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

Highlights

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).

Recommendations

Recommendations for Executive Action

Agency Affected	Recommendation	Status
Department of Labor	The Secretary of Labor should direct OWCP to reestablish district office quality control reviews.	Closed – Implemented When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
Department of Labor	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.	Closed – Implemented When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
Department of Labor	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.	Closed – Not Implemented Labor believes that periodic matches of SSA and Labor benefit rolls will result in proper benefit offsets.
Department of Labor	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.	Closed – Implemented Periodic matches are done on a regular basis; Labor's Inspector General's Office monitors these matches.
Department of Labor	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.	Closed – Implemented OWCP only checked with states where there was a reasonable probability of conducting a match.
Department of Labor	The Secretary of Labor should direct OWCP to ensure that interest and medical expenses are identified and billed to coal mine operators.	Closed – Implemented When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
Department of Labor	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.	Closed – Implemented When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
Department of Labor	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.	Closed – Implemented 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.
Department of Labor	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.	Closed – Implemented When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
Department of Labor	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.	Closed – Implemented 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.
Department of Labor	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.	Closed – Implemented When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
Department of Labor	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.	Closed – Implemented Action was completed and will be verified in early 1986.
Department of Labor	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.	Closed – Implemented According to the Employment Standards Administration, revised accountability standards place greater emphasis on ensuring the accuracy of payments.

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Employment

Black lung diseaseClaims processingCoalminers benefitsDual compensationErroneous paymentsHealth care cost controlInformation systemsReporting requirementsState programsBeneficiaries