oversight

Veterans' Pension Benefits: Improvements Needed to Ensure Only Qualified Veterans and Survivors Receive Benefits

Published by the Government Accountability Office on 2012-05-15.

Below is a raw (and likely hideous) rendition of the original report. (PDF)

             United States Government Accountability Office

GAO          Report to Congressional Requesters




May 2012
             VETERANS’ PENSION
             BENEFITS
             Improvements Needed
             to Ensure Only
             Qualified Veterans and
             Survivors Receive
             Benefits




GAO-12-540
                                               May 2012

                                               VETERANS’ PENSION BENEFITS

                                               Improvements Needed to Ensure Only Qualified
Highlights of GAO-12-540, a report to          Veterans and Survivors Receive Benefits
congressional requesters




Why GAO Did This Study                         What GAO Found
The VA pension program is intended to          The Department of Veterans Affairs’ (VA) pension program design and
provide economic benefits to wartime           management do not adequately ensure that only veterans with financial need
veterans and survivors with financial          receive pension benefits. While the pension program is means tested, there is no
need. GAO was asked to examine (1)             prohibition on transferring assets prior to applying for benefits. Other means-
how the design and management of               tested programs, such as Medicaid, conduct a look-back review to determine if
VA’s pension program ensure that only          an individual has transferred assets at less than fair market value, and if so, may
those with financial need receive              deny benefits for a period of time, known as the penalty period. This control helps
pension benefits and (2) what is known         ensure that only those in financial need receive benefits. In contrast, VA pension
about organizations that are marketing
                                               claimants can transfer assets for less than fair market value immediately prior to
financial products and services to
                                               applying and be approved for benefits. For example, GAO identified a case
enable veterans and survivors to
qualify for VA pension benefits. GAO’s
                                               where a claimant transferred over a million dollars less than 3 months prior to
study included a review of VA’s                applying and was granted benefits. Also, VA’s process for assessing initial
policies and procedures, site visits to        eligibility is inadequate in several key respects. The application form does not
VA’s three Pension Management                  ask for some sources of income and assets such as private retirement income,
Centers, and online research and               annuities, and trusts. As a result, VA lacks complete information on a claimant’s
interviews of organizations that market        financial situation. Also, the form does not ask about asset transfers—information
financial and estate planning services         VA needs to determine whether these assets should be included when assessing
to help veterans and survivors qualify         eligibility. In addition, VA does not verify all the information it does request on the
for VA pension benefits.                       form. For example, VA does not routinely request supporting documents, such as
                                               bank statements or tax records, unless questions are raised. VA’s fiduciary
What GAO Recommends                            program, which appoints individuals to manage the financial affairs of
                                               beneficiaries who are unable to do so themselves, collects financial information
Congress should consider establishing          that may affect some pension recipients’ eligibility, but VA pension claims
a look-back and penalty period for             processors do not have access to all this information. Further, guidance on when
pension claimants who transfer assets          assets should be included as part of a claimant’s net worth is unclear; and VA
for less than fair market value prior to
                                               claims processors must use their own discretion when assessing eligibility for
applying, similar to other federally
                                               benefits, which can lead to inconsistent decisions.
supported means-tested programs.
VA should (1) request information              GAO identified over 200 organizations that market financial and estate planning
about asset transfers and other assets         services to help pension claimants with excess assets meet financial eligibility
and income sources on application              requirements for these benefits. These organizations consist primarily of financial
forms, (2) verify financial information        planners and attorneys who offer products such as annuities and trusts. GAO
during the initial claims process,             judgmentally selected a nongeneralizable sample of 25 organizations, and GAO
(3) strengthen coordination with VA’s          investigative staff successfully contacted 19 while posing as a veteran’s son
fiduciary program, and (4) provide             seeking information on these services. All 19 said a claimant can qualify for
clearer guidance to claims processors
                                               pension benefits by transferring assets before applying, which is permitted under
assessing claimants’ eligibility. In its
                                               the program. Two organization representatives said they helped pension
comments on this report, VA concurred
with three of GAO’s recommendations            claimants with substantial assets, including millionaires, obtain VA’s approval for
and concurred in principle with one,           benefits. About half of the organizations advised repositioning assets into a trust,
citing concerns about the potential            with a family member as the trustee to direct the funds to pay for the veteran’s
burden on claimants and recipients of          expenses. About half also advised placing assets into some type of annuity.
verifying reported financial information.      Some products and services provided, such as deferred annuities, may not be
VA agreed to study the issue further.          suitable for the elderly because they may not have access to all their funds for
                                               their care within their expected lifetime without facing high withdrawal fees. Also,
                                               these products and services may result in ineligibility for Medicaid for a period of
View GAO-12-540. View related video clip.      time. Among the 19 organizations contacted, the majority charged fees, ranging
For more information, contact Daniel Bertoni   from a few hundred dollars for benefits counseling to $10,000 for establishment
at (202) 512-7215 or bertonid@gao.gov.
                                               of a trust.
                                                                                         United States Government Accountability Office
Contents


Letter                                                                                             1
                       Background                                                                  2
                       VA Pension Program Design and Management Do Not Ensure Only
                         Those with Financial Need Receive Benefits                                6
                       Many Organizations Help VA Pension Claimants Transfer Assets to
                         Qualify for Benefits                                                    15
                       Conclusions                                                               22
                       Matter for Congressional Consideration                                    22
                       Recommendations for Executive Action                                      23
                       Agency Comments and Our Evaluation                                        23

Appendix I             Objectives, Scope, and Methodology                                        26



Appendix II            Full Transcript of Selected Calls with Organizations Providing Products
                       and Services to Help Claimants Qualify for VA Pension Benefits          29



Appendix III           Comments from the Department of Veterans Affairs                          58



Appendix IV            GAO Contact and Staff Acknowledgments                                     63



Related GAO Products                                                                             64



Table
                       Table 1: 2012 Maximum Annual Pension Benefit Limits                         4


Figures
                       Figure 1: Section of Application Form Pertaining to Income and
                                Assets                                                             9
                       Figure 2: Excerpts from Websites of Organizations That Offer to
                                Transfer Assets to Help Claimants Qualify for VA Pension
                                Benefits                                                         16



                       Page i                                           GAO-12-540 Veterans’ Benefits
Figure 3: Transcript Excerpts of Calls with Organizations Providing
         Products and Services to Help Claimants Qualify for VA
         Pension Benefits                                                                 17




Abbreviations
EVR       Eligibility Verification Report
IVM       Income Verification Match
PMC       Pension Management Centers
SSA       Social Security Administration
SSI       Supplemental Security Income
VA        Department of Veterans Affairs
VBA       Veterans Benefits Administration


View GAO Components
Video: Examples of Messages from Companies about Transferring
Assets to Qualify for VA Pension Benefits


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Page ii                                                     GAO-12-540 Veterans’ Benefits
United States Government Accountability Office
Washington, DC 20548




                                   May 15, 2012

                                   The Honorable Patty Murray
                                   Chairman
                                   The Honorable Richard Burr
                                   Ranking Member
                                   Committee on Veterans’ Affairs
                                   United States Senate

                                   The Honorable Herb Kohl
                                   Chairman
                                   Special Committee on Aging
                                   United States Senate

                                   The Honorable Ron Wyden
                                   United States Senate

                                   The Department of Veterans Affairs’ (VA) pension program is intended to
                                   provide economic benefits to wartime veterans with financial need. It is
                                   available to veterans who are age 65 and older or who have disabilities that
                                   are unrelated to their military service, as well as to their surviving spouses
                                   and dependent children. To be eligible for VA pension benefits, a claimant
                                   must meet certain income and asset requirements. Recently, concerns
                                   have been raised that some organizations are marketing financial products
                                   and other services to enable claimants whose assets exceed the pension
                                   program’s financial eligibility thresholds to qualify for these benefits. Also,
                                   these organizations may charge substantial fees for products and services
                                   that may not always be in claimants’ best long-term interests.

                                   At your request, we reviewed VA’s pension program. Specifically, we
                                   examined (1) how the design and management of VA’s pension program
                                   ensure that only those with financial need receive pension benefits, and
                                   (2) what is known about organizations that are marketing financial
                                   products and services to veterans and survivors to enable them to qualify
                                   for VA pension benefits. To address our first objective, we reviewed
                                   relevant federal laws and regulations, as well as policies and procedures
                                   regarding how VA assesses financial eligibility for pension benefits. We
                                   interviewed officials from VA headquarters, as well as staff at VA’s three
                                   Pension Management Centers (PMC) to determine how these policies
                                   and procedures are applied. We also reviewed a nongeneralizable
                                   random sample of 85 pension claims that were entered into VA’s
                                   electronic case file system in fiscal year 2010, in which VA had to formally


                                   Page 1                                              GAO-12-540 Veterans’ Benefits
             determine if the claimant met asset thresholds. 1 To address our second
             objective, we conducted internet research and interviews with veterans’
             advocacy groups, VA officials, and state and local officials to identify
             organizations that market financial and estate planning services to help
             veterans and surviving spouses qualify for VA pension benefits. We
             contacted some of these organizations to obtain their views on the types
             and suitability of the products and services they provide. In addition, we
             judgmentally selected 25 organizations to contact where our investigative
             staff posed as the son of an 86-year-old veteran, to obtain first-hand
             information about the types of products and services provided, and
             associated costs for a potential pension claimant. The 25 organizations
             were judgmentally selected to achieve geographic dispersion and include
             both financial planners and attorneys. Based on availability, we had
             discussions with representatives of 19 of these organizations.

             We conducted this performance audit from July 2011 to May 2012 in
             accordance with generally accepted government auditing standards.
             These standards require that we plan and perform the audit to obtain
             sufficient, appropriate evidence to provide a reasonable basis for our
             findings and conclusions based on our audit objectives. We believe that
             the evidence obtained provides a reasonable basis for our findings and
             conclusions based on our audit objectives. Additional information on our
             scope and methodology is provided in appendix I.


             In fiscal year 2011, VA provided about $ 4.3 billion in pension benefits for
Background   about 517,000 recipients. These benefits are available to low-income
             wartime veterans who are age 65 and older, or who are under age 65 but
             are permanently and totally disabled as a result of conditions unrelated to
             their military service. 2 Surviving spouses and dependent children may
             also be eligible for these benefits. At the end of fiscal year 2011, about


             1
               Our sample was nongeneralizable because not all pension claims where VA had to
             determine if the claimant met asset thresholds had been entered into VA’s electronic case
             file system in fiscal year 2010.
             2
               VA currently administers three pension programs, commonly referred to as Improved
             Law Pensions (Pub. L. No. 95-588, 92 Stat. 2497), Prior Law Pensions (Pub. L. No. 86-
             211, 73 Stat. 432), and Old Law Pensions (Pub. L. No. 73-2, 48 Stat. 8). About 95 percent
             of all pension recipients are under the Improved Pension program, and new beneficiaries
             can only accede to this program. We will focus on the Improved Pension program in this
             report. For veterans with service-connected disabilities, VA provides cash benefits through
             its disability compensation program.




             Page 2                                                      GAO-12-540 Veterans’ Benefits
314,000 pension recipients were veterans and about 203,000 were
survivors. Also, about 329,000 recipients were over 65 and the average
age was 71 for veterans and 79 for survivors. Average annual payments
in fiscal year 2011 were $9,669 for veterans and $6,209 for survivors.

VA provides pension benefits through its Veterans Benefits Administration
(VBA), and accredits representatives of veterans’ service organizations,
attorneys, and claims agents to assist claimants with the preparation and
submission of VA claims at no charge. 3 To become accredited, an
individual must meet certain requirements set forth in federal law. 4 Claims
processors assess claims at VBA’s three Pension Management Centers
(PMC) in Philadelphia, Penn.; Milwaukee, Wis.; and Saint Paul, Minn. As
part of the pension program, VA provides enhanced pension benefit
amounts to veterans and surviving family members who demonstrate the
need for aid and attendance, or who are considered permanently
housebound. 5 For pension beneficiaries who are deemed unable to
manage their affairs due to mental impairments, VA appoints a fiduciary
to manage the beneficiary’s finances.

To qualify for pension benefits, claimants’ countable income must not
exceed annual pension limits that are set by statute. These income limits
are also the maximum annual pension payment that a beneficiary may
receive. Such limits may vary based on whether claimants are veterans or
survivors and their family composition, as well as whether claimants need
aid and attendance or are considered housebound. For example, to
qualify for pension benefits in 2012, a veteran with no dependents and
who is in need of Aid and Attendance benefits cannot have income that
exceeds $20,447, while a surviving spouse in similar circumstances


3
 See 38 U.S.C. §§ 5901-5904.
4
 Id.
5
 Veterans may be eligible for Aid and Attendance benefits if they demonstrate an inability
to perform everyday personal functions such as bathing, dressing, eating, adjusting
prosthetic devices, and protecting themselves from hazards or dangers in their daily
environment. They may also be eligible for these benefits if they are a patient in a nursing
home, bedridden, or are blind or nearly blind. Veterans may be eligible for Housebound
benefits if they have a disability rated at 100 percent and, as a result, are permanently or
substantially confined to their homes, or have a disability rated at 100 percent and at least
one other disability rated at 60 percent or more (although these individuals are legally
classified as housebound, they may be able to leave their homes). See GAO, VA
Enhanced Monthly Benefits: Recipient Population Is Changing, and Awareness Could Be
Improved, GAO-12-153 (Washington, D.C.: Dec. 14, 2011).




Page 3                                                        GAO-12-540 Veterans’ Benefits
                                       cannot have an income that exceeds $13,138. In determining if a
                                       claimant’s income is below program thresholds, VA includes recurring
                                       sources of income such as the Social Security Administration’s (SSA)
                                       retirement and disability benefits, but not income from public assistance
                                       programs such as Supplemental Security Income (SSI). VA also allows
                                       some expenses, such as certain unreimbursed medical expenses that
                                       exceed 5 percent of the maximum pension amount the claimant is eligible
                                       for, to be deducted from a claimant’s countable income. The annual
                                       amount pension beneficiaries receive is the difference between their
                                       countable income and the maximum pension amount they would be
                                       eligible for (see table 1). 6

Table 1: 2012 Maximum Annual Pension Benefit Limits

                                                                                              Limit for surviving     Limit for surviving
                            Limit for veteran with           Limit for veteran with              spouse with no         spouse with one
Type of benefit                    no dependents                    one dependent                    dependents               dependent
Pension without Aid and                    $12,256                                $16,051                 $8,219                 $10,759
Attendance or
Housebound benefit
Pension with Housebound                     14,978                                  18,773                10,046                  12,582
benefit
Pension with Aid and                        20,447                                  24,239                13,138                  15,673
Attendance benefit
                                       Source: GAO analysis of information from VA website.



