VA Reviews Veteran Disability Claims for “Fraud”
The Department of Veterans Affairs has announced plans to use an automated fraud-detection tool for disability claims, raising concerns about the VA’s ability to manage such claims, with or without the use of Artificial Intelligence (AI).
VA Reviews Veteran Disability Claims for “Fraud”
The VA says AI technology will scan more than one million disability benefits questionnaires (DBQs) to identify evidence of fabrication in the disability claims process.
What’s a DBQ? According to federal government sources, “DBQs allow Veterans to submit medical evidence from their health care provider to support their claims for disability benefits. Veterans are entitled to a no-cost disability examination by VA if an examination is deemed necessary to decide the claim for benefits.”
But there is concern at the VA that some DBQs are not filled out in good faith. What’s the reality?
>> Never miss on ways to save! Subscribe to the MyMilitaryBenefits Discounts Newsletter today.
How Much VA Disability Claims Fraud Is There?
An article in The Guardian notes that the VA disability claims system paid out nearly $200 billion in benefits in 2024 alone. Claims of VA compensation fraud represent, according to the Guardian, “less than one-one-hundredth of a percent (0.005%) of that total.”
The VA’s automated fraud detection initiative is meant (at press time) to review VA claims documents dating back to 2010. It utilizes artificial intelligence to detect markers of suspicious activity, such as boilerplate language or altered templates. There’s just one problem. Artificial intelligence platforms are notorious for fabricating or “hallucinating” responses to their orders.
In researching this article, one AI platform was given a simple instruction: “Find three examples of automated AI processes that failed.” AI was told specifically not to hallucinate or fabricate a response. What did the AI platform do with these instructions?
It fabricated three instances of AI automation “fails” that did not exist in the real world. The Department of Veterans Affairs wants us to believe they can get better results.
How the AI Review System Handles Alleged Claims Fraud
When the VA’s artificial intelligence tool flags a VA claims document, official sources say the agency likely will order a new medical evaluation. This standard exam confirms the current status of a service-connected condition. The problem with this part of the process is that it can take a long time to get an appointment under the VA system, and the potential for serious backlogs is high, as decidedly non-fraudulent claims are re-examined.
Turning AI loose on the VA medical records system is likely to create a large volume of re-examinations for legit claims, and a percentage of veterans in the VA system since 2010 may need to prepare for potential VA claims audits.
>> Never miss on ways to save! Subscribe to the MyMilitaryBenefits Discounts Newsletter today.
How to do this? Some recommend that veterans keep their health records current and perform regular doctor visits to help correlate the severity of a condition described in a questionnaire. If a review occurs, consistent documentation assists in verifying the claimant’s medical history.
But should veterans who have become sick or injured while serving their country have to resort to such moves?
In addition, Congress is at press time reviewing the FRAUD in VA Disability Exams Act, legislation that would require formal notice when a file is under investigation.
It also aims to prevent benefit reductions without a criminal conviction. Supporters argue these rules provide a necessary defense against decisions based on suspicion alone.
Selective data use is a concern. Stars and Stripes notes some veteran advocates and lawmakers are fed up with what they call “cherry-picking” so-called VA benefits fraud cases from millions of claims “properly awarded to sick and injured former service members,” according to Stripes.com
>> Never miss on ways to save! Subscribe to the MyMilitaryBenefits Discounts Newsletter today.
About the author
Editor-in-Chief Joe Wallace is a 13-year veteran of the United States Air Force and a former reporter/editor for Air Force Television News and the Pentagon Channel. His freelance work includes contract work for Motorola, VALoans.com, and Credit Karma. He is co-founder of Dim Art House in Springfield, Illinois, and spends his non-writing time as an abstract painter, independent publisher, and occasional filmmaker.
