Employment:

Labor Inaccurately Paid Black Lung Benefits--Some Corrective Actions Taken but More Are Needed

HRD-83-46: Published: May 13, 1983. Publicly Released: Jun 14, 1983.

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In response to a congressional request, GAO reviewed the black lung workers' compensation and medical expense payment systems administered by the Department of Labor's Office of Workers' Compensation Programs (OWCP).

GAO estimated that, through 1982, Labor had incorrectly paid 26 percent of the beneficiaries in the GAO sample, resulting in overpayments and underpayments totaling $65 million. GAO also estimated that an amount equaling $24 million of these errors had been corrected by the time that GAO initiated its case file review. In addition, Labor also identified other overpayments which totaled about $5 million. Beneficiaries were inappropriately receiving more than one black lung benefit from Labor, the Social Security Administration (SSA), or from a state workers' compensation program. According to the responsible officials, many payment errors were caused by the work loads created by amendments to the original black lung legislation. GAO identified several problem areas affecting quality control and recordkeeping which contributed to the payment errors. Labor has recognized many of these problems and has initiated actions to reduce future errors. GAO also found that problems in medical payments identified during an inspector general's review still exist and that Labor has not used fee schedules to ensure that medical payments are reasonable.

Recommendations for Executive Action

  1. Status: Closed - Implemented

    Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.

    Recommendation: The Secretary of Labor should direct OWCP to ensure that OWCP accountability reviews and district office quality control reviews address the accuracy of payment changes made after benefits begin.

    Agency Affected: Department of Labor

  2. Status: Closed - Not Implemented

    Comments: Labor believes that periodic matches of SSA and Labor benefit rolls will result in proper benefit offsets.

    Recommendation: The Secretary of Labor should direct OWCP to obtain a complete, up-to-date list of SSA claims decisions to identify when benefits should be offset.

    Agency Affected: Department of Labor

  3. Status: Closed - Implemented

    Comments: Periodic matches are done on a regular basis; Labor's Inspector General's Office monitors these matches.

    Recommendation: The Secretary of Labor should direct OWCP to periodically match Labor's benefits rolls with those of SSA to ensure that individuals are not receiving dual black lung benefits to which they are not entitled.

    Agency Affected: Department of Labor

  4. Status: Closed - Implemented

    Comments: OWCP only checked with states where there was a reasonable probability of conducting a match.

    Recommendation: The Secretary of Labor should direct OWCP to contact state workers' compensation offices and, where possible, establish mechanisms for periodically matching Labor's benefits rolls with state compensation rolls.

    Agency Affected: Department of Labor

  5. Status: Closed - Implemented

    Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.

    Recommendation: The Secretary of Labor should direct OWCP to ensure that interest and medical expenses are identified and billed to coal mine operators.

    Agency Affected: Department of Labor

  6. Status: Closed - Implemented

    Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.

    Recommendation: The Secretary of Labor should request the Office of Inspector General to evaluate the Coal Mine Workers' Compensation Division's new processing system to determine whether it effectively implements previous Inspector General recommendations.

    Agency Affected: Department of Labor

  7. Status: Closed - Implemented

    Comments: In March 1986, final regulations for OWCP fee schedules were published. However, these are legal questions about applying the schedule to the Black Lung Program. According to a Labor official, the medical payment system for black lung incorporates features for ensuring that fees are reasonable.

    Recommendation: The Secretary of Labor should monitor the development and implementation of OWCP fee schedules to ensure that future black lung-related treatment costs are reasonable and that the Coal Mine Workers' Compensation Division appropriately documents payments which exceed these schedules.

    Agency Affected: Department of Labor

  8. Status: Closed - Implemented

    Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.

    Recommendation: The Secretary of Labor should direct OWCP to clarify procedures as to when claims examiners should contact state workers' compensation offices to verify claimants' statements related to state black lung benefits.

    Agency Affected: Department of Labor

  9. Status: Closed - Implemented

    Comments: Labor integrated the dependent monitoring system and the annual questionnaire activities. According to the Employment Standards Administration, the monthly dependent monitoring system reports are generated and distributed for followup.

    Recommendation: The Secretary of Labor should direct OWCP to follow up on dependent monitoring system reports to determine whether documentation supporting continued eligibility is available. When such information is not available or is not provided by beneficiaries, it should ensure that past overpayments are identified and collection action is initiated.

    Agency Affected: Department of Labor

  10. Status: Closed - Implemented

    Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.

    Recommendation: The Secretary of Labor should direct OWCP to redesign the annual postentitlement questionnaire to clarify the information and documentation needed and review, on a timely basis, the questionnaire responses to identify when benefit levels should be adjusted.

    Agency Affected: Department of Labor

  11. Status: Closed - Implemented

    Comments: Action was completed and will be verified in early 1986.

    Recommendation: The Secretary of Labor should direct OWCP to ensure that the new automated system is used to record and monitor collection efforts for new and existing debts.

    Agency Affected: Department of Labor

  12. Status: Closed - Implemented

    Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.

    Recommendation: The Secretary of Labor should direct OWCP to reestablish district office quality control reviews.

    Agency Affected: Department of Labor

  13. Status: Closed - Implemented

    Comments: According to the Employment Standards Administration, revised accountability standards place greater emphasis on ensuring the accuracy of payments.

    Recommendation: The Secretary of Labor should direct OWCP to ensure that supervisors monitor each claims examiner's work by reviewing at least some of the source documents that form the basis for making payment decisions.

    Agency Affected: Department of Labor

 

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