                                       VA’s policy manual specifically states that the pension program is not
                                       intended to protect substantial assets or preserve an estate for a
                                       beneficiary’s heirs. In assessing financial eligibility for pension benefits,
                                       VA also considers net worth or the total value of claimants’ assets, such
                                       as bank accounts, stocks, bonds, mutual funds, and any property other
                                       than the claimant’s dwelling, a reasonable lot area, a vehicle, and
                                       personal belongings. 7 There are no thresholds on the value of a




                                       6
                                        Certain veterans who receive nursing home or domiciliary care at the government’s
                                       expense are only eligible for no more than $90.00 per month in pension benefits.
                                       7
                                        See 38 C.F.R. § 3.275. For claimants who are veterans, VA also assesses the net worth
                                       of the veteran’s spouse to determine financial eligibility.




                                       Page 4                                                                GAO-12-540 Veterans’ Benefits
claimant’s assets that are defined in statute. 8 However, according to VA’s
procedures manual, claims processors are generally required to formally
determine if claimants with assets worth over $80,000 have financial
resources that will last a reasonable period of time to pay for their basic
expenses. In making this determination, claims processors consider net
worth, income, expenses, age, and life expectancy to determine if
claimants’ financial resources are sufficient to pay for their expenses
without assistance from VA. Ongoing eligibility for pension recipients who
previously reported any income other than, or in addition to, Social
Security income is also assessed. These recipients must complete an
annual Eligibility Verification Report (EVR), which requests information on
income and assets, that is used to determine if recipients continue to be
financially eligible for the pension program. 9

Potential VA pension recipients may also be eligible for other means-
tested programs. For example, they may be eligible for Medicaid, a joint
federal-state health care financing program that provides coverage for
long-term care services for certain individuals whose income and
resources do not exceed specific thresholds. Each state administers its
Medicaid program and establishes specific income and resource eligibility
requirements that must fall within federal standards, but we reported in
2007 that in most states, an individual must have $2,000 or less in
countable financial resources to be eligible. 10 Similarly, the SSI program
provides cash benefits to individuals who are age 65 or older, blind, or
disabled, and who have limited income and whose financial resources are
$2,000 or less ($3,000 if the individual lives with their spouse). 11




8
 The relevant statute states that a veteran’s pension shall be denied “when the corpus of
the estate of the veteran or, if the veteran has a spouse, the corpus of the estates of the
veteran and of the veteran’s spouse is such that under all the circumstances, including
consideration of the annual income of the veteran, the veteran’s spouse, and the veteran’s
children, it is reasonable that some part of the corpus of such estates be consumed for the
veteran’s maintenance.” 38 U.S.C. § 1522(a).
9
38 C.F.R. § 3.277.
10
  GAO, Medicaid Long-Term Care: Few Transferred Assets before Applying for Nursing
Home Coverage; Impact of Deficit Reduction Act on Eligibility Is Uncertain, GAO-07-280
(Washington, D.C.: Mar. 26, 2007).
11
 Individuals in some states who require long-term care services can become eligible for
Medicaid benefits through participation in the SSI program.




Page 5                                                      GAO-12-540 Veterans’ Benefits
VA Pension Program
Design and
Management Do Not
Ensure Only Those
with Financial Need
Receive Benefits

Program Allows Claimants      We found several potential vulnerabilities in the VA pension program’s
to Transfer Assets Prior to   design, as well as in VA’s policies and procedures, that hinder the
Applying, Unlike Other        department’s ability to ensure that only those in financial need receive
                              benefits. More specifically, the program allows claimants to transfer
Means-Tested Programs         assets prior to applying for benefits, and VA lacks complete information
                              on claimants’ finances, relies on self-reported information, and does not
                              utilize all opportunities for coordination within the agency. Additionally,
                              guidance that claims processors use may be unclear. Despite being
                              means-tested, the program currently permits VA pension claimants to
                              transfer assets and reduce their net worth prior to applying for these
                              benefits. 12 Federal regulations state that, when evaluating financial
                              eligibility for pension benefits, assets gifted to someone that does not
                              reside in the claimant’s household will reduce the claimant’s net worth if
                              all rights of ownership and control of the assets have been relinquished. 13
                              As a result, prior to applying for benefits, claimants can transfer excess
                              assets to someone outside their household to meet the financial eligibility
                              criteria for VA pension benefits and be approved, as long as they no
                              longer retain ownership or control of the assets. 14 For example, we
                              identified a case involving a pension recipient who transferred over a
                              million dollars in assets into an irrevocable trust less than 3 months prior
                              to applying for these benefits. 15 VA was aware of the asset transfer when



                              12
                               38 C.F.R. § 3.276(b).
                              13
                               Id.
                              14
                                Assets gifted to a family member in the pension claimant’s household do not reduce the
                              claimant’s net worth.
                              15
                                An irrevocable trust is one that cannot be terminated by the individual who set up the
                              trust once it is created. Black’s Law Dictionary (8th ed. 2004).




                              Page 6                                                       GAO-12-540 Veterans’ Benefits
this pension claim was approved and did not count the trust as part of the
claimant’s net worth. Although these types of transfers are generally
permitted under law for the pension program, this practice is not
consistent with other federal means-tested programs and weakens the
pension program’s goal of supporting those with financial need.

In contrast, for Medicaid—another means tested program—federal law
explicitly restricts eligibility for coverage for long term care for certain
individuals who transfer assets for less than fair market value prior to
applying. 16, 17 As a result, when an individual applies for Medicaid
coverage for long-term care, states conduct a look-back—a review to
determine if the applicant transferred assets for less than fair market
value prior to applying. Individuals who transfer assets for less than fair
market value during the 60 months prior to applying may be denied
eligibility for long-term care coverage for a period of time, known as the
penalty period. 18 For example, gifting assets would generally be
considered a transfer of assets at less than fair market value and would
result in a penalty period. Also, under the SSI program, claimants who
transfer assets for less than fair market value prior to applying may
become ineligible for these benefits for up to 36 months. 19




16
 42 U.S.C. § 1396p(c).
17
  An asset transfer at less than fair market value would occur when the claimant gifts or
sells a resource and gets in return an amount that is less than the value of the resource on
the open market at the time of the transfer.
18
  The penalty period is calculated by dividing the uncompensated dollar value of the
assets transferred by the average monthly cost of private nursing home care in the state
(or in the community, at the option of the state). The penalty period generally begins on
the later of (1) the first day of the month during or after which the individual transferred
assets at less than fair market value, or (2) the date on which the individual would have
been eligible for Medicaid coverage for long-term care if it were not for these asset
transfers. Certain asset transfers are exempt from Medicaid penalty provisions such as a
home transferred to an individual’s spouse or disabled child. Asset transfers would also
not be penalized if the individual can demonstrate that the transfer was carried out
exclusively for purposes other than qualifying for Medicaid, or when the state determines
that the penalty would result in undue hardship. 42 U.S.C. § 1396p(c).
19
     42 U.S.C. § 1382b(c)(1)(A).




Page 7                                                        GAO-12-540 Veterans’ Benefits
VA Lacks Complete           VA lacks complete information on claimants’ finances because the forms
Information on Claimants’   used to assess financial eligibility do not prompt applicants to report
Finances                    certain types of income and asset information. While the instructions on
                            the pension application forms ask claimants to report all income sources
                            and assets they own, 20 the forms do not provide spaces for claimants to
                            report some types of income and assets. For example, even though
                            elderly pension claimants may receive private monthly retirement income,
                            such as income from a company’s retirement plan, the application forms
                            do not specifically provide space for claimants to report such income.
                            According to SSA, in 2009, 9 percent of the aggregate income of those
                            age 65 and older consisted of private pension income. 21

                            The application forms do provide a space to report other income sources
                            not specifically itemized on the forms. However, some claims processors
                            we spoke with said claimants who report an amount in that space do not
                            usually specify the source of this income, or if this amount represents a
                            single or a combination of income sources. As a result, they have to
                            follow up with the claimant to obtain this information, which delays the
                            processing of these claims.

                            Similarly, although the application forms specifically ask claimants to
                            report assets such as bank accounts, stocks, and real property, the forms
                            do not ask about other common assets such as annuities and trusts,
                            which need to be considered when VA assesses claimants’ financial
                            eligibility. (See figure 1 to view the section of the application form
                            pertaining to income and assets.) 22 We found cases where claimants did
                            not report assets that they are not specifically asked to report. For
                            example, in one case a claimant did not report a trust with assets valued
                            at about $575,000. In another case, a claimant did not report a trust worth



                            20
                              VA has one pension application form for veterans and another form for surviving
                            spouses and dependents.
                            21
                              Social Security Administration, Fast Facts and Figures about Social Security 2011
                            (Washington D.C.: August 2011).
                            22
                              An annuity is a financial instrument that provides income over a defined period of time
                            for an initial payment of principal. An immediate annuity provides income immediately after
                            the initial lump-sum payment. For a deferred annuity, the initial investment accumulates
                            interest over a specified period of time before payments begin to be received. A trust is an
                            arrangement in which a grantor transfers property to a trustee with the intention that it be
                            held, managed, or administered by the trustee for the benefit of the grantor or certain
                            designated individuals.




                            Page 8                                                       GAO-12-540 Veterans’ Benefits
                                        about $612,000. In contrast, we reviewed several state application forms
                                        for Medicaid long-term care benefits that specifically asked individuals to
                                        report information about annuities and trusts they may own, as well as
                                        retirement income.

Figure 1: Section of Application Form Pertaining to Income and Assets




                                        VA’s application forms also do not provide a specific space for claimants
                                        to report asset transfers, even though the instructions on the veterans’
                                        application form ask claimants to disclose this information. Asset transfers
                                        to someone outside the claimant’s household are allowed under the
                                        pension program, as long as the claimant relinquishes ownership and
                                        control of the asset. However, VA still needs to know about any asset
                                        transfers when assessing a claimant’s financial eligibility because,


                                        Page 9                                             GAO-12-540 Veterans’ Benefits
                             consistent with VA’s regulations, the department must determine whether
                             the claimant retains ownership and control of the transferred asset and if
                             this asset should be counted as part of the claimant’s net worth. Without a
                             designated space to report this type of information, claimants may not
                             report asset transfers on the application forms. For example, we saw one
                             case where a veteran transferred assets worth about $500,000 into an
                             irrevocable trust 2 weeks prior to applying and did not report this on the
                             application. VA learned of this asset transfer because the claims
                             processor inquired about how the claimant’s medical expenses were
                             being paid. If the claims processor had not identified these assets and
                             determined that they should be included in the claimant’s net worth,
                             because the claimant had not relinquished all ownership and control, the
                             claim could have been approved. Application forms that do not
                             specifically request information about certain income sources and assets,
                             as well as asset transfers, may prevent VA from obtaining complete
                             information about claimants’ financial situation to properly assess their
                             eligibility for pension benefits.


VA Relies on Self-Reported   When assessing pension claimants’ eligibility, VA relies primarily on self-
Information, and             reported financial information that, unlike other means-tested programs, is
Verification Processes Are   not independently verified. 23 VA does not require claimants to submit
                             documents that corroborate self-reported financial information with their
Incomplete
                             application, such as bank statements and tax returns. VA also does not
                             require receipts to verify some types of claimed deductible expenses,
                             even though these expenses may be a factor that enables some pension
                             claimants to qualify for benefits. Without independent verification of self-
                             reported financial information, VA will have difficulty detecting fraudulent
                             claims. We identified cases where VA found individuals were advised by
                             third parties to claim expenses they did not incur related to assistance
                             with everyday living activities. For example, we saw one claim that was
                             prepared by a financial planner in which $1,700 in monthly caregiver
                             payments to a daughter were claimed. The claimant subsequently stated
                             to VA that he did not pay his daughter any caregiver fees. In another
                             case, a pension recipient claimed an attorney advised him to claim he
                             was paying his son $1,000 per month for services that were not being
                             provided in order to be eligible for a higher pension rate. The recipient



                             23
                              We reported a similar finding in GAO, Veterans Benefits: Improved Management Would
                             Enhance VA’s Pension Program, GAO-08-112 (Washington D.C.: Feb. 14, 2008).




                             Page 10                                                GAO-12-540 Veterans’ Benefits
subsequently withdrew this claimed medical expense. Most claims
processors we spoke with said they accept self-reported financial
information unless questions arise, and in those cases, supporting
documentation may be requested. In contrast, some state Medicaid
programs and the SSI program require applicants to submit documents
that support some reported financial information, such as bank
statements and tax returns.

VA also does not make use of existing opportunities to verify self-reported
financial information during the initial eligibility determination. For
example, VA conducts computer matches to verify reported income from
SSA benefits during the initial claims assessment process but is not using
this type of technology to verify the accuracy of other self-reported
financial information. Additional automated systems may be available that
would enable VA to independently verify financial information during the
initial eligibility assessment. For example, while VA performs a data
match with Internal Revenue Service and SSA data to assess ongoing
eligibility, it does not perform this match at the time of the initial claims
assessment. In addition, for the SSI program, SSA recently implemented
the Access to Financial Institutions system that allows the program to
electronically request and receive records from financial institutions and
verify an applicant’s or recipient’s financial information. Similarly,
Medicaid requires states to implement an asset verification system for
assessing applicants’ and recipients’ financial eligibility. 24

VA’s efforts to verify ongoing eligibility for pension benefits also have
some shortcomings. Pension recipients who have previously reported
income in addition to, or other than, Social Security income must annually
complete an EVR. However, like the application forms, the EVRs do not
provide spaces for claimants to report private retirement income,
annuities, trusts, or asset transfers, and self-reported financial information
is not independently verified unless the claims processor has questions.
In addition, because not all pension recipients complete an EVR, VA may
not be able to identify potential changes in the financial situation of
recipients that may affect their ongoing eligibility for these benefits.

Other efforts to verify ongoing eligibility may not be effective in identifying
ineligible pension recipients. VA’s Income Verification Match (IVM)



24
 42 U.S.C. § 1396w.




