
 

Page 4 GAO-13-632 VA Travel Reimbursement

rating is less than 30 percent; receive VA pension benefits; have an 

annual income below a set annual rate;6 present clear evidence that they 

are unable to defray the cost of travel; or are traveling for compensation 

and pension exams.7 Certain caregivers also may be eligible for travel 

reimbursement. Generally, eligible veterans are only reimbursed for 

round-trip travel costs associated with scheduled appointments, except in 

the case of emergency care.8

Since the program’s inception, Congress has made several modifications, 

including adjusting eligibility requirements, types of travel expenses 

covered, deductible costs,9 and mileage reimbursement rates. For 

example, in fiscal years 2008 and 2009, Congress directed VA to 

increase its mileage reimbursement rate from 11 cents per mile to 

28.5 cents per mile and then to 41.5 cents per mile. Committee reports 

accompanying VA’s fiscal years 2008 and 2009 Medical Services 

appropriations indicated that the committees identified specific amounts 

to fund these rate increases.10

 

6

For calendar year 2013, the annual income rate for a veteran with no dependents was 

$12,465.

7

Compensation and pension exams are physical exams provided to veterans applying for 

service-connected disability compensation to determine the degree of their disability.

8

Eligible veterans who do not have scheduled appointments but do receive care from VA 

are only reimbursed for travel costs associated with their return trip.

9

Except in some circumstances, such as severe financial hardship, an amount of $3 per 

one-way trip (with a monthly maximum of $18) is required by law to be deducted from 

beneficiary travel payments. See 38 U.S.C. § 111(c).

10The committees identified $125 million in VA’s 2008 Medical Services appropriation and 

$133 million in VA’s 2009 Medical Services appropriation to fund the increases in travel 

reimbursement rates. See House Comm. on Appropriations, 110th Cong., Committee 

Print on H.R. 2764 / Public Law 110-161, Division I—Military Construction and Veterans 

Affairs and Related Agencies Appropriations Act, 2008, at 1957 (2007), accompanying the 

Consolidated Appropriations Act, 2008 (Pub. L. No. 110-161, 121 Stat. 1844 (2007)); 

73 Fed. Reg. 6291 (Feb. 1, 2008); House Comm. on Appropriations, 110th Cong., 

Committee Print on H.R. 2638 / Public Law 110-329, Division E—Military Construction and 

Veterans Affairs and Related Agencies Appropriations Act, 2009, at 750-51 (2008), 

accompanying the Consolidated Security, Disaster Assistance, and Continuing 

Appropriations Act, 2009 (Pub. L. No. 110-329, 122 Stat. 3574 (2008)); 73 Fed. Reg. 

68,498 (Nov. 18, 2008).
 

Page 5 GAO-13-632 VA Travel Reimbursement

Spending for the Beneficiary Travel Program increased from about 

$370 million in fiscal year 2008 to about $860 million in fiscal year 2012, 

with mileage reimbursement accounting for an increased proportion of the 

spending in this same period. (See fig. 1.) According to VHA officials, the 

increase in spending was primarily due to the increased number of 

veterans claiming mileage reimbursement, a rise in the average number 

of claims per veteran, and higher mileage reimbursement rates. For 

example, according to VHA, the number of veterans claiming mileage 

reimbursement increased from about 450,000 in fiscal year 2008 to about 

1,450,000 in fiscal year 2012.11

Figure 1: Spending for VHA’s Beneficiary Travel Program, Fiscal Year 2008 through 

Fiscal Year 2012

a

Other includes expenses other than mileage, such as tolls, meals, lodging, and special mode 

transportation costs such as ambulance services and wheelchair vans.

 

11According to VHA, the number of veterans claiming mileage reimbursement in fiscal 

year 2008 is an estimate based on limited national data.

Program Spending
 

Page 6 GAO-13-632 VA Travel Reimbursement

VHA’s Chief Business Office is responsible for establishing policies and 

providing guidance to medical centers for the Beneficiary Travel Program. 

