Summary
In light of the recent mobilizations associated with the Global War on Terrorism, GAO was asked to determine if the Army's overall environment and controls provided reasonable assurance that soldiers who were injured or became ill in the line of duty were receiving the pay and other benefits to which they were entitled in an accurate and timely manner. GAO's audit used a case study approach to provide perspective on the nature of these pay deficiencies in the key areas of (1) overall environment and management controls, (2) processes, and (3) systems. GAO also assessed whether recent actions the Army has taken to address these problems will offer effective and lasting solutions.
Injured and ill reserve component soldiers--who are entitled to extend their active duty service to receive medical treatment--have been inappropriately removed from active duty status in the automated systems that control pay and access to medical care. The Army acknowledges the problem but does not know how many injured soldiers have been affected by it. GAO identified 38 reserve component soldiers who said they had experienced problems with the active duty medical extension order process and subsequently fell off their active duty orders. Of those, 24 experienced gaps in their pay and benefits due to delays in processing extended active duty orders. Many of the case study soldiers incurred severe, permanent injuries fighting for their country including loss of limb, hearing loss, and back injuries. Nonetheless, these soldiers had to navigate the convoluted and poorly defined process for extending active duty service. The Army's process for extending active duty orders for injured soldiers lacks an adequate control environment and management controls--including (1) clear and comprehensive guidance, (2) a system to provide visibility over injured soldiers, and (3) adequate training and education programs. The Army has also not established user-friendly processes--including clear approval criteria and adequate infrastructure and support services. Many Army locations have used ad hoc procedures to keep soldiers in pay status; however, these procedures often circumvent key internal controls and put the Army at risk of making improper and potentially fraudulent payments. Finally, the Army's nonintegrated systems, which require extensive errorprone manual data entry, further delay access to pay and benefits. The Army recently implemented the Medical Retention Processing (MRP) program, which takes the place of the previous process in most cases. MRP, which authorizes an automatic 179 days of pay and benefits, may have resolved many of the processing delays experienced by soldiers. However, MRP has some of the same issues and may also result in overpayments to soldiers who are released early from their MRP orders. Out of 132 soldiers the Army identified as being released from active duty, 15 received pay past their release date--totaling approximately $62,000.
Recommendations
Our recommendations from this work are listed below with a Contact for more information. Status will change
from "In process" to "Implemented" or "Not implemented" based on our follow up work.
Director:
Team:
Phone:
Gregory D. Kutz
Government Accountability Office: Financial Management and Assurance
(202) 512-9505
Recommendations for Executive Action
Recommendation: The Secretary of the Army should direct the Deputy Chief of Staff, Army G-1 to develop and promulgate--with appropriate input from the Regional Medical Commands, hospital commanders, medical hold unit commanders, and case managers--comprehensive, integrated policies and procedures for managing and treating reserve component soldiers with service-connected injuries or illnesses. At a minimum, standard operating procedures, and guidance should be developed that address specific organizational responsibilities for managing programs that deal with injured or ill reserve component soldiers, including specifying which officials have the ultimate responsibility for the success of these programs.
Agency Affected: Department of Defense: Department of the Army
Status: Implemented
Comments: The Department of the Army issued Medical Holdover (MHO) Consolidated Guidance, which includes clear and comprehensive guidance for the installations to utilize in effectively managing the Medical Retention Processing (MRP) program, including specific organizational responsibilities for administering MRP.
Recommendation: The Secretary of the Army should direct the Deputy Chief of Staff, Army G-1 to develop and promulgate--with appropriate input from the Regional Medical Commands, hospital commanders, medical hold unit commanders, and case managers--comprehensive, integrated policies and procedures for managing and treating reserve component soldiers with service-connected injuries or illnesses. At a minimum, standard operating procedures, and guidance should be developed that address where orders that extend a soldier's active duty status are to be issued, how they are to be distributed, and to whom they are to be distributed--for both command and control purposes and to update the Army's pay, personnel, and medical eligibility systems.
Agency Affected: Department of Defense: Department of the Army
Status: Implemented
Comments: The Department of the Army issued Medical Holdover (MHO) Consolidated Guidance, which includes clear and comprehensive guidance for the installations to utilize in effectively managing the Medical Retention Processing (MRP) program, including an Order Distribution List covering the command and control, pay, personnel, and medical eligibility functions.
Recommendation: The Secretary of the Army should direct the Deputy Chief of Staff, Army G-1 to develop and promulgate--with appropriate input from the Regional Medical Commands, hospital commanders, medical hold unit commanders, and case managers--comprehensive, integrated policies and procedures for managing and treating reserve component soldiers with service-connected injuries or illnesses. At a minimum, standard operating procedures, and guidance should be developed that address standards for being retained on active duty orders, including time frames and criteria for extension or retention beyond one year.