Page 11                                              GAO-12-540 Veterans’ Benefits
                             program uses a computer match to compare income reported to VA by
                             pension recipients for a given year with SSA earned income data and IRS
                             unearned income data for that year, to determine if these recipients have
                             any unreported income. However, there is about a 15-month lag between
                             when a pension recipient reports income and when the IVM can be
                             conducted, and the delay may be even longer. For example, in 2011, VA
                             was completing IVMs for income information that was reported in 2007.
                             As a result, improper payments may be made to ineligible pension
                             recipients for at least over a year, but possibly several years, before the
                             error is detected. In one case we reviewed, a beneficiary, who was
                             approved for benefits in 2004 and reported $900 in net worth when he
                             applied, had stocks worth over $162,000 at that time, which was only
                             identified through the IVM process in 2007. This created an overpayment
                             of over $18,000 that VA eventually waived. 25 In addition to the IVM not
                             being conducted in a timely manner, the match does not identify any
                             assets that do not generate income, such as deferred annuities for which
                             payments have not begun. Therefore, the IVM would not be effective in
                             identifying these types of assets. Ultimately, delays in the IVM process
                             prevent VA from promptly detecting improper pension payments and
                             increase the magnitude of these payments.


Opportunities for Internal   Opportunities for coordination between VA’s pension and fiduciary
Coordination Are Not         programs to identify ineligible pension recipients are not always
Maximized                    maximized. 26 According to VA officials, over half of VA beneficiaries in the
                             fiduciary program are pension recipients. Field examiners in this program
                             visit beneficiaries and fiduciaries, and prepare reports that may contain
                             financial information of some pension recipients. Claims processors had
                             access to these reports, but VA issued guidance in July 2011 that
                             restricts pension claims processors from accessing them in VA’s
                             electronic case file system. VA determined that claims processors did not
                             need to review fiduciary program reports as part of their daily work. This
                             guidance was issued due to concerns about the privacy of fiduciaries’
                             personal information, and concerns that pension recipients in the fiduciary


                             25
                               VA regulations set forth that overpayments will not be collected when it is determined
                             that collection would be “against equity and good conscience.” 38 C.F.R. § 1.962.
                             26
                               VA’s fiduciary program appoints and monitors third parties to help manage and protect
                             the funds of VA beneficiaries who are unable to manage their own affairs due to mental
                             impairments. Fiduciaries can be a spouse or other family member, or an entity such as a
                             law firm, hospital, or nursing home. See 38 U.S.C. § 5502.




                             Page 12                                                      GAO-12-540 Veterans’ Benefits
                          program were being put under greater scrutiny. However, fiduciary field
                          exam reports may contain information on beneficiaries’ finances that
                          could be useful for claims processors in assessing eligibility for pension
                          benefits. While safeguarding fiduciaries’ personal information is important,
                          access to these reports allows claims processors to obtain a more
                          accurate picture of a beneficiary’s financial situation. As a result, critical
                          information to identify potentially ineligible individuals is not received,
                          which may result in improper payments. Fiduciary program staff must
                          notify the pertinent PMC when they identify information that may affect
                          the ongoing eligibility of a pension recipient for these benefits, such as
                          changes in a recipient’s income and assets. Claims processors generally
                          rely on notification from fiduciary program staff about possible financial
                          ineligibility of pension beneficiaries, since these claims processors no
                          longer have direct access to those documents. A VA official from one of
                          the PMCs told us that when claims processors had access to field exam
                          reports prior to the issuance of the new guidance, cases of asset
                          transfers or unreported assets were identified from reviews of these
                          reports, even when there was no prior notification from fiduciary program
                          staff. In addition, as part of our case file review, we identified cases of
                          asset transfers or unreported assets that were identified in fiduciary field
                          exam reports. Without access to field exam reports from the fiduciary
                          program, claims processors may not have all available information to
                          assess an individual’s financial eligibility.


Unclear Guidance on       VA’s guidance to claims processors on assessing financial eligibility for
Assessing Financial       VA pension benefits is unclear about when certain assets should be
Eligibility May Lead to   counted as part of an applicant’s net worth. As a result, claims processors
                          may make inconsistent eligibility decisions. For example, VA’s procedures
Inconsistent Decisions    manual states that the value of any property owned by pension claimants
                          must be considered when assessing financial eligibility for benefits, but
                          the manual does not specifically discuss when or under what
                          circumstance annuities or trusts should count as part of net worth.
                          According to VA officials, and consistent with VA regulations, the decision
                          as to whether an asset should be counted in a claimant’s net worth
                          depends on whether the claimant has ownership and control of the asset.
                          However, VA has not adequately defined the concept of ownership and
                          control of assets in either its regulations or internal guidance and policy
                          documents. As a result, VA cannot ensure that claims processors are
                          making fully informed eligibility decisions that are consistent with VA
                          policy.




                          Page 13                                             GAO-12-540 Veterans’ Benefits
Several claims processors we spoke with confirmed that guidance on
assessing net worth is unclear, and that it is difficult to determine when to
count certain assets. For example, one claims processor expressed
uncertainty whether to count trusts established for children residing
outside of a claimant’s household when the funds are being used to pay
for claimant’s expenses, since VA’s regulations do not directly address
these types of cases. A VA official acknowledged that guidance on what
constitutes ownership and control of an asset could be improved. We
were provided local training material from one PMC on when to count
assets in a trust and found that it seemed inconsistent with VA’s
regulations regarding when to count assets. For example, the PMC
training material stated that a claim involving assets transferred into a
trust a claimant cannot access would likely be denied due to excess net
worth. However, as we noted earlier, VA regulations indicate that assets
gifted to someone outside a claimant’s household should not be counted
as part of net worth if ownership and control of the asset has been
relinquished. Also, according to VA officials we spoke with, claims
processors do not have access to VA attorneys who could assist them in
examining trust agreements and other documents to determine if a
claimant has ownership and control of an asset.

Unclear or disparate guidance about counting assets as part of net worth
may also lead to different decisions in similar cases. For example, we
saw two separate cases in which, just prior to applying, claimants
transferred excess assets into trusts to which they did not have access.
One of the claims was approved, but the other was denied. For the
approved claim, VA determined the claimant did not have ownership and
control of the trust and therefore did not count it in the veteran’s net
worth. For the denied claim, VA also determined that the claimant did not
have access to the trust, but the claim was denied because the claims
processor felt the applicant was attempting to manipulate assets to qualify
for benefits. The denial letter to the claimant explained that VA’s income
programs are not intended to protect substantial assets or build up the
beneficiary’s estate for heirs.

Further, we found that VA also lacks specific guidance on how to
determine whether or not a claimant’s financial resources are sufficient to
meet their basic needs without the pension benefit. VA’s procedures
manual states that pension claims should be denied if a claimant’s
financial resources are sufficient enough to pay for their living expenses
for a “reasonable period of time,” but it does not define this term. As a
result, claims processors must use their own discretion to determine what
period of time is reasonable for claimants to use their assets before


Page 14                                            GAO-12-540 Veterans’ Benefits
                           needing the assistance of the VA pension. Among case files we reviewed,
                           we found inconsistent claims decisions for claimants whose financial
                           resources would last about the same amount of time and who had similar
                           life expectancies. For example, two veterans whose net worth was
                           projected to provide for their needs for 2 years received different
                           decisions on their claims based on this net worth. In this instance, a 90-
                           year-old with a life expectancy of 4.4 years was denied benefits, while a
                           94-year-old with a life expectancy of 3.2 years was approved. Also, when
                           we presented a hypothetical scenario of a claimant whose financial
                           resources would last a specific amount of time, different processors at the
                           same PMC gave differing opinions about whether the claimant should be
                           approved for benefits. 27



Many Organizations
Help VA Pension
Claimants Transfer
Assets to Qualify for
Benefits

Over 200 Organizations     We identified over 200 organizations located throughout the country that
Market Services to Help    market their services to help veterans and surviving spouses qualify for VA
Qualify Veterans and       pension benefits by transferring or preserving excess assets. 28 These
                           organizations consist primarily of financial planners and attorneys offering
Surviving Spouses for VA
                           products and services such as annuities and the establishment of trusts, to
Pension Benefits           enable potential VA pension claimants with excess assets to meet financial
                           eligibility criteria for VA pension benefits. For example, one organization
                           marketed on its website that it develops financial plans which include
                           various insurance products, and that its specific area of expertise is to help
                           VA pension claimants with hundreds of thousands of dollars in assets
                           obtain approval for these benefits. Also, a law firm we identified marketed
                           transferring excess assets into special trusts to enable VA pension


                           27
                             We asked claims processors at VA’s three PMCs whether they would approve or deny a
                           claim involving an applicant with a life expectancy of 10 years whose net worth would be
                           depleted in 5 years.
                           28
                            See appendix I for an explanation of how we identified these organizations.




                           Page 15                                                    GAO-12-540 Veterans’ Benefits
claimants to qualify for these benefits. These services being marketed and
provided by these organizations are legally permissible under program
rules because current federal law and regulations allow VA pension
claimants to transfer assets and reduce their net worth prior to applying for
benefits. (See figure 2 for excerpts from websites of organizations that offer
to transfer assets to help claimants qualify for pension benefits.)

Figure 2: Excerpts from Websites of Organizations That Offer to Transfer Assets to
Help Claimants Qualify for VA Pension Benefits




During our investigative calls to 19 organizations, all of them correctly
pointed out that pension claimants can legally transfer assets prior to
applying. These organizations indicated that it is possible to qualify for VA
pension benefits despite having excess assets, and almost all provided
information on how to transfer these assets. (See figure 3 for transcript




Page 16                                                GAO-12-540 Veterans’ Benefits
                                         excerpts of calls with organizations on services they provide to qualify for
                                         VA pension benefits.) 29

Figure 3: Transcript Excerpts of Calls with Organizations Providing Products and Services to Help Claimants Qualify for VA
Pension Benefits




                                         Note: To hear additional audio excerpts from the three phone calls, go to
                                         http://www.gao.gov/multimedia/video#video_id=590696.


                                         A number of different strategies may be used to transfer pension claimants’
                                         excess assets so that they meet financial eligibility thresholds. Among the
                                         19 organizations our investigative staff contacted, about half advised
                                         transferring excess assets into an irrevocable trust with a family member as
                                         the trustee to direct funds to pay for the veteran’s expenses. About half


                                         29
                                           Representatives’ quotes in figure 3 are not from organizations whose websites are
                                         quoted in figure 2.




                                         Page 17                                                             GAO-12-540 Veterans’ Benefits
also advised placing excess assets into some type of annuity. Among
these, several advised placing excess assets into an immediate annuity
that generates income for the client. In employing this strategy, assets that
VA would count when determining financial eligibility for pension benefits
are converted into monthly income. This monthly income would fall below
program thresholds and enable the claimant to still qualify for the benefits.
About one-third of the organizations recommended strategies that included
the use of both annuities and trusts. For example, one organization we
contacted advised repositioning some excess assets into an irrevocable
trust, with the son as the trustee, and placing remaining excess assets into
a deferred annuity that would not be completely accessible, since most of
the funds could not be withdrawn without a penalty. In addition, several
organization representatives we interviewed also told us they may advise
using caretaker agreements to enable a client to qualify for VA pension
benefits. Organizations told us this strategy generally involves the pension
claimant transferring assets to family members as part of a contract, in
exchange for caretaker services to be provided by these family members
for the remainder of the claimant’s lifetime.

Some organization representatives we interviewed told us that
transferring assets to qualify for VA pension benefits is advantageous for
elderly pension claimants because it enables them to have more income
to pay for care expenses and remain out of a nursing home for a longer
period of time. For example, representatives from one organization said
the use of immediate income annuities allows pension claimants to
increase their monthly income that, combined with the VA pension, could
help pay for assisted living or in-home care costs. Other financial
planners and attorneys said if claimants do not conduct financial or estate
planning to qualify for the VA pension and instead spend down their
assets prior to applying, the monthly amount of the pension benefit they
eventually receive may be insufficient to pay for their long-term care.
They said that, as a result, these claimants may decide to seek Medicaid
coverage for nursing home care because of their lack of financial
resources, when they could have remained in an assisted living facility or
at home with the aid of the VA pension. Some of these organizations told
us that nursing home care financed by Medicaid is more costly for the
government than if the veteran had received the VA pension benefit and
obtained care in a lower-cost assisted living facility.

Many organizations we identified also conduct presentations on VA
pension benefits at assisted living or retirement communities to identify
prospective clients. According to attorneys and officials from state attorneys
general offices we spoke with, managers of assisted living facilities or


Page 18                                             GAO-12-540 Veterans’ Benefits
                         retirement communities may have an interest in inviting organization
                         representatives to conduct presentations on VA pension benefits because
                         these benefits allow them to obtain new residents by making the costs
                         more affordable. For example, we obtained documentation indicating that
                         one retirement community paid an organization representative a fee for a
                         new resident he helped the facility obtain. Another community in another
                         state paid organization representatives fees to assist residents in
                         completing the VA pension application.


Some Products and        Some products may not be suitable for elderly veterans because they
Services May Adversely   may lose access to funds they may need for future expenses, such as
Affect Claimants         medical care. To help elderly clients become financially eligible for VA
                         pension benefits, some organizations may sell deferred annuities, which
                         would make the client unable to access the funds in the annuity during
                         their expected lifetime without facing high withdrawal fees, according to
                         some attorneys we spoke with. An elderly advocacy organization
                         representative we spoke with also noted that elderly individuals are
                         impoverishing themselves by purchasing these products when they may
                         need the transferred assets to pay for their long-term care expenses. As
                         part of our investigative work, one organization provided a financial plan
                         to qualify for VA pension benefits that included both an immediate annuity
                         as well as a deferred annuity for an 86-year-old veteran that would
                         generate payments only after the veteran’s life expectancy.

                         Some organizations that assist in transferring assets to qualify people for
                         VA pension benefits may not consider the implications of these transfers
                         on eligibility for Medicaid coverage for long-term care. Individuals who
                         transfer assets to qualify for the VA pension may become ineligible for
                         Medicaid coverage for long-term care services they may need in the
                         future. For example, asset transfers that may enable someone to qualify
                         for the VA pension program, such as gifts to someone not residing in a
                         claimant’s household, the purchase of deferred annuities, or the
                         establishment of trusts, may result in a delay in Medicaid eligibility if the
                         assets were transferred for less than fair market value during the 60-
                         month look-back period. According to several attorneys we spoke with,
                         some organization representatives are unaware or indifferent to the
                         adverse effects on Medicaid eligibility of the products and services they
                         market to qualify for the VA pension. As a result, potential pension
                         claimants may be unaware the purchase of these products and services
                         may subsequently delay their eligibility for Medicaid.