These policies describe, for example, the eligibility requirements and the 

types of travel expenses that are reimbursable.12 VHA’s Office of Finance 

is responsible for establishing national policies for the processing of 

payments for reimbursement and financial quality assurance.13 Veterans 

Integrated Service Networks (VISN) have no specific oversight 

responsibilities for the Beneficiary Travel Program beyond the general 

responsibility of ensuring compliance with VHA’s policies at the medical 

centers within their region.14

VHA’s policies outline requirements for the Beneficiary Travel Program’s 

reimbursement process, and can be summarized into the following three 

broad steps:

Administration of the program is largely 

handled at the local medical center level.

• Veteran applies for travel reimbursement: VHA policies stipulate 

that veterans must apply for reimbursement within 30 calendar days 

of the travel. Veterans must provide information on the travel costs 

incurred to the medical center responsible for the care.

• Medical center reviews eligibility and determines reimbursement 

amount: After the veteran applies for reimbursement, VHA requires 

medical centers to assess the veteran’s eligibility for reimbursement,15

 

12See Veterans Health Administration, VHA Beneficiary Travel, VHA Handbook 1601B.05 

(July 21, 2010).

determine distance traveled, and apply appropriate deductibles. For 

example, VHA policies stipulate that except under certain 

circumstances, veterans are reimbursed for mileage between their 

13See Department of Veterans Affairs, VA Financial Policies and Procedures, vol. VIII 

(September 2010) and Veterans Health Administration, VHA Finance Quality Assurance 

Reviews, VHA Handbook 1730.02 (Washington, D.C.: Mar. 16, 2011).

14Each of VA’s 21 VISNs is responsible for managing and overseeing medical centers 

within a defined geographic area.

15Eligibility for reimbursement is assessed by reviewing the veteran’s eligibility for the 

program (such as service-connected disability rating or income level) and the veteran’s 

record to ensure an appointment was completed.

Program Management and 

Oversight
 

Page 7 GAO-13-632 VA Travel Reimbursement

place of residence and the nearest VA facility where the care could be 

provided.16

• Medical center reimburses veteran: After eligibility has been verified 

and reimbursement amounts determined, medical centers reimburse 

veterans those amounts.

Medical centers also have local procedures for managing the program. 

(See app. I for examples of procedures used by some of the medical 

centers included in our review.)

In February 2013, the VA OIG released a report summarizing findings 

from its audit of VHA’s Beneficiary Travel Program.17 The audit revealed 

problems such as inadequate management and oversight, and inaccurate 

payment amounts. Specifically, the VA OIG reported that it did not have 

reasonable assurance that Beneficiary Travel Program costs were 

accurate or were being paid only to eligible veterans. The VA OIG report 

found that from January 2010 through March 2011 VA paid $89 million 

more in beneficiary travel reimbursements than facilities approved, 

including $42.5 million in unexplained payments.18

Additionally, VHA has identified the Beneficiary Travel Program as being 

susceptible to significant improper payments. The Improper Payments 

Elimination and Recovery Act of 2010 (IPERA) requires agencies with 

programs identified as being susceptible to significant improper payments 

to estimate the annual amount of improper payments for each program 

On the basis of its 

findings, the VA OIG recommended that VHA establish and implement 

procedures to strengthen authorization, payment, and oversight controls 

for the program. VHA concurred with the OIG’s findings and 

recommendations and reported that it would, among other things, be 

implementing several initiatives to address the findings.

 

16Veterans can be reimbursed for travel to VA facilities, including medical centers and 

community-based outpatient clinics, or to non-VA facilities if VA determines that it is 

necessary to obtain care at a non-VA facility.

17See Department of Veterans Affairs, Office of Inspector General, Veterans Health 

Administration: Audit of the Beneficiary Travel Program. 

18According to the report, the VA OIG could not determine the reason for $42.5 million in 

unexplained payments due to the lack of an adequate audit trail and system limitations. 

The VA OIG found that the remaining $46.5 million of this discrepancy was due to 

miscoded expenses.
 