Agency Affected: Department of Defense: Department of the Army
Status: Implemented
Comments: The Department of the Army has issued Medical Holdover (MHO) Consolidated Guidance, which includes eligibility criteria for being retained on active duty orders, including guidelines for extension of orders beyond one year.
Recommendation: The Secretary of the Army should direct the Deputy Chief of Staff, Army G-1 to develop and promulgate--with appropriate input from the Regional Medical Commands, hospital commanders, medical hold unit commanders, and case managers--comprehensive, integrated policies and procedures for managing and treating reserve component soldiers with service-connected injuries or illnesses. At a minimum, standard operating procedures, and guidance should be developed that address criteria that clearly establishes priorities for where a soldier may be attached for medical care (i.e. medical facility has the specialties and the capacity needed to treat the soldier, proximity to soldier's residence).
Agency Affected: Department of Defense: Department of the Army
Status: Implemented
Comments: The Department of the Army issued Medical Holdover (MHO) Consolidated Guidance, which includes guidelines for soldiers on Medical Retention Processing (MRP) orders--including both those assigned to an MRP Unit and those assigned to a Community Based Healthcare Organization (CBHCO) location--based on eligibility criteria set forth in the Consolidated Guidance.
Recommendation: The Secretary of the Army should direct the Deputy Chief of Staff, Army G-1 to develop and promulgate--with appropriate input from the Regional Medical Commands, hospital commanders, medical hold unit commanders, and case managers--comprehensive, integrated policies and procedures for managing and treating reserve component soldiers with service-connected injuries or illnesses. At a minimum, standard operating procedures, and guidance should be developed that address minimum eligibility criteria for soldiers applying for such programs as Active Duty Medical Extension (ADME) and MRP.
Agency Affected: Department of Defense: Department of the Army
Status: Implemented
Comments: The Department of the Army issued Medical Holdover (MHO) Consolidated Guidance, which includes minimum eligibility criteria for soldiers applying for the Medical Retention processing (MRP) and Active Duty Medical Extension (ADME) programs.
Recommendation: The Secretary of the Army should direct the Deputy Chief of Staff, Army G-1 to develop and promulgate--with appropriate input from the Regional Medical Commands, hospital commanders, medical hold unit commanders, and case managers--comprehensive, integrated policies and procedures for managing and treating reserve component soldiers with service-connected injuries or illnesses. At a minimum, standard operating procedures, and guidance should be developed that address avenues through which soldiers may apply for such programsas ADME and MRP.
Agency Affected: Department of Defense: Department of the Army
Status: Implemented
Comments: The Department of the Army issued Medical Holdover (MHO) Consolidated Guidance, which includes guidance on the avenues through which eligible soldier may apply for MRP and ADME.
Recommendation: The Secretary of the Army should direct the Deputy Chief of Staff, Army G-1 to develop and promulgate--with appropriate input from the Regional Medical Commands, hospital commanders, medical hold unit commanders, and case managers--comprehensive, integrated policies and procedures for managing and treating reserve component soldiers with service-connected injuries or illnesses. At a minimum, standard operating procedures, and guidance should be developed that address specific documentation required to retain or extend active duty orders for medical treatment or evaluation.
Agency Affected: Department of Defense: Department of the Army
Status: Implemented
Comments: The Department of the Army has issued Medical Holdover (MHO) Consolidated Guidance, which includes a list and examples of the specific documentation required to retain or extend active duty orders for the purpose of medical treatment or evaluation.
Recommendation: The Secretary of the Army should direct the Deputy Chief of Staff, Army G-1 to develop and promulgate--with appropriate input from the Regional Medical Commands, hospital commanders, medical hold unit commanders, and case managers--comprehensive, integrated policies and procedures for managing and treating reserve component soldiers with service-connected injuries or illnesses. At a minimum, standard operating procedures, and guidance should be developed that address entitlements of eavh program for both the soldier and his/her dependents.
Agency Affected: Department of Defense: Department of the Army
Status: Implemented
Comments: The Department of the Army has issued Medical Holdover (MHO) Consolidated Guidance, which includes a list of the entitlements available for injured reserve component soldiers and their dependents.
Recommendation: The Secretary of the Army should direct the Deputy Chief of Staff, Army G-1 to develop and promulgate--with appropriate input from the Regional Medical Commands, hospital commanders, medical hold unit commanders, and case managers--comprehensive, integrated policies and procedures for managing and treating reserve component soldiers with service-connected injuries or illnesses. At a minimum, standard operating procedures, and guidance should be developed that address correctly linking the cost of these programs to the mission or operation in which the soldier was involved.