                         Page 19                                             GAO-12-540 Veterans’ Benefits
In addition to the potential adverse impact of transferring assets, we
heard concerns that marketing strategies used by some of these
companies may be misleading. According to several attorneys we spoke
with, some organization representatives market their services in a way
that leads potential pension claimants and their family members to
believe they are veterans advocates working for a nonprofit organization,
or are endorsed by VA. As a result, they may fail to realize these
representatives are actually interested in selling financial Products. For
example, some organization representatives may tell attendees during
presentations at assisted living facilities that their services consist of
providing information on VA pension benefits and assisting with the
application, and do not disclose they are insurance agents selling
annuities to help people qualify for these benefits. One elder law attorney
we spoke with said that many attendees at these presentations may have
Alzheimer’s disease or dementia, and are not in a position to make
decisions about their finances. Therefore, they are vulnerable to being
convinced by these representatives that they must purchase a financial
product to qualify for these benefits.

Concerns have also been raised that VA’s accreditation of individuals to
assist with applying for VA benefits may have unintended consequences.
According to attorneys and officials in one state, organization
representatives use their VA accreditation to assist in preparing claims as
a marketing tool that generates trust and allows them to attract clients.
Claimants may not understand that this accreditation only means that the
individual is proficient in VA’s policies and procedures to assist in
preparing and submitting VA benefits claims, and does not ensure the
Products and services these individuals are selling are in claimant’s best
interests.

Finally, some organizations may provide erroneous information to clients,
or fail to follow through on assisting them with submitting the pension
application, which can adversely affect pension claimants. For example,
one veteran said he was told by an organization representative to sell his
home prior to applying for the VA pension and that he did not have to
report the proceeds from the sale on the application. He followed this
advice, but VA identified these assets, which caused him to incur a debt
to VA of $40,000 resulting from a benefit overpayment. Organizations
may also promise assistance with the application process to any
interested pension claimant but, unbeknownst to the claimant, may not
follow through in providing this service if the claimant does not want to
transfer assets. For example, the daughter of a veteran we spoke with,
who sought application assistance from an organization representative,


Page 20                                           GAO-12-540 Veterans’ Benefits
                              told us the representative never submitted her father’s pension claim to
                              VA as promised. She learned of this about a year after she thought the
                              claim was submitted and had to reapply through a county veterans
                              service officer. Her father was approved 2 months later but passed away
                              less than a month after his approval. She believes her father could have
                              received benefits for a year if the representative had submitted the claim,
                              and believes he did not do so because she did not want to use his
                              services to transfer assets.


Costs for Services to         The costs of services provided by these organizations to assist in
Transfer Assets Varied, but   qualifying for VA pension benefits varied, but organizations may be
Some Organizations May        charging prohibited fees. Among the 19 organizations our investigative
                              staff contacted for this review, about one-third said they did not charge for
Be Charging Prohibited        their services to help claimants qualify for VA pension benefits. For
Fees                          example, financial planners told us that, generally, there are no direct
                              costs associated with transferring assets into an annuity, but that costs
                              would be included in the terms of the annuity, such as the commission
                              earned by the insurance agent. Among organizations that did charge for
                              services, fees ranged from a few hundred dollars for benefits counseling
                              to up to $10,000 for the establishment of a trust. Also, although federal
                              law prohibits charging fees to assist in completing and submitting
                              applications for VA benefits, representatives from veterans advocacy
                              groups and some attorneys we spoke with raised concerns that these
                              organizations may be charging for fees related to the application, or find
                              ways to circumvent this prohibition, such as by claiming they are charging
                              for benefits counseling. For example, one organization our investigative
                              staff contacted charged $850 to have an attorney work on the application
                              process, a $225 analysis fee, and $1,600 for the establishment of a trust.
                              Another organization representative indicated he charged a “long-term
                              planning fee” of $1,200 to be paid prior to services being provided. The
                              organization representative asked that someone other than the veteran
                              pay this fee, claiming that only disinterested third parties can be charged
                              fees but not the veteran. In addition, concerns have been raised that fees
                              charged may be excessive for the services provided. In July 2011,
                              California enacted a law generally prohibiting unreasonable fees from
                              being charged for these services. 30



                              30
                                See Cal. Civ. Code § 1770(a)(24). An “unreasonable fee” is defined as a fee that is
                              exorbitant and disproportionate to the services performed.




                              Page 21                                                     GAO-12-540 Veterans’ Benefits
                The VA pension program provides a critical benefit to veterans, many of
Conclusions     whom are elderly, who have only limited financial resources to support
                themselves. Current federal law allows veterans to transfer significant
                assets prior to applying for a VA pension and still be approved for benefits,
                but this arrangement seems to circumvent the intended purpose of the
                program and wastes taxpayer dollars. Without stronger controls over asset
                transfers, similar to other means-tested programs like Medicaid’s look-back
                and penalty period, VA cannot ensure that only those with financial need
                receive pension benefits. As a result, VA pension claimants who have
                sufficient assets to pay for their expenses can transfer these assets and
                qualify for this means-tested benefit. Moreover, because VA’s policies and
                procedures for assessing the initial financial eligibility of pension claimants
                do not adequately ensure that only veterans and surviving spouses who
                meet financial eligibility requirements are granted benefits, the program is
                vulnerable to abuse. In particular, claims processors’ reliance on unverified
                self-reported information when assessing eligibility means that VA cannot
                be assured that it is obtaining all relevant financial information from
                claimants, including information on asset transfers, trusts, annuities, and
                other forms of retirement income. Without all this information, claims
                processors may improperly grant pension benefits to claimants who do not
                meet financial eligibility requirements. In addition, while safeguarding
                fiduciaries’ personal information is important, the lack of adequate
                coordination between VA’s pension and fiduciary programs may result in
                missed opportunities to identify financially ineligible pension claimants,
                further undermining program integrity. Finally, because VA’s guidance
                concerning when assets should be counted as part of a claimant’s net
                worth and how to evaluate a claimant’s net worth in determining eligibility
                lack sufficient clarity, the program remains vulnerable to inconsistent
                interpretation and payments to ineligible individuals. Ultimately, in this era
                of constrained financial resources, VA has a responsibility to manage
                limited funds wisely, and help ensure continued public support for this
                important program.


                To ensure that only those in financial need are granted VA pension
Matter for      benefits, Congress should consider establishing a look-back and penalty
Congressional   period for claimants who transfer assets for less than fair market value
                prior to applying, similar to other means-tested programs.
Consideration




                Page 22                                              GAO-12-540 Veterans’ Benefits
                      To improve VA’s ability to ensure that only veterans and surviving
Recommendations for   spouses with financial need receive VA pension benefits, the Secretary of
Executive Action      Veterans Affairs should direct the Undersecretary for Benefits to take the
                      following four actions:

                      1. Modify pension application forms, as well as EVR forms, to include
                         space for claimants or recipients to report asset transfers, and to
                         specify annuities, trusts, or private retirement income. For assets,
                         such as annuities and trusts that are reported, forms should also
                         request related documentation to enable claims processors to
                         determine if claimants or recipients retain ownership and control of
                         these assets.

                      2. For all claimants, verify financial information during the initial claims
                         assessment process. This may include requesting supporting
                         documentation such as bank statements and tax returns, or using
                         automated databases that can verify financial information.

                      3. Strengthen coordination between pension and fiduciary programs to
                         identify pension claimants or recipients who have transferred or
                         unreported assets, such as allowing claims processors access to
                         fiduciary field exam reports for these cases.

                      4. Revise the VA procedures manual to better define the concept of
                         ownership and control to help claims processors determine when
                         specific types of assets such as annuities and trusts should be
                         counted as part of net worth, and establish a more specific criteria for
                         what is considered a reasonable period of time for pension claimants
                         to use up their financial resources before becoming eligible for
                         pension benefits.


                      We provided a draft of this report to the Secretary of Veterans Affairs for
Agency Comments       review and comment. In its comments (see app. III), VA generally agreed
and Our Evaluation    with our conclusions, concurred with three of our recommendations, and
                      concurred in principle with one other recommendation.

                      The agency concurred with our recommendation to modify pension
                      application and eligibility verification forms to include a space for
                      claimants or recipients to report asset transfers, to specify annuities,
                      trusts, and private retirement income, and to request related supporting
                      documentation.



                      Page 23                                             GAO-12-540 Veterans’ Benefits
VA concurred in principle with our second recommendation that the
department verify financial information during the initial claims process.
VA noted, however, that conducting this verification would add additional
time to adjudicate pension claims. VA said it expects to complete an
analysis by November 1, 2012 of whether financial information can be
verified without placing undue burdens on claimants and recipients. We
acknowledge that rigorous verification processes can sometimes entail
additional time during the initial claims phase, but we continue to believe
that such verification is an important part of ensuring that VA adequately
balances its stewardship responsibilities with its service activities. We
support the analysis VA is undertaking.

Regarding our recommendation to strengthen coordination between the
pension and fiduciary programs, VA concurred and noted that it has
established a workgroup that is developing procedures to further enable
fiduciary program staff to share income information with pension program
staff.

VA also concurred with our recommendation that the procedures manual
be revised to better define the concept of ownership and control of assets
and to establish a more specific criteria for what is considered a
reasonable period of time for claimants to use their financial resources
before becoming eligible for pension benefits. VA stated that it is drafting
regulations that would address the effect on eligibility of transferring
assets prior to applying for pension benefits. They noted these
regulations would address and clarify the various factors VA uses to
determine whether a claimant’s net worth precludes eligibility for pension
benefits and would provide a more consistent set of rules for adjudicating
claims. They added that upon completion of the rulemaking proceeding
VA will amend its manual provisions consistent with the new regulations
and provide the procedures to implement them. They expect to complete
this revision by December 1, 2013.

While VA did not directly comment on GAO’s Matter for Congressional
Consideration related to establishing a statutory look-back and penalty
period, VA did note that “unlike Medicaid and SSI, the statutes governing
VA’s pension program lack provisions addressing the effects of transfers
of assets on eligibility for program benefits, e.g., a look-back and penalty
period.” VA asserted that after identifying gaps in VA’s regulations on this
point, it has begun drafting regulations to address the issue. VA noted in
its comments that any regulations it promulgates on this issue will be
subject to challenge in the U.S. Court of Appeals for the Federal Circuit.
While we commend VA’s efforts in this area, having a clearer statutory


Page 24                                            GAO-12-540 Veterans’ Benefits
basis for this regulatory effort may help ensure that the regulations,
should they be finalized, would be more likely to withstand potential legal
challenges in the courts.


As agreed with your offices, unless you publicly announce the contents of
this report earlier, we plan no further distribution until 30 days from the
report date. At that time, we will send copies of this report to the
appropriate congressional committees, the Secretary of Veterans Affairs,
and other interested parties. The report is also available at no charge on
GAO’s website at http:/www.gao.gov.

If you or your staff members have any questions concerning this report,
please contact me at (202) 512-7215 or bertonid@gao.gov. Contact
points for our Offices of Congressional Relations and Public Affairs may
be found on the last page of this report. Staff members who made key
contributions to this report are listed in appendix IV.




Daniel Bertoni
Director, Education, Workforce,
  and Income Security Issues




Page 25                                           GAO-12-540 Veterans’ Benefits
Appendix I: Objectives, Scope, and
              Appendix I: Objectives, Scope, and
              Methodology



Methodology

              The objectives of our review were to examine (1) how the design and
              management of the Department of Veterans Affairs’ (VA) pension
              program ensure that only those with financial need receive pension
              benefits and (2) what is known about organizations that are marketing
              financial products and services to veterans and survivors to enable them
              to qualify for VA pension benefits.

              To determine how the design and management of VA’s pension program
              ensure that only those with financial need receive pension benefits, we
              reviewed relevant federal laws and regulations, as well as VA’s policies,
              procedures, and guidance regarding how VA assesses financial eligibility
              for pension benefits. We examined VA’s pension application forms and
              other documents VA uses to collect financial information from pension
              claimants or recipients. Also, we visited VA’s three PMCs in Philadelphia,
              Milwaukee, and St. Paul, and interviewed staff and officials from these
              locations as well as from VA’s central office. To verify how VA assesses
              the net worth of pension claimants, we conducted a review of a
              nongeneralizable random sample of 85 of the total of 3,196 fiscal year
              2010 pension claim files completed by each of the PMCs that were
              entered in VA’s electronic case file system, in which VA had to formally
              determine if the claimant’s assets were excessive to be approved for
              pension benefits. We also reviewed pension claims files VA provided us
              that involved asset transfers or unreported income and assets. In
              addition, we reviewed past GAO reports on VA’s pension program,
              Medicaid coverage for long-term care, and the Supplemental Security
              Income program, as well as relevant federal laws and regulations to learn
              how these other means-tested programs assess financial eligibility of
              claimants.

              To determine what is known about organizations that are marketing
              financial products and services to veterans and survivors to enable them
              to qualify for VA pension benefits, we conducted an Internet search and
              interviews with stakeholders to identify organizations that market financial
              products and services to help veterans and surviving spouses meet the
              eligibility criteria for VA pension benefits. For our Internet search, we used
              the following search terms “Veterans Affairs and Pension Benefits,”
              “Veterans Affairs and Aid and Attendance Benefits,” and “Veterans Affairs
              and Pension and Aid and Attendance Benefits.” We applied three criteria
              when we examined the content of the websites obtained from our results
              to develop a list of organizations that market these services. To be
              included in our list, the organization’s website must indicate they provide
              services to help someone qualify for VA pension benefits or assess
              eligibility for VA benefits, and either indicate they provide products such


              Page 26                                             GAO-12-540 Veterans’ Benefits
Appendix I: Objectives, Scope, and
Methodology




as annuities or trusts to transfer assets or indicate they provide services
to protect or preserve assets. In addition to our Internet search, we also
included in our list several organizations that met these criteria that we
identified through interviews with veterans advocacy groups, state
officials, and attorneys. In applying these criteria, we developed a list of
over 200 organizations that market these services. We used a
methodology where two analysts had to agree that the organization met
the criteria.

Our investigative staff contacted a judgmental sample of 25 of the
organizations on our list posing as the son of an 86-year-old veteran with
over $300,000 in countable assets who is interested in applying for VA
pension benefits. The 25 organizations were judgmentally selected to
achieve geographic dispersion and include both financial planners and
attorneys. For these calls, we sought to identify the types of products
being marketed, their terms and costs, and the effect on the veterans’
access to their assets. The addresses for the main offices of the
companies selected represent 13 different states that encompass about
one-half of the veteran population age 65 and older. These states also
include three states that represent one-fourth of the veteran population
age 65 and older. Of the 25 companies contacted, our investigative staff
was able to have a discussion with a representative for 19 of these
organizations. For the other six companies, we either did not receive a
response to a phone message or our phone calls to the organization were
not answered.