Page 8 GAO-13-632 VA Travel Reimbursement

and publish these estimates and corresponding corrective actions in an 

annual report;

19 VA includes this information in its annual Performance 

and Accountability Report. For VA’s 2012 Performance and Accountability 

Report, VHA estimated that the Beneficiary Travel Program had 

$71 million in improper payments.20 IPERA also requires federal 

agencies’ inspectors general to annually determine whether their 

respective agencies are in compliance with IPERA requirements and to 

report on their determinations. In March 2013, the VA OIG reported 

limitations in VHA’s methodology for estimating improper payments for 

the Beneficiary Travel Program and other programs but noted that this 

was not a matter of noncompliance with IPERA requirements.21

VHA has developed multiple efforts to improve the management and 

oversight of its process for reimbursing veterans’ travel expenses for 

medical appointments. However, lack of internal controls for some efforts 

may hinder VHA’s ability to improve the process.

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. (See table 1.) 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 

 

19Pub. L. No. 111-204, 124 Stat. 2224 (2010).

20See Department of Veterans Affairs, Department of Veterans Affairs (VA) 2012 

Performance and Accountability Report. 

21See Department of Veterans Affairs, Office of Inspector General, Department of 

Veterans Affairs: Review of VA’s Compliance with the Improper Payments Elimination and 

Recovery Act for FY 2012, 12-04241-138 (Washington, D.C.: Mar. 15, 2013).

VHA Has Developed 

Efforts to Improve the 

Beneficiary Travel 

Program, but Lack of 

Internal Controls May 

Impede Their 

Effectiveness 

VHA Has Developed 

Efforts That Aim to 

Improve the Management 

and Oversight of the 

Beneficiary Travel 

Program
 

Page 9 GAO-13-632 VA Travel Reimbursement

number of miles from the veteran’s residence to the closest VA medical 

facility where care could be provided.

The efforts are in various stages of development and implementation, 

with some being fully implemented in all medical centers, while others are 

in earlier stages. For some of the efforts, VHA has utilized a pilot process 

in a small number of medical centers to help identify and resolve potential 

problems before releasing the efforts VHA-wide to all medical centers. 

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.22 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, 2013.23 VHA has requested and received an extension from 

the Department of the Treasury on the implementation of electronic funds 

payments to allow VHA to simultaneously implement both the EFT and 

Debit Card efforts. VHA anticipates VHA-wide implementation of both 

efforts by December 31, 2013.

 

22These VISNs were selected because several of their medical centers volunteered to 

work with VHA on the EFT effort, and were familiar with the effort. VHA officials told us 

that they did not use set criteria to select the pilot sites for the EFT effort, and did not see 

a downside of selecting pilot sites based on medical centers’ willingness to participate. 

GAO has reported previously on pilot implementation within VA. See GAO, VA Dialysis 

Pilot: Increased Attention to Planning, Implementation, and Performance Measurement 

Needed to Help Achieve Goals, GAO-12-584 (Washington, D.C.: May 23, 2012).

23See 75 Fed. Reg. 80,315 (Dec. 22, 2010).
 

Page 10 GAO-13-632 VA Travel Reimbursement

Table 1: VHA-Identified Efforts to Improve the Management and Oversight of the Beneficiary Travel Program

Effort Description

Implementation status, 

as of May 14, 2013

Beneficiary Travel 

Analytics Tool 

(Data Mining 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.

●

Beneficiary Travel 

Eligibility Review 

Web-based tool that identifies cases where previously disbursed travel 

benefits need to be collected from veterans whose income levels were 

determined—after final verification—to be above eligibility thresholds. 

●

Beneficiary Travel 

Resource Center

Internal VA Web-based content management system with beneficiary travel 

information, such as links to fact sheets, trainings, and policy guidance, for 

VA staff use. 

●

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 where care 

could be provided. The software is designed to enable VA medical center 

staff to decrease payment processing time and to eliminate the variability in 

how medical centers calculate veterans’ mileage reimbursement.

●

VistA Enhancements Software addition to the VistA system—VA’s electronic health records 

system—that helps medical centers conduct electronic reimbursement 

authorizations and payments by consolidating information needed to 

determine veterans’ eligibility and reimbursement amounts, including income 

level and any deductibles to be applied. The software is designed to improve 

efficiency, mitigate risks, and better detect improper payments for the 

Beneficiary Travel Program.

