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.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. 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 rating is less than 30 percent; receive VA pension benefits; have an annual income below a set annual rate; present clear evidence that they are unable to defray the cost of travel; or are traveling for compensation and pension exams. 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. Since the program’s inception, Congress has made several modifications, including adjusting eligibility requirements, types of travel expenses covered, deductible costs, 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. 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. 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. VHA’s Office of Finance is responsible for establishing national policies for the processing of payments for reimbursement and financial quality assurance. 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.handled at the local medical center level. Administration of the program is largely VHA’s policies outline requirements for the Beneficiary Travel Program’s reimbursement process, and can be summarized into the following three broad steps: 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,determine distance traveled, and apply appropriate deductibles. For example, VHA policies stipulate that except under certain circumstances, veterans are reimbursed for mileage between their place of residence and the nearest VA facility where the care could be provided. 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. 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. 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. 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 and publish these estimates and corresponding corrective actions in an annual report; 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. 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. 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 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. 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. 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. 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. 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 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.