To learn more about the types of products and services that may be
provided to enable someone to meet the financial eligibility criteria for VA
pension benefits, we also interviewed attorneys and financial planners, as
well as representatives from the National Association of Insurance
Commissioners. To identify the implications of transferring assets to
qualify for VA pension benefits, we spoke with attorneys, representatives
of veterans and elderly advocacy groups, state and local government
officials, and family members of pension claimants that we were referred
to who used the services of organizations to apply for these benefits. To
learn about any investigations involving the practices of some of these
companies, we spoke with officials from VA’s Office of Inspector General
and officials from state attorneys general offices in California, Iowa,
Montana, Oregon, Pennsylvania, Texas, and Washington.




Page 27                                             GAO-12-540 Veterans’ Benefits
Appendix I: Objectives, Scope, and
Methodology




We conducted this performance audit from July 2011 to May 2012 in
accordance with generally accepted government auditing standards.
Those standards require that we plan and perform the audit to obtain
sufficient, appropriate evidence to provide a reasonable basis for our
findings and conclusions based on our audit objectives. We believe that
the evidence obtained provides a reasonable basis for our findings and
conclusions based on our audit objectives.




Page 28                                         GAO-12-540 Veterans’ Benefits
Appendix II: Full Transcript of Selected Calls with
                 Appendix II: Full Transcript of Selected Calls
                 with Organizations Providing Products and
                 Services to Help Claimants Qualify for VA

Organizations Providing Products and Services to
                 Pension Benefits



Help Claimants Qualify for VA Pension Benefits

                 The Department of Veterans Affairs (VA) provides pension benefits to
                 eligible veterans and surviving spouses whose income and assets are
                 below program thresholds. However, current VA regulations permit
                 claimants to transfer excess assets prior to applying. Organizations
                 market financial Products and services to help prospective pension
                 claimants transfer excess assets and become financially eligible for these
                 benefits. An investigator from our Forensic Audits and Investigative
                 Service team had phone conversations with representatives from 19 of
                 these organizations to learn if the organization would transfer a claimant’s
                 excess assets, the types of services provided, and any fees charged.
                 (See appendix I for more information on our scope and methodology.)
                 Because VA’s pension benefits are meant for claimants with financial
                 need, we selected portions of three of these calls that show organizations
                 transfer significant assets to help claimants qualify for the benefits, and
                 the types of services they provide to do so. The full transcripts of these
                 three calls are provided below.

                 Call 1: Caller is a GAO investigator phoning on behalf of his
                 fictitious 86-year-old father who was a veteran, seeking VA pension
                 benefits, who wants to learn about the services provided by the
                 company. The company representative describes how his father can
                 qualify for these benefits, despite having significant assets.

                 (Whereupon, an outgoing call was placed by the GAO investigator to a
                 company representative.)

                           COMPANY REPRESENTATIVE: [name].

                           GAO INVESTIGATOR: Hello?

                           COMPANY REPRESENTATIVE: Hello, this is [name].

                           GAO INVESTIGATOR: Hey, [name], this is [name].

                           COMPANY REPRESENTATIVE: Hey, [name], how are you doing?

                           GAO INVESTIGATOR: I’m doing good. I got your messages. I’m sorry, it’s just
                 been a little nuts.

                           COMPANY REPRESENTATIVE: Not a problem.

                           GAO INVESTIGATOR: You still there?

                           COMPANY REPRESENTATIVE: Yeah, I’m here. Yes.




                 Page 29                                                    GAO-12-540 Veterans’ Benefits
Appendix II: Full Transcript of Selected Calls
with Organizations Providing Products and
Services to Help Claimants Qualify for VA
Pension Benefits




          GAO INVESTIGATOR: I was calling — it’s your brother or your brother-in-law
that I spoke to?

            COMPANY REPRESENTATIVE: My brother-in-law.

         GAO INVESTIGATOR: Yeah, I’m trying to make a decision here with my father.
We are going to have to, you know, make some decisions on what we’re going to do with
him. And I just wanted to see, you know, before we go draining all his resources, what our
options are.

            COMPANY REPRESENTATIVE: Okay. You don’t — he’s not in a community yet
or he is?

            GAO INVESTIGATOR: He’s not, he’s still living at his house.

            COMPANY REPRESENTATIVE: Okay.

          GAO INVESTIGATOR: But, you know, he’s got a lot of, you know, physical
limitations, he’s got difficulty hearing, and he can’t really move around, so you know –

         COMPANY REPRESENTATIVE: Did his doctor say he needs assistance from
another person on a regular basis?

          GAO INVESTIGATOR: Well, I imagine. I mean, I didn’t ask that question,
specifically, but I’m sure he would. I mean, right now, you know, we’re kind of trying to
take care of him ourselves, and you know, we’ve got somebody helping, but we’re going
to need something more full time.

         COMPANY REPRESENTATIVE: Yeah. You guys are helping out with cooking,
cleaning. Is he still able to drive or no?

            GAO INVESTIGATOR: No.

         COMPANY REPRESENTATIVE: Okay. So he needs transportation. You know,
these are the things they are looking for. Did you say his vision is an issue?

            GAO INVESTIGATOR: No, his hearing, is what I said.

            COMPANY REPRESENTATIVE: (Laughter) I’m sorry.

            GAO INVESTIGATOR: And his, not yours.

          COMPANY REPRESENTATIVE: (Laughter) Well, maybe mine, a little bit.
Anyhow, yeah, the VA kind of looks at, you know, daily activities — the activities of daily
living. And if he can’t do some of those things, he needs assistance, you know, then he
can qualify for the benefit.

         They don’t mean if somebody is completely bedridden or handicapped, they just
mean if somebody needs assistance and help with some parts of their life.




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Appendix II: Full Transcript of Selected Calls
with Organizations Providing Products and
Services to Help Claimants Qualify for VA
Pension Benefits




         What we would be able to do – we have people that are still able to drive and live
at home, but they can’t do certain — they can’t carry the bags from the car if they go
grocery shopping, because they don’t have the dexterity or the strength.

          GAO INVESTIGATOR: All right.

           COMPANY REPRESENTATIVE: So, you know, the VA looks at it and says, they
can’t even go shopping for themselves, they can’t carry the bags from the car, they can’t
lift them, you know, how are they going to get them into the house?

           GAO INVESTIGATOR: Well, I’m sure that’s not a problem. I mean, he definitely
is, you know, he needs help with just going to the bathroom, getting in and out of bed and
stuff like that.

          COMPANY REPRESENTATIVE: Yeah. He needs help getting in and out of bed,
getting to the bathroom, those are the things they’re looking at. Absolutely, he needs this
assistance, and he can qualify for the benefit.

        And everything else is just about preparing yourself for the benefit, doing the
paperwork and so forth.

          GAO INVESTIGATOR: Okay.

          COMPANY REPRESENTATIVE: And that a process, in and of itself. What I
would suggest is get together, you know. This is — this doesn’t— this isn’t like a one-time
sit-down and it’s all done, you know. This can take several weeks, and sometimes even
up to six weeks, to get all the paperwork completed.

          GAO INVESTIGATOR: Okay.

          COMPANY REPRESENTATIVE: So you know, but it’s a matter of getting
started. You know, and that’s what I — you know, if your dad needs assistance, and he
was a wartime Veteran, we can get him the benefit. All right?

        GAO INVESTIGATOR: Okay. Well, you know what, my big concern – [inaudible]
yeah, you know, which I mentioned to your brother-in-law is, um — you know, he’s got
some assets, and I don’t know how that affects things.

          COMPANY REPRESENTATIVE: You know, the assets come into play, and
that’s part of the process. We would explain all that to you – what, what — where you
need to go, how — what needs to be done.

        Ideally, an accredited attorney that we – that we work with, he’ll have that
conversation with you. He’ll explain that to you in more detail.

          GAO INVESTIGATOR: Okay.

         COMPANY REPRESENTATIVE: But anyone — and I will just tell you this. The
VA allows you to qualify, regardless of what your assets are. And I’ve had people with
over a million dollars qualify for this benefit.




Page 31                                                      GAO-12-540 Veterans’ Benefits
Appendix II: Full Transcript of Selected Calls
with Organizations Providing Products and
Services to Help Claimants Qualify for VA
Pension Benefits




           GAO INVESTIGATOR: Wow.

       COMPANY REPRESENTATIVE: So you know, you’ll hear you can only have this
much money, you can do this. You’ll even be told you don’t qualify.

         GAO INVESTIGATOR: And how do you do that, though, I mean, that’s what I
don’t understand.

          COMPANY REPRESENTATIVE: Well, you have to reposition the assets, that’s
all. You know, like I said, that’s — that’s part of what the attorney will talk about.

          From a process standpoint, I’ll gather all the information that we need from you,
what will go on the VA application. And we will get a letter back from our VA-accredited
attorney, and he will outline and tell you you do or you don’t qualify.

         Some people qualify immediately; other people, like in your situation, if your
family has some assets, you may have to jump through some hoops in order to get the
benefit.

           But the VA outlines it and says, this is what you’re allowed to do, in order to
qualify.

         And, you know, we’ll share that with you. We’ll show you exactly what you need
to do, how to do it, because it has to be done a certain way in order to qualify.

          Look at this as kind of something you’re going to do one time, all right? This isn’t
like doing your taxes, you know, where you need to remember it to understand it for next
year.

           You are going to do this once, and it’s going to be out of your life.

          GAO INVESTIGATOR: Okay. Here’s a question that I have. Does he still have
control of the assets?

           COMPANY REPRESENTATIVE: Your family will.

           GAO INVESTIGATOR: Okay.

         COMPANY REPRESENTATIVE: Yeah, your family will. I mean, all his money,
his monthly money, will go right into his checking account, just like it probably does, Social
Security, pension, whatever. The VA benefit will go right into his checking account. All that
money will keep going right into his account, and he will have access to that.

           GAO INVESTIGATOR: Okay, all right. Okay, just so I understand it, so you’re
just talking about putting it under a different name or are you putting it in a special
account?

         COMPANY REPRESENTATIVE: [name], here’s the thing. I can’t get into all that
with you over the phone.




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Appendix II: Full Transcript of Selected Calls
with Organizations Providing Products and
Services to Help Claimants Qualify for VA
Pension Benefits




          GAO INVESTIGATOR: Okay.

        COMPANY REPRESENTATIVE: It will get so complicated and so confusing.
This conversation that I need to have with you will take about an hour, just to get the
process started, and then we will get into all that stuff.

           Every person I have tried to help with this benefit, when they try to get to the —
like into the high school level questions, before understanding the kindergarten and grade
school level questions, they never get the benefit, because they can’t — they can’t under
—they get so confused.

          So it’s almost like, once you’ve seen a dead body you can’t unsee it, and you
can’t focus on anything else. And so what I’m trying to share with you, you know, if you
just, you know, take a bite at a time, you know, like the old saying, you can’t eat an
elephant in one bite, we need just a bite of your time.

          You will get through this and you’ll get the money.

          But if we try to jump ahead, you know, I’ll tell you, it’s never been successful.

          GAO INVESTIGATOR: Okay. What –

        COMPANY REPRESENTATIVE: And I hope you understand. I’m just giving you
my expertise and experience in this.

        We do over — we submit over four hundred apps a month, and everybody gets
the benefit, so we know how to do it, we know how to get it done.

         And nothing is going to be a surprise to you. Everything is going to be here, this
is your option. If you want this, you’ve got to do this.

        And then it’s up for you to decide. But it’s just a matter of getting you to that point
where you have all the facts, so you can make a decision.

          And so the questions you’re asking are all valid, you know, they are all the
questions that we’ll be delving into very deeply. If you need a CPA involved, we have a
CPA on our team. We have our attorney on our team that I use, [name]. He’ll be a part of
all the conversations if we need, so all throughout.

          And none of that is costing you any money, because that’s part of my fee.

         But what I’m saying is, all those questions that you have now, when you are
ready for the answers, we’ll have those conversations. But right now, you’re not ready for
the answers. It’s difficult to understand this, why this, what that?

        All those answers you are going to get from me right now are going to create
more and more questions, and things are going to get so confusing for you.

          GAO INVESTIGATOR: Okay.




Page 33                                                         GAO-12-540 Veterans’ Benefits
Appendix II: Full Transcript of Selected Calls
with Organizations Providing Products and
Services to Help Claimants Qualify for VA
Pension Benefits




           COMPANY REPRESENTATIVE: This process is already confusing enough, I’ve
got to tell you.

          GAO INVESTIGATOR: Okay.

        COMPANY REPRESENTATIVE: There are some three hundred to four hundred
thousand applications a month — I mean, I shouldn’t say a month. The VA has over —
between three hundred and four hundred thousand applications backlogged, sitting there,
because people didn’t do the process right, and it will take them up to two years to get
approved.

         You know, that — that’s — it is difficult. It has to be done a certain way, and I’ll
get you there. I promise, I’ll get you there, but you just have to go through it step-by-step.

        GAO INVESTIGATOR: Okay. Well, the only other question I have then is the
cost. What is the cost involved?

          COMPANY REPRESENTATIVE: If there is any cost, it would be with the
attorney. They charge — they’ll charge a fee for setting up certain documents, and we’ll
get to that, as well.

          The worst case, let’s say your dad, he has a house, and you’re not able to sell
the house. See, while he’s living in it, they don’t care that he owns a home, but when he’s
out of the house, they consider it an asset.

         We have to — we’ll have to do something with the house, as well. If you were
planning on selling it, fine.

          If you weren’t planning on selling it, that’s fine, too, but we’ll have to address it.

        The worst case scenario would be about fourteen hundred bucks. That’s a worst
case scenario.

          GAO INVESTIGATOR: Okay.

          COMPANY REPRESENTATIVE: And when you understand what that all entails,
you’ll be like, geez, fourteen hundred bucks, let’s find out tomorrow. That’s another thing,
you know, when you understand everything that you get with that.

       And he’ll make sure everything is done the right way so that the VA can never
come back at you, seeing that the house is protected, your mother is protected, you know.

        I’m just saying, there’s a whole lot to it, and to try to answer it over the phone is
more than tough.

         GAO INVESTIGATOR: Okay. All right. So there’s no — that’s just an attorney
fee? I mean, there’s no fee for you?

          COMPANY REPRESENTATIVE: Exactly.




Page 34                                                           GAO-12-540 Veterans’ Benefits
Appendix II: Full Transcript of Selected Calls
with Organizations Providing Products and
Services to Help Claimants Qualify for VA
Pension Benefits




          GAO INVESTIGATOR: There’s no fee for you, at all?

          COMPANY REPRESENTATIVE: No, not at all.

          GAO INVESTIGATOR: Does the VA pay you or something?

         COMPANY REPRESENTATIVE: Hang on a second. Let me do this. I hate to try
to get you — are you busy during the day?