●

Beneficiary Travel 

Payment and 

Reconciliation 

Program Database

Software tool that enables medical centers to reconcile the reimbursements 

that have been approved for payment with those that have been paid. The 

tool is designed to help reduce the payment processing workload for medical 

centers and improve the efficiency of and standardize payment processes. 

VHA anticipates VHA-wide implementation by May 31, 2013.

◓

Debit Card A VHA-wide card that veterans can use to receive travel reimbursement 

funds electronically. This effort implements a Department of the Treasury 

requirement for federal agencies to provide debit card options for electronic 

payments by March 1, 2013, and aims to improve efficiency, increase 

oversight, and reduce the amount of cash on hand. VHA has requested and 

received an extension from the Department of the Treasury, and anticipates 

VHA-wide implementation by December 31, 2013.

◓

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 by March 1, 2013, and aims to improve efficiency, increase 

oversight, and reduce the amount of cash on hand. VHA has requested and 

received an extension from the Department of the Treasury, and anticipates 

VHA-wide implementation by December 31, 2013. 

◓
 

Page 11 GAO-13-632 VA Travel Reimbursement

Effort Description

Implementation status, 

as of May 14, 2013

Facility Audit Tool Standardized audit process tool to provide VA networks the ability to audit 

their facilities’ past travel reimbursement transactions and operations. The 

tool is designed to help identify opportunities to improve processes that may 

reduce improper payments. VHA does not have a date for VHA-wide 

implementation.



Standard Operating 

Procedures 

(Revised)

Comprehensive standard operating procedures developed for medical 

centers to use in the management of the Beneficiary Travel Program that 

include new or revised processes and documents, such as a revised travel 

reimbursement application. VHA anticipates VHA-wide implementation of 

the procedures by June 30, 2013. 



Travel 

Reimbursement 

Regulations 

(Revised)

Regulations to be revised to incorporate recent legislative changes and 

clarify identified areas of potential confusion, such as the definition of the 

closest facility for care. VHA does not have a date for VHA-wide 

implementation because, according to officials, publication of regulations is a 

lengthy process and cannot be reliably predicted. 



Source: GAO analysis of VHA information.

Legend:

● Fully implemented (e.g., rolled out VHA-wide to all medical centers)

◓ Partially implemented (e.g., in pilot phase in selected medical centers) 

 In development, but not yet implemented

Some of VHA’s efforts to improve the Beneficiary Travel Program have 

been developed in response to OIG and IPERA report findings as 

corrective actions to improve monitoring and oversight of the program and 

to decrease improper payments.23F

24 One such effort is the Facility Audit 

Tool—a tool used to audit facilities’ past travel reimbursement 

transactions and operations through a more standardized process. 

Currently this tool is being used by VHA’s Office of Finance to annually 

audit programs identified as susceptible to improper payments under 

IPERA. VHA officials told us that this tool may ultimately be used by 

VISNs to audit their facilities’ past travel reimbursement transactions and 

operations, but did not have a time frame for its VHA-wide 

implementation.

Officials from the six medical centers we interviewed told us the new 

efforts that have been implemented generally improved or would improve 

some aspects of the Beneficiary Travel Program. For example, medical 

center officials reported that the implementation of the Dashboard had 

increased staff efficiency by decreasing the time needed to determine a 

 

24See Department of Veterans Affairs, 2012 Performance and Accountability Report. 
 

Page 12 GAO-13-632 VA Travel Reimbursement

veteran’s eligibility, as well as increased the accuracy of payments, in line 

with VHA’s goals for this program. In addition, officials said EFT would 

help improve oversight over the payment process. Compared to the 

process of paying veterans in cash, EFT provides an opportunity for the 

medical center staff—in this case the fiscal office staff—to review and 

audit travel payments before a reimbursement is issued to the veteran. 

Officials said these reviews could help medical centers reduce improper 

payments, and that EFT also improves security at medical centers 

because less cash is on hand for reimbursements.

