Report 2008-113 Summary - December 2008

Victim Compensation and Government Claims Board

:

It Has Begun Improving the Victim Compensation Program, but More Remains to Be Done

HIGHLIGHTS

Our review of the Victim Compensation Program (program) at the Victim Compensation and Government Claims Board (board) revealed the following:

RESULTS IN BRIEF

California's Victim Compensation Program (program) provides compensation for victims of crimes who are injured or threatened with injury. Eligible family members or other specified persons may also be eligible for compensation under the program. The program covers many types of services, including medical and mental health services, when the costs are not covered by other sources, such as insurance. The Victim Compensation and Government Claims Board (board) administers the program.

State law prescribes the type of compensation the board can make, and depending on the circumstances, payment can be made either directly to an individual or to a provider of services. From fiscal years 2001-02 through 2004-05, program compensation payments sustained a 50 percent decrease ($123.9 million to $61.6 million) as a result of the board members' attempts to maintain the fiscal viability of the Restitution Fund, from which the board makes disbursements for the program. Compensation payments have increased since fiscal year 2004-05, but not to the level they reached in fiscal year 2001-02.

Despite the significant decline in payments, the costs the board incurs to support the program have increased. These costs account for a significant portion of Restitution Fund disbursements—ranging from 26 percent to 42 percent annually during the seven year period we reviewed. However, the board does not set a goal that focuses on the correlation between compensation payments and program support costs, nor does it set similar goals, although creating and maintaining such goals could help the board ensure that it is providing the highest possible level of assistance to victims and their families.

Our testing of 49 applications from fiscal years 2003-04 through 2007-08 revealed that the board generally complied with state laws and regulations for determining whether applicants are eligible for program benefits. However, the program did not always process applications and bills as promptly or efficiently as it could have. State law requires the board to approve or deny applications within an average of 90 calendar days and to take no longer than 180 calendar days from the acceptance date to approve or deny any individual application. For the 49 applications we reviewed, the average processing time was 76 days, which is well within the statutory average. However, we noted two instances in which the board did not make a determination within 180 days of the application acceptance date. We also noted various instances in which the board did not demonstrate that it approved or denied applications as promptly as it could have after receiving the information necessary to make a determination.

State law also requires the board to pay initial mental health bills within 90 days of receipt and bills for medical services within an average of 90 days of receipt, if the application has been approved. Although state law does not require all bill types to be paid within specific time frames, we believe 90 days is reasonable. For comparative purposes, we measured all of the bills against the 90 day time frame. For the 77 paid bills we reviewed, the average processing time was 66 days. However, in 23 instances, staff took more than 90 days to pay the bills.

The board's procedures for following up with outside entities—such as law enforcement, physicians, hospitals, and employers—to obtain information necessary to verify bills are not sufficiently detailed and contribute to inconsistencies in staff efforts to obtain the information promptly. Even when staff initially request information promptly and follow up if it is not received, some entities delay their response. The board told us it is reaching out to some entities to emphasize the importance of providing requested information in a timely manner. This needs to be a continuing area of focus for the board. Further, although the board has procedures to verify whether bills are reimbursable from other sources such as insurance or public assistance, staff were not consistent in following these procedures. Also, the board could not always provide documentation to support the formal approval of the applications and bills we reviewed.

The board began transitioning to its current system for processing applications and bills, the Compensation and Restitution System (CaRES), in late June 2006 and began using CaRES exclusively after June 2008. Although the board expects to gain efficiencies and benefits from the use of the new system—such as speeding up payments to applicants and providers, enhancing customer service, and facilitating improved sharing of workload—it generally has not developed benchmarks or measured results. Further, the board has experienced numerous problems with the transition to CaRES. Perhaps most troubling was our identification of payments that appeared to be erroneous. Specifically, data from CaRES indicated that bills that had been denied were paid, bills that had been marked as purged from the system were paid, and amounts exceeding the figures billed were paid. Although board staff provided explanations for these payments, asserting that the payments were appropriate but that the data were flawed due to problems with the system, the fact that they were unaware of these items indicates an absence of controls that would prevent erroneous payments from occurring. Representatives we interviewed from five victim witness assistance centers (assistance centers) told us that during the transition they experienced an increase in complaints regarding delays in processing applications and bills. We also discovered that the board lacks the necessary documentation for the system, hindering its ability to efficiently undertake modifications to CaRES or respond to questions about the system.