          GAO INVESTIGATOR: Ummmm.

         COMPANY REPRESENTATIVE: Is there like an hour of time that you and I can
get together and get the process started, so I can show you how — how it all works?

          GAO INVESTIGATOR: Yeah, I mean, probably, but probably not until, you know,
after the holidays.

         COMPANY REPRESENTATIVE: Okay. Then let’s do this. If you have your
schedule, my schedule is tied up until the second week of January, already filled with
seminars and things to — so people can come and see me. The second week I have at
least two seminars, and I usually have thirty to forty people at each seminar.

          GAO INVESTIGATOR: Uh-huh.

         COMPANY REPRESENTATIVE: And then about half of those people sit down
with me and want to go to the next step.

          GAO INVESTIGATOR: Right.

           COMPANY REPRESENTATIVE: So if I do two or four presentations, I mean, I’ve
got thirty to fifty appointments during the second week of January. So if you and I can get
together in the first week, I can get you started before all that mess starts.

         GAO INVESTIGATOR: Okay. Well, I wonder if it wouldn’t be beneficial to go to
one of the seminars?

          COMPANY REPRESENTATIVE: Well, the seminar is in [name].

          GAO INVESTIGATOR: In where?

         COMPANY REPRESENTATIVE: In [name], but really, what I do there is more of
a blanket meeting.

         If you already know you have a situation, you already know you have an interest,
I go over that same information that I go over in the seminar. But the seminar, it’s just
information, and I will be giving that to you face-to-face, and be able to collect the
information and get started on the process.




Page 35                                                     GAO-12-540 Veterans’ Benefits
Appendix II: Full Transcript of Selected Calls
with Organizations Providing Products and
Services to Help Claimants Qualify for VA
Pension Benefits




          GAO INVESTIGATOR: Okay. Yeah, I mean, I don’t have a lot of questions, you
know, I just want to know what types of Products : you’re talking about that we would —
where the assets would go, how — I mean, are we talking about –

          COMPANY REPRESENTATIVE: It all depends on your dad’s needs. Right now
we don’t know – I don’t know anything about your situation. I don’t know what your costs
are, I don’t know what his expenses, his needs are. I don’t have any idea what the cash
flow management requirements will be –

          GAO INVESTIGATOR: Yeah.

          COMPANY REPRESENTATIVE: — this year, next year, five years down the
road. You know, as a financial advisor, you know, I come from the banking industry, where
I worked in the trust department, and my clients were all multi, multi-millionaires. And all I
did for them was identify what their needs were going to be year in and year out, into the
future –

          GAO INVESTIGATOR: Right.

         COMPANY REPRESENTATIVE: — protecting their assets, so that they knew
that money was going to be there (unintelligible). Like your dad, the last thing he wants to
do is have his nest egg at risk.

          GAO INVESTIGATOR: Right.

         COMPANY REPRESENTATIVE: He’s going to need — he’s going to need
income from it to maybe offset some of the cost of his retirement community, perhaps.

          GAO INVESTIGATOR: Uh-huh.

         COMPANY REPRESENTATIVE: I don’t know, you know, I don’t have any
answers, at this point, because I don’t know what his needs are, what your family needs
are, you know, how many kids are there, who all is involved.

         GAO INVESTIGATOR: I mean, basically, it’s just him. I mean, he’s got his Social
Security, and then, if he qualifies for the VA Pension, he would have that. So I imagine
that would be enough income for him. So it’s just a matter of doing something with the
assets, so he doesn’t lose it. So –

         COMPANY REPRESENTATIVE: Exactly. And that’s something you and I will
discuss and work on. Are you — are you handling his affairs now?

          GAO INVESTIGATOR: Yeah, uh-huh.

          COMPANY REPRESENTATIVE: So you take care of all of his bills?

          GAO INVESTIGATOR: Yeah.




Page 36                                                       GAO-12-540 Veterans’ Benefits
Appendix II: Full Transcript of Selected Calls
with Organizations Providing Products and
Services to Help Claimants Qualify for VA
Pension Benefits




         COMPANY REPRESENTATIVE: So you are the person who understands best,
you know, what your parents, you know, what the family, you know, your father, your
mother, your parents, what their requirements are.

          Now your mother has passed; is that correct?

          GAO INVESTIGATOR: Yes, uh-huh.

          COMPANY REPRESENTATIVE: Okay, so we’re just talking about your dad
here.

          GAO INVESTIGATOR: Right.

           COMPANY REPRESENTATIVE: So here’s — the VA just increased the payment
to the Veteran, single Veteran, to right around seventeen hundred a month, tax-free, so
it’s a pretty substantial benefit; that’s over twenty thousand dollars a year.

          If you are looking at his — looking at what his Social Security is –

          GAO INVESTIGATOR: Right.

         COMPANY REPRESENTATIVE: — you add that, plus his VA, it may cover his
long-term care facility.

          GAO INVESTIGATOR: Uh-huh, yeah, his Social Security is twelve hundred, so
you’re talking about somewhere close to almost three thousand dollars a month.

         COMPANY REPRESENTATIVE: Yeah, exactly, so that’s not bad, that’s not bad.
Now it depends on what kind of community he would be looking at, but you know, that’s. .
.

         You know, the hardest part is getting started, and then once you get to a certain
point, you’ll be like, yeah, I get it, I get it, now I understand, this is what we do.

          Let me ask you, is Tuesday the 3rd or is Wednesday the 4th a better day for
you?

          GAO INVESTIGATOR: Well, probably Wednesday will be better for me.

          COMPANY REPRESENTATIVE: And you’re in [state]?

          GAO INVESTIGATOR: Yes.

          COMPANY REPRESENTATIVE: Okay. How does 10 a.m. work?

          GAO INVESTIGATOR: Are you talking about coming down to me or where?

          COMPANY REPRESENTATIVE: Yeah, absolutely, I’d come to you.




Page 37                                                        GAO-12-540 Veterans’ Benefits
Appendix II: Full Transcript of Selected Calls
with Organizations Providing Products and
Services to Help Claimants Qualify for VA
Pension Benefits




        GAO INVESTIGATOR: That sounds good, tentatively. I’ve got to check and
make sure that — I have to check a couple things here, but I mean, it sounds good.

          COMPANY REPRESENTATIVE: What address is the best place to meet you?

           GAO INVESTIGATOR: Well, you know, I’m guessing that it might be just as good
to do it at the office. I’ll tell you what, are you going to be around this afternoon?

          COMPANY REPRESENTATIVE: Yeah, do you want to give me a call back?

        GAO INVESTIGATOR: Yeah, let me give you a call back. Let me check the
schedule and make sure it’s good. I think it would probably be easier just to do this at the
office.

          COMPANY REPRESENTATIVE: Okay. What city is it?

          GAO INVESTIGATOR: I’m sorry?

          COMPANY REPRESENTATIVE: What city is your office in?

          GAO INVESTIGATOR: In [city].

          COMPANY REPRESENTATIVE: That sounds so familiar. As you are going down
83, that’s

          GAO INVESTIGATOR: Near [city].

        COMPANY REPRESENTATIVE: Near [city], okay, (unintelligible). All right, good.
Give me a call back just to confirm if 10 a.m. works. If I don’t answer, just leave a
message. I may go out and do some shopping (unintelligible).

          GAO INVESTIGATOR: All right. I’ll just leave a message on your voicemail.

          COMPANY REPRESENTATIVE: Yeah, and — good.

          GAO INVESTIGATOR: Sounds good.

          COMPANY REPRESENTATIVE: All right, [name].

          GAO INVESTIGATOR: Thanks for your time, I appreciate it.

          COMPANY REPRESENTATIVE: Nice talking to you.

          GAO INVESTIGATOR: Alright, Bye.




Page 38                                                       GAO-12-540 Veterans’ Benefits
Appendix II: Full Transcript of Selected Calls
with Organizations Providing Products and
Services to Help Claimants Qualify for VA
Pension Benefits




Call 2: Caller is a GAO investigator phoning on behalf of his
fictitious 86-year-old father who was a veteran, seeking VA pension
benefits, who wants to learn about the services provided by the
company. The company representative describes how his father can
qualify for these benefits, despite having significant assets.

(Whereupon, an outgoing call was placed by the GAO investigator to a
company representative.)

          COMPANY REPRESENTATIVE: Hello? Hello?

          GAO INVESTIGATOR: Hi.

          COMPANY REPRESENTATIVE: Hi. This is [name]. Did somebody call this
number?

        GAO INVESTIGATOR: Yeah, I did. I did. I was trying to get some information on
VA benefits.

          COMPANY REPRESENTATIVE: Okay. What can I help you with?

          GAO INVESTIGATOR: Well, I’m just trying to figure out my — this is for my
father.

          COMPANY REPRESENTATIVE: Uh-huh.

         GAO INVESTIGATOR: And, you know, he’s not currently getting benefits. He
gets Social Security.

          COMPANY REPRESENTATIVE: Right.

         GAO INVESTIGATOR: But, you know, I was — I’m trying to see if maybe he
could qualify for benefits. But the problem is he’s got, you know, some assets, and I’m not
sure, you know, if that precludes him from getting benefits or not. So I wanted to talk to
somebody –

         COMPANY REPRESENTATIVE: No. No. Is he — does he need some help
around the house or has he got some medical or physical impairments –

          GAO INVESTIGATOR: Yeah.

          COMPANY REPRESENTATIVE: — right now?

         GAO INVESTIGATOR: Yeah. I mean, he’s 86. I mean, mentally he’s fine. But,
you know, physically he needs a lot of help in just, you know, walking and getting in and
out of bed.

          COMPANY REPRESENTATIVE: Okay.




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          GAO INVESTIGATOR: And, I mean, yeah, he needs help.

         COMPANY REPRESENTATIVE: Sure. If you will — if you will do me a favor, I’m
going to send you — do you have an e-mail address?

        GAO INVESTIGATOR: Well, not really. But, I mean, I can probably get
something. But what do you need?

          COMPANY REPRESENTATIVE: Well, I was going to send you a little form, and
if you can just spend a few minutes and fill it out, then I can tell you if your father is
available for benefits or not.

          GAO INVESTIGATOR: Okay. I mean, I mean, basically I’m assuming he –

         COMPANY REPRESENTATIVE: I probably could do this — I could do this over
the phone, too. But right now I’m just going and jumping on a conference call. So I can call
you back and I can ask you the questions I need to ask you, if you want. Maybe in — I’d
say within a couple of hours I can get back with you.

          GAO INVESTIGATOR: Okay. Yeah, that might work.

          COMPANY REPRESENTATIVE: Okay. It is a means-tested and an asset-tested
– uh, benefit, but – um, essentially there are legal work-arounds. And if you know, it’s
basically you have to put together a good presentation for the Veterans Administration.
And that’s what we do. We help people um — position assets and coordinate the
presentation effort to the VA. So there’s really not many kinds — if, in fact, your father has
lost some of the activities of daily living, then we really can’t get him qualified. So I’ll just –

          GAO INVESTIGATOR: Yeah.

          COMPANY REPRESENTATIVE: — make a short explanation like that.

            GAO INVESTIGATOR: Yeah. And just to kind of make it short, I mean, his
income isn’t the thing, because he’s only getting Social Security. But he’s got assets that
are probably — between his house and some savings and stuff, he’s probably, you know,
a little bit over $500,000.

          And I’m wondering if that precludes him from qualifying.

          COMPANY REPRESENTATIVE: No. No, it doesn’t, especially if he’s got a little
bit of uh — flexibility. How much is the house worth? The house is really not an issue at
all.

          GAO INVESTIGATOR: Yeah, that’s probably about 200,000.

          COMPANY REPRESENTATIVE: Oh, so you have 300 in other stuff? Okay.
Yeah, I’ve qualified people with that — beyond $700,000 worth of liquid assets. So that’s
not the issue. But sometimes the older folks, you know, your father being 82 –

          GAO INVESTIGATOR: Eighty-six.




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         COMPANY REPRESENTATIVE: Eighty-six, I’m sorry. Sometimes they — oh,
they’re not — what would be the word? They’re sometimes control freaks, meaning
sometimes what we have to do is retitle assets. He would still be totally in control of them,
but not under his direct purvey.

          So if he can understand the strategy, he could understand that, you know, he’s
entitled to the benefit. It could be — he’s single right now?

          GAO INVESTIGATOR: Yeah, yeah. His wife is dead.

          COMPANY REPRESENTATIVE: Okay. So, you know, basically he performed for
his country. If he was able to get aid and attendance, he would get real close to —
actually, this year is $19,736 per year. And if that means something to him, then we can
help him out. If it doesn’t, then

          he’ll just have to go through spend-down and spend it.

        So we can — we can make it work, but he’s got to be willing to help us. Okay?
We can’t force people to do something that they’re not wanting to do.

          GAO INVESTIGATOR: I got it.

          COMPANY REPRESENTATIVE: Okay. It’s real simple –

        GAO INVESTIGATOR: What sorts of things are you talking about? I mean,
where do we put it?

         COMPANY REPRESENTATIVE: Well, for instance, do you have power of
attorney for him right now?

          GAO INVESTIGATOR: Well, I don’t. But, you know, he’s pretty — he’s pretty
lucid. I mean, I — I can probably get it.

          COMPANY REPRESENTATIVE: Well, typically speaking, for people that have
had a child or relative assigned a power of attorney, then they’ve kind of realized that, you
know, if something happens, they may need some help. Somebody acting in their financial
capacity if they get in a situation where they can’t perform or somebody to make some
medical decisions for them.

          So at that point in time, they’ve kind of acquiesced to the fact that, you know, at
this point in my life, I need a little bit of help.

         So I was going to say, if he’d already given you power of attorney, then
essentially what he said is, you know, he trusts you.

          GAO INVESTIGATOR: Uh-huh.

         COMPANY REPRESENTATIVE: And if that’s the case, then essentially it’s going
to be that type of a relationship where things may be put into special types of trusts where




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he is still — where you would have a fiduciary responsibility to him. So it’s a contractual
obligation. It’s — all the money is for the benefit of him, but it’s not under his direct control.

          Now, that’s not necessarily the only way it can be done. There are also what we
call care contracts where essentially he can kind of prepay in a contractual manner for his
future care. It gets it out of his immediate possession and would help qualify for those
types of benefits.

          So there’s a myriad of strategies. I work with an attorney. We’ll make sure it
works for you. But he just has to understand that either he wants to get the benefit or he
doesn’t. If he does, we can make it work. If he doesn’t, then that’s okay, too.

          GAO INVESTIGATOR: Right. Well, I mean –

          COMPANY REPRESENTATIVE: It’s up to him.