Although medical center officials provided positive feedback on some of 

the efforts, they also identified implementation challenges. For example, 

medical center officials reported difficulty tracking EFT reimbursements, 

and that staff members had received many calls from veterans who were 

confused by only limited information transmitted with the EFT direct 

deposits. In addition, when veterans claimed reimbursements for multiple 

appointments, they did not know which appointment was associated with 

which electronic reimbursement payment, or which reimbursements were 

still pending. According to medical center officials, investigating pending 

reimbursements is time consuming and takes time away from staff 

members’ reimbursement-processing responsibilities. Medical center 

officials also said the lack of information transmitted with the payments 

hinders acceptance of the EFT process in general, as veterans do not 

have complete confidence that their reimbursements are timely and 

accurate.

In our review of VHA’s efforts to improve the Beneficiary Travel Program, 

we found that internal controls were lacking for some of the efforts. The 

implementation of internal controls is important for ensuring efforts 

achieve intended outcomes and minimizing operational problems. Without 

these internal controls in place, VHA cannot ensure that the efforts will 

meet its goals, such as improved management and oversight.

Plan for 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 (Data Mining Tool), as would 

be consistent with internal control standards. According to established 

internal control standards, efforts to improve performance and efficiency 

should include the evaluation of appropriate performance indicators of the 

effort to gauge progress and inform decision making in resolving any 

problems. The Web-based Beneficiary Travel Analytics Tool, 

implemented March 31, 2013, generates travel reimbursement pattern

Lack of Internal Controls 

for Some Efforts May 

Hinder VHA’s Ability to 

Improve the Beneficiary 

Travel Program
 

Page 13 GAO-13-632 VA Travel Reimbursement

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. According to 

VHA officials, medical centers are expected to use the reports generated 

by the tool to diagnose any problems in their own travel reimbursement 

processes and to implement appropriate corrective actions. VHA expects 

medical centers to submit documentation to VHA’s Chief Business Office 

on any resulting corrective actions they have taken. Officials told us that 

they expect to review the corrective actions; however, as of May 14, 

2013, they did not have a documented plan for evaluating travel 

reimbursement pattern data collected for all medical centers on an 

aggregated (VHA-wide) basis.

An appropriate evaluation plan consistent with internal controls would 

include documentation of the frequency of performance indicator 

evaluations, and an analysis plan for assessing either all, or a portion of, 

the travel reimbursement pattern data. Officials acknowledged the need 

to fully develop a plan to ensure that potential weaknesses are identified 

so that needed program improvements may be made. A plan for 

evaluating the data on a VHA-wide basis is necessary to ensure that the 

power of the Beneficiary Travel Analytics Tool is more fully realized.

Timely Guidance. VHA has not provided timely guidance to medical 

centers on its new EFT effort, as would be consistent with internal control 

standards. According to these standards, reliable and timely program 

information should be provided to management and others to ensure that 

responsibilities are being carried out and VHA goals are being met. 

Specifically, despite being aware of the March 1, 2013, Department of the 

Treasury deadline for implementation of EFT in December 2010, VHA did 

not provide guidance to medical centers on how to implement the effort 

until February 22, 2013. Had the guidance been provided earlier, it would 

have provided timely, key information to medical centers on the 

implementation of EFT, including the process that medical centers should 

be using to enroll veterans; the procedures for veterans to request a 

waiver from an electronic payment when they have an immediate need 

for a cash payment; and VHA’s contingency plan for the travel 

reimbursement process due to its delay in providing policies for 

implementing EFT VHA-wide. By delaying the issuance of the guidance, 

VHA failed to ensure that all medical centers were provided with 

consistent and timely guidance, which, according to medical center 

officials we spoke with, led to frustration for medical centers, as well as 

confusion for veterans. For example, most medical centers in our review 
 

Page 14 GAO-13-632 VA Travel Reimbursement

already had developed their own local procedures for enrolling veterans 

into EFT and processing payments before VHA’s EFT pilot began; 

officials from some of the medical centers in our review expressed 

frustration that they would have to revise some of these processes when 

the VHA-wide effort was eventually implemented.