The board's current process for managing its workload is informal: It has not established benchmarks, performance measures, or formal written procedures for workload management. Because the reporting function in CaRES, which would provide aging information concerning items not yet processed, is not working yet, the board is forced to use ad hoc reports that are not reliable, causing it to lack important information needed to effectively manage its workload. Our efforts to assess the board's processing of its backlog were hampered by data problems and the transition to CaRES. However, our analysis of processing times for the board's initial decisions on completed CaRES applications indicates that, while on average the board is making decisions on applications within the statutory deadline, it is not doing so within the statutory deadline established for individual applications in many instances. Our analysis of the average time taken to process bills, for bills received through request for payment, is 87 days, which does not include the additional time between payment request and when a payment is issued. 1

For outreach, an important responsibility, the board's primary focus in fiscal year 2007-08 was to increase awareness of the program. Its efforts include a variety of activities such as a multimedia campaign and improving outreach materials. The board worked with its key partners—joint powers (JP) units, which review applications and bills at the local level, and victim advocates at assistance centers—to further expand outreach efforts. However, representatives we spoke to at several of the assistance centers do not think the public is generally aware of program services and believe the board could conduct more outreach to certain groups.

The board has not established a comprehensive outreach plan to assist it in appropriately prioritizing its efforts and focusing on those in need of program services. It is just beginning to consider demographic and crime statistics information in planning outreach. Further, the board has an opportunity to do more to ensure that it is reaching vulnerable populations—those groups of individuals that are more susceptible to being victims of crime and those that are less likely to participate in the program. In May 2008 the board identified a goal to increase program awareness by 10 percent by July 2009. However, as of October 2008 management was still considering various outreach efforts and how best to quantitatively measure their success.

RECOMMENDATIONS

The board should establish a complementary set of goals designed to measure its success in maximizing assistance to victims and their families. These goals should include one that focuses on the correlation of compensation payments to program support costs and one that establishes a target fund balance.

To improve its processing time for making decisions on applications and for paying bills, the board should identify the primary problems leading to delays and take action to resolve them. As part of its efforts, it should develop specific procedures for staff to use when following up with verifying entities, and it should continue its outreach efforts to communicate to verifying entities the importance of responding promptly to requests for information.

The board should ensure that staff consistently verify and document that bills received could not be paid from other reimbursable sources. Additionally, the board should consistently maintain documentation of its formal approval of applications and bills.

To ensure that it maximizes its use of CaRES, the board should continue correcting problems as they arise and develop goals, objectives, and benchmarks related to the functions it carries out under CaRES that will allow it to measure its progress in providing prompt, high quality service. Additionally, it should develop and maintain system documentation sufficient to allow staff to address modifications and questions about the system more efficiently and effectively.

The board should develop written procedures for managing its workload and should implement the reporting function in CaRES as soon as possible. Further, it should establish benchmarks and performance measures to evaluate whether it is effectively managing its workload.

To ensure that the board appropriately carries out its outreach efforts, it should develop a comprehensive plan that prioritizes its efforts and focuses on those in need of program services, and it should consider demographic and crime statistics information when planning outreach strategies. Additionally, the board should seek input from key stakeholders such as assistance centers, JP units, and other advocacy groups and associations to gain insight regarding underserved and vulnerable populations. Further, it should establish quantitative measures to evaluate the effectiveness of its outreach efforts.

AGENCY COMMENTS

The board responded that it agreed with the recommendations and outlined a number of steps that it will take to implement them.

1 The 66 days previously discussed reflects the average processing time of 77 paid bills associated with our review of 49 applications for a five year period. The 87 days discussed here represents the average processing time of bills as reported by CaRES, which reflects the board's more recent performance.