Agency Affected: Department of Defense: Department of the Army
Status: Implemented
Comments: The Medical Retention Processing (MRP) program replaced the Active Duty Medical Extension (ADME) process for treating mobilized reserve component soldiers with service-related injuries or illnesses incurred as part of the Global War on Terror (GWOT). Under the new MRP program, the costs associated with providing medical care to these soldiers are correctly linked to GWOT funds.
Recommendation: The Secretary of the Army should direct the Deputy Chief of Staff, Army G-1 to require that the officials designated with the responsibility for managing these programs develop performance measures to evaluate the program's success. Such performance measures should be sufficient to enable the Army to evaluate the efficiency and effectiveness of these programs--including timeliness of application processing, soldier satisfaction, and the length of time soldiers are in the program.
Agency Affected: Department of Defense: Department of the Army
Status: In process
Comments: Although the Army has begun tracking some management information related to MRP, it is unclear how this information has been used to improve decision making.
Recommendation: The Secretary of the Army should direct the Deputy Chief of Staff, Army G-1 to require that the officials designated with the responsibility for managing these programs develop performance measures to evaluate the program's success. Such performance measures should be sufficient to enable the Army to take any corrective actions needed to address documented shortcomings in program performance.
Agency Affected: Department of Defense: Department of the Army
Status: In process
Comments: Although the Army has begun tracking some management information related to MRP, it is unclear how this information has been used to improve decision making.
Recommendation: The Secretary of the Army should direct the Deputy Chief of Staff, Army G-1 to provide the infrastructure and resources needed to support these programs and make needed process improvements to provide reasonable assurance that officials responsible for managing and treating injured and ill reserve component soldiers are adequately trained on program requirements, benefits, and processes.
Agency Affected: Department of Defense: Department of the Army
Status: In process
Comments: We found that although the Army has provided more training and education opportunities under the new MRP program than were offered under ADME, additional actions are needed to provide mandatory, formalized training and education for those officials responsible for managing and treating injured or ill reserve component soldiers.
Recommendation: The Secretary of the Army should direct the Deputy Chief of Staff, Army G-1 to provide the infrastructure and resources needed to support these programs and make needed process improvements to provide reasonable assurance that reserve component soldiers and unit commanders will be educated on these programs, their requirements, and their benefits.
Agency Affected: Department of Defense: Department of the Army
Status: In process
Comments: Although the Army has provided more training and education opportunities under the new MRP program than were offered under ADME, additional actions to provide mandatory, formalized training and education for reserve component soldiers are still needed.
Recommendation: The Secretary of the Army should direct the Deputy Chief of Staff, Army G-1 to provide the infrastructure and resources needed to support these programs and make needed process improvements to provide reasonable assurance that the administrative burden on the soldier is alleviated through coordinated, customer-friendly processes and easy access to staff responsible for both the administrative and medical treatment aspects of the programs.
Agency Affected: Department of Defense: Department of the Army
Status: Implemented
Comments: The Medical Retention Processing (MRP) program, which replaced the Active Duty Medical Extension (ADME) process for reserve component soldiers mobilized as part of the Global War on Terror, has dramatically reduced the administrative burden on soldiers because the application process is more streamlined. Also, the Department of the Army has issued Medical Holdover (MHO) Consolidated Guidance, which includes the Medical Holdover (MHO) Soldier's Handbook. The handbook is given to soldiers entering the MRP program and describes in detail the program's processes and procedures, as well as the soldier's responsibilities while remaining on active duty orders to receive medical treatment.
Recommendation: The Secretary of the Army should direct the Deputy Chief of Staff, Army G-1 to provide the infrastructure and resources needed to support these programs and make needed process improvements to provide reasonable assurance that paper-intensive application processes are replaced with user-friendly automated processes, to the extent possible, through which soldiers are notified or have easy access to the current status of their application.
Agency Affected: Department of Defense: Department of the Army
Status: Implemented
Comments: The Medical Retention Processing (MRP) program, which replaced the Active Duty Medical Extension (ADME) process for reserve component soldiers mobilized as part of the Global War on Terror, is more user-friendly than the ADME program. Because MRP applications are approved in two to three days instead of two or three weeks, which was the case under ADME, the need for automated processes to track the status of applications is less important. Also, the Department of the Army has issued Medical Holdover (MHO) Consolidated Guidance, which includes an initial packet checklist, extension packet checklist, and an administrative function checklist for all soldiers to use who are applying for MRP.