Effective Communication. 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. Specifically, VHA did not share information on EFT with 

medical centers to help them inform veterans of the coming changes until 

February 22, 2013. VHA officials acknowledged they failed to develop a 

communications plan in a timely manner, and agreed that this is 

something they should have done to help ensure the success of the 

conversion to EFT. By not communicating this information in a timely 

manner, VHA did not ensure that medical centers had consistent and 

accurate information for informing veterans of the change in payment 

options, potentially affecting veterans’ enrollment in EFT and their 

satisfaction with the new reimbursement process. Although officials from 

some medical centers we spoke with said they have developed their own 

materials for communicating with veterans about EFT, having 

communication materials come from VHA headquarters would have 

carried more weight with veterans and provided more consistency across 

all medical centers for this VHA-wide effort.

Plan for Monitoring Compliance. 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. For example, 

medical centers are required to use the Dashboard, and VHA officials told 

us that VHA-wide procedures for using the Dashboard will be included in 

the program’s revised Standard Operating Procedures. However, VHA 

officials told us they do not have a plan in place to ensure that each 

medical center is using this new software. Without knowing whether all 

medical centers are using this required software or using it consistently, 

VHA cannot ensure that the Dashboard’s goals, including standardizing 

the mileage calculations, will be realized.

Furthermore, because medical centers have the flexibility to develop local 

procedures for administering the Beneficiary Travel Program, it is 

important that VHA monitor local procedures to ensure they are 

consistent with VHA policies. For example, one medical center in our 

review automatically generates travel reimbursement payments to eligible 

veterans after each completed appointment. Thus, instead of applying for 
 

Page 15 GAO-13-632 VA Travel Reimbursement

reimbursement after each medical center appointment, eligible veterans 

who have a signature on record can simply leave the medical center after 

their appointment and receive their reimbursement payment by mail or 

direct deposit. Acknowledging that this automatic payment procedure is 

different from other medical centers, medical center officials said it has 

greatly increased the efficiency of their management of the Beneficiary 

Travel Program and has received positive feedback from veterans and 

staff. Monitoring compliance with program policies, especially due to 

differences in local procedures, is an important internal control for 

ensuring that program goals are being met.

Use Information to Improve Efficiency. VHA does not routinely collect 

information on medical centers’ local procedures for administering the 

Beneficiary Travel Program to identify and share best practices. 

According to federal internal control standards, identifying and sharing 

best practices is an essential part of ensuring an effective and efficient 

use of resources. For example, officials at one of the medical centers we 

interviewed said that installing drop boxes at multiple locations around 

their facility was a simple and efficient way to make the process more 

convenient for veterans, shorten lines at the Beneficiary Travel Office, 

and improve staff productivity. Some medical center officials described 

sharing best practices on an ad hoc basis with colleagues in other 

medical centers, and said that learning from others’ experiences is 

valuable to their administration of the Beneficiary Travel Program. 

Although VHA officials described one instance of evaluating a software 

program for national use that was developed and implemented at one 

medical center, they have not regularly solicited information on best 

practices; instead, they have relied on medical center and VISN officials 

to identify and share information. A more systematic identification and 

sharing of best practices would enhance medical centers’ access to the 

same information in order to minimize problems and maximize 

efficiencies within the Beneficiary Travel Program.

For more than 70 years, VHA’s Beneficiary Travel Program has 

reimbursed eligible veterans for travel expenses associated with medical 

appointments. 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. This increase is of particular note, as 

travel reimbursements come out of the same VA medical center funds 

used for patient care. At the same time spending is increasing, concerns 

have been raised about the accuracy of payments and VHA’s 

management and oversight of the program.

Conclusions 
 

Page 16 GAO-13-632 VA Travel Reimbursement

In response to these concerns, VHA has taken steps to improve its 

process for reimbursing veterans for travel expenses by developing 

multiple efforts aimed at enhancing management and oversight of the 

program. However, some of the efforts lack key internal controls that 

would help VHA better manage and oversee its program. 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. Without appropriate management and oversight, 

VHA is unable to ensure that its Beneficiary Travel Program—which is on 

track to spend nearly $1 billion dollars annually in the next few years—is 

operating effectively, including assurances that payments made through 

the program are appropriate.

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 

improvement efforts, and

• routinely collecting information to identify and share best practices 

across medical centers.