        GAO INVESTIGATOR: — I don’t think he wants to lose his assets. And, you
know, you know, we don’t want him to lose his assets. And that’s — that’s the biggest
concern now.

         COMPANY REPRESENTATIVE: Right. There’s — there’s a — yeah, well, he will
if he needs the care. Then the other issue you have coming up, too, of course, is
sometimes folks that mostly qualify for the benefit will essentially possibly qualify for
Medicaid, too. And what that means is that, yes, I mean, if his expenses go to $6-7-8-9-
10,000 a month, then he will lose his assets unless he does something to protect them. So
we can help out in that regard, too.

          GAO INVESTIGATOR: Okay.

         COMPANY REPRESENTATIVE: It’s — you really don’t have — you don’t have
an e-mail address really?

        GAO INVESTIGATOR: Well, I can get one for you, yeah. I’m not real computer
— I’m not a computer guy. That’s all.

         COMPANY REPRESENTATIVE: Okay. Well, I can appreciate that. We probably
— I’m thinking here — is this your cell number?

          GAO INVESTIGATOR: Uh-huh. Uh-huh.

          COMPANY REPRESENTATIVE: You wouldn’t be able to print it if I gave it to you
so –

          GAO INVESTIGATOR: Do you have something on your web site?

           COMPANY REPRESENTATIVE: I don’t have a — I don’t have the form
embedded. Let’s just talk in a couple of hours. I’ll ask you the question. You know, I can
tell pretty much right now that I can help you out. It’s just a matter to the extent where you
need to ask your father — well, probably before you talk to me again. Say, Hey, Dad, you
know, I talked to an accredited VA application guy, and he says that, you know, we can




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get you the benefit but there is some strategy involved. And if you want to hear it, fine. If
not, that’s okay, too.

            You know, that’s just really what you need to do with this.

            GAO INVESTIGATOR: All right. What do you guys charge for that?

          COMPANY REPRESENTATIVE: Well, for the — there’s two ways. Let’s just
leave it at a thousand — $1,050, okay?

            GAO INVESTIGATOR: Just a straight fee?

          COMPANY REPRESENTATIVE: Yeah, $1,050. Of course, what we really want
to do is to be able to – we can give you the recommendations and turn you loose, and you
go out there on the street and try to implement it.

          But, you know, you probably really want to kind of go through us and let us help
you in the full way. I will send you enough information and the attorney’s information so
that you’ll understand that we really are a full-fledged service organization and can really
help you through this mix.

         And then, you know, once we help you out, you can either go down to the local
VA office and have them fill out the paperwork. Is your father — is your father in the same
town as you or is he — where is your father?

          GAO INVESTIGATOR: Yeah, he’s not that far away. About, you know, seven,
eight miles away.

            COMPANY REPRESENTATIVE: Okay. Where — where are you located?

            GAO INVESTIGATOR: I’m actually in north [state].

            COMPANY REPRESENTATIVE: Oh, are you? What part?

            GAO INVESTIGATOR: Well, are you familiar with [city] at all?

            COMPANY REPRESENTATIVE: Yes. I went to [college] so –

            GAO INVESTIGATOR: Oh, no kidding.

            COMPANY REPRESENTATIVE: Yeah. And my sister lives in [city] right now,
actually.

            GAO INVESTIGATOR: Okay.

         COMPANY REPRESENTATIVE: And actually we lived in [city] for a few years
when I was real young. Yeah, I’m familiar with [state]. I’m a native of [state]. So, yeah, we
can help out. So I wish you had some kind of an e-mail.




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        GAO INVESTIGATOR: Well, let me see if I can do something. I mean, you know,
my brother might have something that I can — I can use.

         COMPANY REPRESENTATIVE: Okay. Yeah, because, really, this is a family
discussion. You know, all the kids — how many kids are there besides you?

          GAO INVESTIGATOR: Just me and my brother.

         COMPANY REPRESENTATIVE: All right. So you guys are really going to need
to put your heads together and say, hey, this makes sense for us or it doesn’t. You know,
dad is going to have to cooperate or he’s not. And, you know, sometimes, to be honest
with you — I deal with older folks, you know — they just don’t give a rat’s fanny. And so
you can’t make the horse drink, you know.

          GAO INVESTIGATOR: I don’t think –

          COMPANY REPRESENTATIVE: But if he wants to protect his asset –

          GAO INVESTIGATOR: Yeah, I mean, he’s — you know, mentally he’s fine. I
don’t think that’s going to be a problem. I mean, he –

          COMPANY REPRESENTATIVE: All right. Well, if he wants to protect his assets –

          GAO INVESTIGATOR: Right.

          COMPANY REPRESENTATIVE: Most of the time — most of the time they want
their kids to wind up with the money. And sometimes, you know, they don’t care as much.
But I can’t get in your father’s head, so you need to kind of ask him if that’s the case. If he
wants to protect the money, you can have him protect the money.

          GAO INVESTIGATOR: Okay. All right.

          COMPANY REPRESENTATIVE: Okay?

         GAO INVESTIGATOR: Sounds good. All right. I appreciate it. Well, let me see if I
can get an e-mail address and give you a buzz back.

         COMPANY REPRESENTATIVE: All right. Hey, let me do this. Let me give you
my cell number, please, so you should be — because I’m in and out so much. It’s
[telephone number] –

          GAO INVESTIGATOR: Uh-huh.

          COMPANY REPRESENTATIVE: — [telephone number].

          GAO INVESTIGATOR: Okay.

          COMPANY REPRESENTATIVE: [telephone number].

          GAO INVESTIGATOR: Okay. All right. Got it.




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          COMPANY REPRESENTATIVE: All right, buddy. Take care.

         GAO INVESTIGATOR: I’m sorry. What did you say your name — what did you
say your name was again? I’m sorry.

          COMPANY REPRESENTATIVE: [name]—

          GAO INVESTIGATOR: [name]. Oh, that’s right,[name].

          COMPANY REPRESENTATIVE: [name], [name]. Yeah. All right.

          GAO INVESTIGATOR: Okay. Thank you.

          COMPANY REPRESENTATIVE: Okay. Thank you. Bye now.

Call 3: Caller is a GAO investigator phoning on behalf of his
fictitious 86-year-old father who was a veteran, seeking VA pension
benefits, who wants to learn about the services provided by the
company. The company representative describes how his father can
qualify for these benefits, despite having significant assets.

(Whereupon, an outgoing call was placed by the GAO investigator to a
company representative.)

          SPEAKER ONE: [company name], [name], can I help you?

         GAO INVESTIGATOR: Yeah, I hope so. I want to talk to somebody about
possibly getting VA benefits for my father.

          COMPANY REPRESENTATIVE: Okay. And your name?

          GAO INVESTIGATOR: My name is [name].

         COMPANY REPRESENTATIVE: Hi, [name]. Can you tell me a little bit about
your dad’s situation?

          GAO INVESTIGATOR: Well, he’s a World War II veteran.

          COMPANY REPRESENTATIVE: Okay.

          GAO INVESTIGATOR: He’s 86 years old. Are you there?

          COMPANY REPRESENTATIVE: What is the nature of his illness?

          GAO INVESTIGATOR: I’m sorry?

          COMPANY REPRESENTATIVE: Can you tell me about his illness, please.

          GAO INVESTIGATOR: Well, you know, aside from getting old?



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          COMPANY REPRESENTATIVE: Yeah.

          GAO INVESTIGATOR: He’s having a lot of — he can’t walk too well.

          He’s got a lot of, you know, joint problems and stuff like that.

           So he can’t — he needs a lot of help getting in and out of bed, taking baths and
stuff like that.

          He’s also got — he doesn’t hear very well.

          COMPANY REPRESENTATIVE: And how old is your dad?

          GAO INVESTIGATOR: He’s 86.

          COMPANY REPRESENTATIVE: God bless him.

          GAO INVESTIGATOR: I mean, mentally he’s fine, but physically he’s, you know,
I guess just wearing out.

          COMPANY REPRESENTATIVE: Where does he live? Is he living with you or is
he in a facility?

          GAO INVESTIGATOR: No, he’s got a place, he’s got a house.

         COMPANY REPRESENTATIVE: Ok. Are you planning on leaving him at the
house, staying at the house?

          Is he going to have any in-home health care coming in?

         GAO INVESTIGATOR: Yeah, I mean, in-home, I would think, because I mean,
mentally he’s fine.

        COMPANY REPRESENTATIVE: Have you checked with an in-home health care
agency to come to the house?

          GAO INVESTIGATOR: Well, yeah, he’s got people coming in already.

          COMPANY REPRESENTATIVE: He does. Okay.

          GAO INVESTIGATOR: I mean, that’s kind of why I’m –

          COMPANY REPRESENTATIVE: I see. The reason why I ask those questions is
that in order to get VA benefits, called Aid and Attendance, which is a benefit that the
government will pay up to nineteen fifty per month, tax-free, and the government usually
pays that 9 months out from the time we apply.

          And you get also a retroactive, so it would be 8 months on top of that.

          GAO INVESTIGATOR: Okay.




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          COMPANY REPRESENTATIVE: It’s that they need to have something in place
like in-home health care already being used or about to be used, or he lives in an
assisted-living facility or a nursing home.

             And those are key. One of those three things have to be in place or about to be
in place.

         GAO INVESTIGATOR: He is getting help already at the house. I mean, that’s
one of the things.

             I mean, we’re spending a lot of money.

          And you know, he’s got — he’s got some assets, but I mean, as far as income,
all he’s got is his Social Security.

         COMPANY REPRESENTATIVE: Tell me about his Social Security. What is
coming in per month, as far as income?

             GAO INVESTIGATOR: He’s got eleven fifty coming in a month.

             COMPANY REPRESENTATIVE: Okay. Anything else?

         GAO INVESTIGATOR: Well, no, because he’s got some — you know, he owns
his own house.

             COMPANY REPRESENTATIVE: Right. I’m just asking; I don’t know your
situation.

             But eleven fifty a month in Social Security. No other income is coming in.

             No savings?

        GAO INVESTIGATOR: No, he’s got some savings and stuff, but I mean, I’m
concerned, again, he’s going to lose all that.

             COMPANY REPRESENTATIVE: Right.

          See, how we work — first of all, I’m accredited by the VA. And what we do is we
plug into the software to see what dad qualifies for.

          And what we plug into the software is money going in, money going out, money
saved, illnesses, what his illness issues are, in other words, what the home health care
agency is doing for dad.

             All of that plays a major role in crunching the numbers to see what dad qualified
for.

             And in most cases, [name], it’s not a matter of if he qualifies, it’s a matter of how
much.




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          GAO INVESTIGATOR: Okay.

        COMPANY REPRESENTATIVE: That’s going to have to be our next
conversation.

          I’m just trying to get a little information to see if I can guide you in the right
direction.

         My question to you regarding the home health care, do you have an idea what
they’re charging you per month?

        GAO INVESTIGATOR: Well, you know, it’s probably around a little over two
thousand, maybe twenty-five hundred a month.

        COMPANY REPRESENTATIVE: Okay. And so here’s what you have, [name].
You have more money going out than coming in, as far as income.

          GAO INVESTIGATOR: Right.

        COMPANY REPRESENTATIVE: So you have a shortfall of about fourteen
hundred dollars, thirteen fifty, a month going out for care.

          And that’s a good thing, when it comes to applying for the VA benefits.

          There’s other factors, I’m just giving you kind of an overview.

          GAO INVESTIGATOR: Okay.

         COMPANY REPRESENTATIVE: And it could be, you know, dad may qualify for
up to the full nineteen fifty a month.

          I don’t care if twenty-five hundred is coming in, and twenty-five hundred is going
out the door, the software, with all of the bells and whistles of what we have to plug into it,
it may kick out that dad needs nineteen fifteen a month.

          GAO INVESTIGATOR: Okay, but here’s the problem.

          COMPANY REPRESENTATIVE: He may have a shortfall of fourteen hundred.

        GAO INVESTIGATOR: Yeah, but here’s my concern though, is that he’s got —
he owns his own house, and then he’s got like a mutual fund and he’s got some savings.

        And of course, that’s not going to last very long with this negative, you know,
income that he’s got going on.

          COMPANY REPRESENTATIVE: Correct.

          GAO INVESTIGATOR: But how is he going to qualify for anything with those
assets?




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          COMPANY REPRESENTATIVE: Well, the VA has different scenarios.

        For example, the VA will allow us to do estate planning to reposition the assets
so he can qualify.

          The VA may be able to allow him to keep a certain amount.

         How much money are we talking about in savings or stocks or bonds or mutual
funds total?

          Just off the top of your head. You don’t have to be exact.

        GAO INVESTIGATOR: I’m guessing he’s got maybe ninety thousand in savings
and about two hundred — about a quarter of a million, probably, in mutual funds.

          A little over two fifty, two sixty maybe.

         COMPANY REPRESENTATIVE: All right. So if he’s not opposed, there’s like
several scenarios.

          So let’s just talk about money. Those with assets of which we would call your
dad.

         Is he opposed to repositioning the assets to where — are you the power-of-
attorney, [name]?

          GAO INVESTIGATOR: Like I say, he’s got his mental facilities, so I’m not.

          I mean, I could be, but I mean, at this point, he’s still able to function for himself.

         COMPANY REPRESENTATIVE: Well, your issues here are you have about a
quarter of a million dollars plus cash.

         The government is going to want him to use his money first, if we don’t do estate
planning, which we’re allowed to do, according to the VA parameters.

          GAO INVESTIGATOR: Okay, so what does that mean? Where — what would
you do?

          COMPANY REPRESENTATIVE: What that means is basically is repositioning
the assets to where – it may – and I don’t — again, the software tells us what we can and
can’t do.

          But I’m just going to give you a — kind of a hypothetical.

          Uh — For example, you may be able to reposition, reallocate those funds into a
trust that [name], Jr. — if you’re a Jr. – I’ll just – [name], you –

          GAO INVESTIGATOR: [Inaudible].




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           COMPANY REPRESENTATIVE: — would be the trustee of.

         And we’re allowed to apply for VA benefits the day after, by reallocating those
funds, so that dad can qualify.

           And he may get nineteen fifty a month, tax-free, plus retroactive, for the 8 months
waiting.

         So he may get a full check of about almost twenty something thousand dollars,
and the funds thereafter come each month to you tax-free.

           Does he want that? I don’t know.

        Those are some of the scenarios that the software will kick out, and let us know
what we can and can’t do.

        But the bottom line is, if you went to the VA directly and told them — because
you would have to be forthright, and tell them that you had this money — they would reject
you immediately, until you spend down to your last fifteen hundred dollars.