Recommendation: The Secretary of the Army should direct the Deputy Chief of Staff, Army G-1 to provide the infrastructure and resources needed to support these programs and make needed process improvements to provide reasonable assurance that the practice of garnishing soldiers' wages to resolve accounting problems created by the use of retroactive rescissions of soldiers' orders is ended.
Agency Affected: Department of Defense: Department of the Army
Status: Implemented
Comments: The Medical Retention Processing (MRP) program, which replaced the Active Duty Medical Extension (ADME) process for reserve component soldiers mobilized as part of the Global War on Terror, uses a more streamlined application process than that used by the ADME program. Therefore, soldiers' active duty orders do not expire before new orders are issued, which was the case with ADME. As a result, Army installations no longer need to garnish soldiers' wages to resolve accounting problems created by the use of ad hoc procedures used to keep soldiers in pay status.
Recommendation: The Secretary of the Army should direct the Deputy Chief of Staff, Army G-1 to, in the near term, require that the gaining Military Treatment Facility (MTF) is notified and receives a copy of the soldier's orders when a soldier is transferred from one MTF to another for treatment.
Agency Affected: Department of Defense: Department of the Army
Status: Implemented
Comments: The Department of the Army issued Medical Holdover (MHO) Consolidated Guidance, which contains guidelines requiring the losing MTF to notify and provide a copy of the soldier's orders to the gaining MTF when a soldier is transferred from one MTF to another for treatment. Based on our ongoing work in this area, all of the installations we visited were routinely following this guidance.
Recommendation: The Secretary of the Army should direct the Deputy Chief of Staff, Army G-1 to, in the near term, require that the information in the Medical Operational Data System is routinely updated and utilized to the maximum extent possible to provide visibility over and manage injured and ill reserve component soldiers.
Agency Affected: Department of Defense: Department of the Army
Status: Implemented
Comments: Officials at each of the installations we visited told us that MODS was reliable, accurate, complete, and useful in managing soldiers on Medical Retention Processing (MRP) orders. Our follow up data reliability assessments at these installations confirmed that data in MODS were reasonably accurate and complete. In addition, we found Army officials were routinely using MODS to track and manage soldiers on MRP orders, as instructed in Army's guidance on the program.
Recommendation: The Secretary of the Army should direct the Deputy Chief of Staff, Army G-1 to, in the near term, require that new orders extending active duty for injured or ill soldiers are sent directly to the staff responsible for updating the appropriate pay, personnel, and medical eligibility systems.
Agency Affected: Department of Defense: Department of the Army
Status: Implemented
Comments: The Department of the Army has issued Medical Holdover (MHO) Consolidated Guidance, which includes an Order Distribution List and requires that new orders be sent directly to the organizations responsible for updating the pay, personnel, and medical eligibility systems.
Recommendation: The Secretary of the Army should direct the Deputy Chief of Staff, Army G-1 to, in the near term, require that controls are put in place to provide assurance that the order end date in the pay system is changed to reflect the actual date the soldier was released from active duty when soldiers are released from active duty before their orders expire.
Agency Affected: Department of Defense: Department of the Army
Status: In process
Comments: The Army has not put additional controls in place to provide assurance that the order end date in the pay system is changed to reflect the actual date the soldier was released from active duty when soldiers are released from active duty before their orders expire. As a result, the Army risks overpaying these soldiers.
Recommendation: The Secretary of the Army should direct the Deputy Chief of Staff, Army G-1 to, in the long term, design and implement integrated order writing, pay, personnel, and medical eligibility systems that provide visibility over injured and ill reserve component soldiers.
Agency Affected: Department of Defense: Department of the Army
Status: In process
Comments: Manual processes and nonintegrated order writing, pay, personnel, and medical eligibility systems at the Army are labor intensive, require extensive error-prone manual data entry and reentry, and continue to contribute to processing delays that affect the visibility over reserve component soldiers in the MRP program.
Recommendation: The Secretary of the Army should direct the Deputy Chief of Staff, Army G-1 to, in the long term, design and implement integrated order writing, pay, personnel, and medical eligibility systems that ensure that the order writing system automatically updates the pay, personnel, and medical eligibility systems.
Agency Affected: Department of Defense: Department of the Army
Status: In process
Comments: The Army has not created an order writing system that automatically updates the pay, personnel, and medical eligibility systems. Manual processes and nonintegrated order writing, pay, personnel, and medical eligibility systems at the Army are labor intensive, require extensive error-prone manual data entry and reentry, and continue to contribute to processing delays that affect the Army's ability to ensure efficient visibility and accountability over reserve component soldiers.