We provided a draft of this report to VA for comment. VA generally 

agreed with our conclusions and concurred with our recommendation. VA 

identified the activities that VHA would undertake to ensure appropriate 

internal controls have been identified and applied related to the four 

specific efforts we noted: performance indicators for the Beneficiary 

Travel Analytics Tool, guidance and communication to medical centers 

regarding EFT, compliance with Dashboard and other improvement 

Recommendation for 

Executive Action

Agency Comments 

and Our Evaluation
 

Page 17 GAO-13-632 VA Travel Reimbursement

efforts, and identification and sharing of best practices across medical 

centers. VA did not directly address ensuring that appropriate internal 

controls are identified and applied in the development and implementation 

of all efforts aimed at improving the program. We continue to emphasize 

the importance of internal controls to the success of VHA's efforts. VA’s 

comments are reprinted in appendix II. VA also provided technical 

comments, which we have incorporated as appropriate.

We are sending copies of this report to the Secretary of Veterans Affairs 

and appropriate congressional committees. In addition, the report will be 

available at no charge on the GAO website at http://www.gao.gov. 

If you or your staff have any questions about this report, please contact 

me at (202) 512-7114 or draperd@gao.gov. Contact points for our Offices 

of Congressional Relations and Public Affairs may be found on the last 

page of this report. GAO staff who made key contributions to this report 

are listed in appendix III.

Debra A. Draper

Director, Health Care
Page 18 GAO-13-632 VA Travel Reimbursement

List of Requesters

The Honorable Jeff Miller

Chairman

Committee on Veterans’ Affairs

House of Representatives

The Honorable Karen Bass

House of Representatives

The Honorable Ken Calvert

House of Representatives

The Honorable John Campbell

House of Representatives

The Honorable Lois Capps

House of Representatives

The Honorable Judy Chu

House of Representatives

The Honorable Jim Costa

House of Representatives

The Honorable Susan Davis

House of Representatives

The Honorable Joe Heck

House of Representatives

The Honorable Duncan D. Hunter

House of Representatives

The Honorable Darrell Issa

House of Representatives

The Honorable Kevin McCarthy

House of Representatives

The Honorable Howard P. McKeon

House of Representatives
Page 19 GAO-13-632 VA Travel Reimbursement

The Honorable Gary Miller

House of Representatives

The Honorable Grace Napolitano

House of Representatives

The Honorable Dana Rohrabacher

House of Representatives

The Honorable Lucille Roybal-Allard

House of Representatives

The Honorable Ed Royce

House of Representatives

The Honorable Loretta Sanchez

House of Representatives

The Honorable Adam Schiff

House of Representatives

The Honorable Brad Sherman

House of Representatives

The Honorable Henry A. Waxman

House of Representatives
Appendix I: Examples of VA Medical Center 

Procedures for Administering the Beneficiary 

Travel Program

Page 20 GAO-13-632 VA Travel Reimbursement

Travel reimbursement 

policy requirement Example of medical center procedurea Medical center rationale 

Veteran applies for travel 

reimbursement 

Veteran submits claim for reimbursement at 

medical center travel office.

Allows medical center to provide same-day claim 

review, and in some cases reimbursement.

Veteran puts claim for reimbursement in a 

designated drop box.

Helps reduce the lines at the medical center’s 

travel office, is more convenient for veterans, and 

allows medical center staff more time to review 

the claim.

Medical center reviews eligibility 

and determines reimbursement 

amount

Medical center staff check veteran’s name 

against photo identification for each claim 

submitted in person.

Helps improve accuracy and reduce improper 

payments by ensuring the appropriate person is 

reimbursed.

Medical center staff check veteran’s address 

and name against information maintained in 

VA’s data system for claims not submitted in 

person, such as for a veteran using a drop box.

Helps improve accuracy and reduce improper 

payments by ensuring correct addresses are 

used, and VA has consistent information about 

the veteran in its data system.

Medical center reimburses 

veteran

Reimbursement provided primarily through 

cash.b Allows for same-day reimbursement.

Reimbursement provided primarily through a 

check.b Limits cash payments, which may shorten veterans’ time waiting at the medical center’s 

travel office, and reduces security and other risks 

associated with having large amounts of cash onhand at medical centers. Also, helps ensure VHA 

has valid addresses for veterans for calculating 

travel reimbursements, because these addresses 

are where the checks are mailed.

Reimbursement provided primarily through 

direct deposit or a debit card.

Limits cash payments, which may shorten 

veterans’ time waiting at the medical center’s 

travel office, and reduces security and other risks 

associated with having large amounts of cash onhand at medical centers. Also, turn-around time 

for veterans’ receipt of direct deposit or debit 

card reimbursements is generally shorter than for 

check reimbursements.

Source: VHA and the VA medical centers included in our review.

a

VA medical centers may employ one or more of these procedures; for example, a medical center 

may allow veterans to apply for travel reimbursement by submitting a claim at the travel office, putting 

a claim in a designated drop box, or both.

b

This procedure will change with full implementation of the Electronic Funds Transfer and Debit Card 

efforts.

Appendix I: Examples of VA Medical Center 

Procedures for Administering the Beneficiary 

Travel Program
Appendix II: Comments from the Department 

of Veterans Affairs

Page 21 GAO-13-632 VA Travel Reimbursement

Appendix II: Comments from the Department 

of Veterans Affairs
Appendix II: Comments from the Department 

of Veterans Affairs

Page 22 GAO-13-632 VA Travel Reimbursement
Appendix II: Comments from the Department 

of Veterans Affairs

Page 23 GAO-13-632 VA Travel Reimbursement
Appendix III: GAO Contact and Staff 

Acknowledgments

Page 24 GAO-13-632 VA Travel Reimbursement

Debra A. Draper, (202) 512-7114 or draperd@gao.gov

In addition to the contact named above, Janina Austin, Assistant Director; 

Jennie Apter; Robin Burke; Kelli Jones; Lisa Motley; and Karin Wallestad 

made key contributions to this report.

Appendix III: GAO Contact and Staff 

Acknowledgments 

GAO Contact

Staff 

Acknowledgments 

(291087)
The Government Accountability Office, the audit, evaluation, and 

investigative arm of Congress, exists to support Congress in meeting its 

constitutional responsibilities and to help improve the performance and 

accountability of the federal government for the American people. GAO 

examines the use of public funds; evaluates federal programs and 

policies; and provides analyses, recommendations, and other assistance 

to help Congress make informed oversight, policy, and funding decisions. 

GAO’s commitment to good government is reflected in its core values of 

accountability, integrity, and reliability.

The fastest and easiest way to obtain copies of GAO documents at no 

cost is through GAO’s website (http://www.gao.gov). Each weekday 

afternoon, GAO posts on its website newly released reports, testimony, 

and correspondence. To have GAO e-mail you a list of newly posted 

products, go to http://www.gao.gov and select “E-mail Updates.”

The price of each GAO publication reflects GAO’s actual cost of 

production and distribution and depends on the number of pages in the 

publication and whether the publication is printed in color or black and 

white. Pricing and ordering information is posted on GAO’s website, 

http://www.gao.gov/ordering.htm. 

Place orders by calling (202) 512-6000, toll free (866) 801-7077, or 

TDD (202) 512-2537. 

Orders may be paid for using American Express, Discover Card, 

MasterCard, Visa, check, or money order. Call for additional information.

Connect with GAO on Facebook, Flickr, Twitter, and YouTube. 

Subscribe to our RSS Feeds or E-mail Updates. Listen to our Podcasts. 

Visit GAO on the web at www.gao.gov. 

Contact:

Website: http://www.gao.gov/fraudnet/fraudnet.htm

E-mail: fraudnet@gao.gov

Automated answering system: (800) 424-5454 or (202) 512-7470

Katherine Siggerud, Managing Director, siggerudk@gao.gov, (202) 512-

4400, U.S. Government Accountability Office, 441 G Street NW, Room 

7125, Washington, DC 20548

Chuck Young, Managing Director, youngc1@gao.gov, (202) 512-4800

U.S. Government Accountability Office, 441 G Street NW, Room 7149 

Washington, DC 20548

GAO’s Mission

Obtaining Copies of 

GAO Reports and 

Testimony 

Order by Phone 

Connect with GAO

To Report Fraud, 

Waste, and Abuse in 

Federal Programs

Congressional 

Relations 

Public Affairs

Please Print on Recycled Paper.