           Or there are options that you could do.

         And that’s where an accredited VA claims agent comes in, myself, because we
work with attorneys that do estate planning that are able to do these type of things.

       So those are the questions you want to talk to your dad about, even though he
may have his faculties, and he may be able to make decisions.

        Is he willing to pull the trigger and let you make the decisions? Because that’s
what he may have to do.

           GAO INVESTIGATOR: Well, I’m just –

           COMPANY REPRESENTATIVE: I’m just giving you one of the scenarios.

        But our niche is that we deal with people with assets, if they are willing to let the
power-of-attorney make those decisions, then we can apply for VA benefits without a
hiccup.

           GAO INVESTIGATOR: Okay, all right.

         COMPANY REPRESENTATIVE: So those are the questions that I probably
would talk to my dad about.

           GAO INVESTIGATOR: He’s pretty reasonable.

           COMPANY REPRESENTATIVE: Because quite frankly, there is a gap.

        And dad, who knows, can get worse, and then you may have to put him into a
nursing — an assisted-living facility, which is twice what you’re paying now.




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         And now it becomes a do or die situation, where do you want to preserve the
Estate, or do you want to spend it down?

          And those are the questions — those are hard questions to ask.

         GAO INVESTIGATOR: Yeah. You know, what I’m seeing now is that those
assets are – are dwindling because —

          COMPANY REPRESENTATIVE: The economy.

         GAO INVESTIGATOR: Yeah, and we’re putting out more than, you know, he’s
only got a little bit coming in with the social security. That’s not covering it.

         COMPANY REPRESENTATIVE: No, that’s right. And what these types of estate
planning devices, that’s allowed, according to the VA, it’s real simple.

         I mean, they make it very clear that the — by the way, are you the power-of-
attorney?

          GAO INVESTIGATOR: I don’t have a power-of-attorney, but I can probably get
one.

        COMPANY REPRESENTATIVE: I would do that yesterday. I would — forget
whether we met each other or not. You need to get that done.

          What I would suggest — can I make a suggestion?

          GAO INVESTIGATOR: Uh-huh.

          COMPANY REPRESENTATIVE: Go to Office Depot –

          GAO INVESTIGATOR: Yes.

        COMPANY REPRESENTATIVE: — get a general power-of-attorney in place.
Have a notary notarize it, which will make it legally binding that day of notary.

         And now you have a power-of-attorney in place, so that if anything happens to
dad, God forbid, he has a stroke and he becomes mentally incapacitated, you’ve already
got something in writing where you can make decisions for him, and you don’t have to go
through the court system.

          GAO INVESTIGATOR: That makes sense.

        COMPANY REPRESENTATIVE: So I would do that immediately. And I would tell
dad. He wouldn’t be opposed to that, would he?

        GAO INVESTIGATOR: I don’t think so, no. But by the same token, he can still
make his own decisions, so I want him to –




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         COMPANY REPRESENTATIVE: That’s doesn’t change. I mean, he still makes
his own decisions, even with the power-of-attorney in place.

          The power-of-attorney is only in case he does become incapacitated.

          GAO INVESTIGATOR: Uh-huh.

        COMPANY REPRESENTATIVE: Okay. You are basically doing preventive
medicine. And that’s what we’re suggesting here.

         If the software kicks out — and I don’t know until I get a fact-finder filled out by
you in detail, and it’s an 8-page fact-finder, it takes me about 7 hours with the attorney to
go through all this.

          And we don’t charge to fill out the VA forms.

          We do not charge to represent dad for the VA benefits, but we do charge a flat
rate to do the seven hours, eight hours of due diligence to figure out what is going to be
the right avenue, because they are only going to have one scenario that’s going to fit
dad’s situation, once we get that fact-finder in.

         Because once we get that fact-finder in, the software tells us exactly what we can
and can’t do.

          GAO INVESTIGATOR: All right. And how much is that? What’s the cost of that?

          COMPANY REPRESENTATIVE: Fifteen hundred dollars.

          GAO INVESTIGATOR: Fifteen hundred, okay.

         COMPANY REPRESENTATIVE: But it’s not a matter of if dad qualifies, it’s a
matter of how much.

         I will tell you, because he’s a living vet, our experience from the software, the
software will kick back between sixteen to nineteen hundred dollars that he would qualify
for, because he’s a living vet,. whereas if it was mom, and dad was dead, the surviving
spouse always gets less.

          GAO INVESTIGATOR: Okay.

           COMPANY REPRESENTATIVE: Now if dad qualifies for the nineteen fifty — let’s
just use that as an example — times, ah, he’ll get a check on the ninth month, if we apply
for it yesterday, and got everything in place, he would get a check from the government for
seventeen thousand five hundred fifty dollars, tax-free.

         And then, each month thereafter, he would get nineteen fifty coming in, each
month, tax-free.

          GAO INVESTIGATOR: Whoa.




Page 52                                                        GAO-12-540 Veterans’ Benefits
Appendix II: Full Transcript of Selected Calls
with Organizations Providing Products and
Services to Help Claimants Qualify for VA
Pension Benefits




           COMPANY REPRESENTATIVE: That’s how that works. I’m here to tell you, that
for fifteen hundred dollars, you’ll get your money back on the first month that you apply,
basically.

          GAO INVESTIGATOR: Yeah, yeah.

          COMPANY REPRESENTATIVE: But once we do what we need to do, and if he’s
not objected — objecting to the reallocating and repositioning of those funds, because
quite frankly, at 86, I know he has two hundred and fifty thousand in mutual funds, but you
know, that’s a concern to me right there, because of the loss and what’s going on in the
economy.

          GAO INVESTIGATOR: Uh-huh.

         COMPANY REPRESENTATIVE: So is he willing to pull the trigger and get it out
of harm’s way, so that he would get between 4 to 6 percent, and not — and not at any
risk?

         Because if we do reposition the funds, it’s very likely that it has to be an account
that cannot go backwards.

          GAO INVESTIGATOR: All right. So what type of thing are you talking about?

           COMPANY REPRESENTATIVE: It could be CDs, it could be annuities, but the
point is, it has to be an account that’s protected, that can’t go backwards.

         There’s not an attorney, that I know that’s accredited, that would will take any
case that’s going to be tied into stocks, bonds, or mutual funds, because they can lose
their base, they can lose their principal, they can lose their gains.

          And the attorney signs off on that stuff, when he represents the VA.

          GAO INVESTIGATOR: Okay. And if he’s putting it into something, and he’s
getting 4 to 6 percent, does that money go to him or where does that go?

          COMPANY REPRESENTATIVE: If it stays into the account, it goes to him.

        How it works, basically, [name], it’s that the power-of-attorney is the decision
maker with dad.

          You become the trustee.

          GAO INVESTIGATOR: Okay.

          COMPANY REPRESENTATIVE: You are the pivot, you are the person we go to.

         Because everything has to be reallocated out of dad’s name, titled to the trust, so
that [name] controls it, [name] cuts the checks.




Page 53                                                        GAO-12-540 Veterans’ Benefits
Appendix II: Full Transcript of Selected Calls
with Organizations Providing Products and
Services to Help Claimants Qualify for VA
Pension Benefits




        Dad’s allowed to keep money in his account, that’s not a question. It’s a question
of how much is he allowed to keep in his account.

        That depends on the software coming back and telling us what he’s allowed to
keep, what he’s not allowed to keep.

          GAO INVESTIGATOR: Uh-huh, uh-huh.

          COMPANY REPRESENTATIVE: Do you follow?

         GAO INVESTIGATOR: If I use any of that money for him or for me, I have to
count that as income?

          COMPANY REPRESENTATIVE: Great question. Let’s talk about for him first.

         If you use the money for him — first of all, the Trust will Dad has what? — am I
correct by saying he has over two fifty, combined, like three forty?

        GAO INVESTIGATOR: Yeah. Well, like I say, he’s got about ninety in savings
and another two — maybe about two sixty in a mutual fund.

          COMPANY REPRESENTATIVE: So three fifty he has total.

          GAO INVESTIGATOR: Okay, yeah.

          COMPANY REPRESENTATIVE: So what would happen, in this Trust account,
visualize it as there’s a checkbook access.

          In the checkbook access, you’re able — you’re going to have up to three fifty,
what’s going to be liquid is going to be roughly about close to a hundred and fifty thousand
dollars, or a hundred thousand minimum.

          GAO INVESTIGATOR: Okay.

        COMPANY REPRESENTATIVE: So that’s for incidentals, for dad’s needs, for
whatever. It doesn’t make a difference.

          I don’t have to know what it’s for.

         GAO INVESTIGATOR: Okay. But if I use that, does somebody, either I or him,
have to count that as income?

        COMPANY REPRESENTATIVE: Well, if he cashes in his – are these IRAs? Do
you know?

          GAO INVESTIGATOR: Well, no. I mean –

        COMPANY REPRESENTATIVE: Okay. If they’re not IRAs, and they’re just non-
IRAs, non-401(k)s, non-retirement plans –




Page 54                                                      GAO-12-540 Veterans’ Benefits
Appendix II: Full Transcript of Selected Calls
with Organizations Providing Products and
Services to Help Claimants Qualify for VA
Pension Benefits




          GAO INVESTIGATOR: Right.

        COMPANY REPRESENTATIVE: — then, no, you could use them into the
account —, and they could be taxable— for whatever, it’s not countable as income.

        But if they are IRAs, then you would have to cash in the IRAs and then it would
become income.

          GAO INVESTIGATOR: Okay.

        COMPANY REPRESENTATIVE: But the other account, when it’s put into the put
and keep account — let’s say you have three hundred and fifty thousand.

          A hundred to a hundred fifty goes into the checkbook access.

          The other two hundred or whatever goes into a put and keep account earning
four to six percent.

          GAO INVESTIGATOR: Is that like an annuity or something?

         COMPANY REPRESENTATIVE: That doesn’t earn any interest. That’s
accessible dollars, liquid dollars, when you need it for emergency.

          The other account will earn 4 to 6 percent.

        So it depends on what you want to put into that other account, and how much
you want to keep liquid.

          GAO INVESTIGATOR: Okay. Well, the account that’s earning 4 to 6 percent,
what is that in? Is that an annuity or what is that?

            COMPANY REPRESENTATIVE: It would be an annuity that has accessibility to
it, but it’s tax-free, it’s not being — it’s not being taxed.

          GAO INVESTIGATOR: Okay. All right. But I wouldn’t have access to that
money?

        COMPANY REPRESENTATIVE: You will have access to that money. Each year
you have access to it, up to 10 percent free withdrawal, with no penalty.

          GAO INVESTIGATOR: Okay.

         COMPANY REPRESENTATIVE: And if — but that’s why we want to keep some
of that money out in the Trust account checkbook, that is basically accessible, totally
liquid.

          So the software will kick out what we can and can’t do.

         I’m projecting that probably a hundred and fifty of it, up to a hundred and fifty,
could be liquid.




Page 55                                                        GAO-12-540 Veterans’ Benefits
Appendix II: Full Transcript of Selected Calls
with Organizations Providing Products and
Services to Help Claimants Qualify for VA
Pension Benefits




          Now you may not need a hundred and fifty liquid. So the more you put into the
annuity, the more interest you’re going to earn on those funds.

          GAO INVESTIGATOR: Uh-huh.

          COMPANY REPRESENTATIVE: That’s a decision you have to make with dad.

          GAO INVESTIGATOR: Okay.

         COMPANY REPRESENTATIVE: But from my experience on the software, I’ve
seen between, - a hundred and fifty or a hundred thousand go into the annuity — checking
account, and the rest goes into the annuity.

          GAO INVESTIGATOR: Uh-huh.

          Well, hopefully, you’re talking this VA thing.

        Is that really — the nineteen or whatever that he would qualify for, is that a
pension or what is that?

        COMPANY REPRESENTATIVE: It’s — it’s — I’m sorry. It’s going to be
considered what is called Aid and Attendance.

          GAO INVESTIGATOR: Okay.

          COMPANY REPRESENTATIVE: It’s aiding him with him attendance for his care,
and that is the home health care.

         Remember, I mentioned that there’s three things that have to be in place in order
for us even to apply for the VA benefits called Aid and Attendance.

         And that he is already getting aid, you know, from a home health care, or
assisted-living or in a nursing home.

          GAO INVESTIGATOR: Uh-huh. All right.

          COMPANY REPRESENTATIVE: And so we’re applying for specifically that.
That’s all I deal with.

          I don’t deal with any of the other benefits that the VA has.

          GAO INVESTIGATOR: Okay. All right, all right.

        COMPANY REPRESENTATIVE: But you do have some obstacles. You have
some issues that you need to discuss with dad.

          If you’re interested, I believe that it’s a fit.

          It’s not a matter of if he qualifies, it’s a matter of how much. But the computer will
tell us what we can and can’t do.




Page 56                                                         GAO-12-540 Veterans’ Benefits
Appendix II: Full Transcript of Selected Calls
with Organizations Providing Products and
Services to Help Claimants Qualify for VA
Pension Benefits




         And then, if you like, I can e-mail you the fact-finder and the information. There’s
two forms I would send to you that you would send back to me, signed, with a check, and
the address is on the fact-finder.

          If you like, I can e-mail it to you, if you have an e-mail address.

          GAO INVESTIGATOR: I’ll tell you what, I want to talk to him about it first.

        COMPANY REPRESENTATIVE: Okay, great. Just keep us in mind. You have
our number; give us a call.

         GAO INVESTIGATOR: Okay. I’m trying to think if I have any other questions for
you. I was just trying to write down a couple things here.

          All right, I mean, I guess that’s it.

        COMPANY REPRESENTATIVE: The problem that you have right now is that you
have assets.

        We have to definitely — I know, from experience, that if you have assets, there
may be a strong possibility of repositioning some of those assets.

        And there’s a way to reposition some to the trust and there’s a way to reposition
some to dad, and there’s a way to reposition to [name].

          GAO INVESTIGATOR: Right, right.

          COMPANY REPRESENTATIVE: That all comes from the software, once it kicks
it out.

         GAO INVESTIGATOR: All right. And you said that the cost is fifteen hundred
bucks for the –

          COMPANY REPRESENTATIVE: Flat rate, yeah, no extra costs.

          GAO INVESTIGATOR: All right. Well, let me talk to him and I’ll get back to you.

          COMPANY REPRESENTATIVE: All right. Nice meeting you, [name].

          GAO INVESTIGATOR: Thank you for your time.

          COMPANY REPRESENTATIVE: Bye bye.




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Appendix III: Comments from the
              Appendix III: Comments from the Department
              of Veterans Affairs



Department of Veterans Affairs




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of Veterans Affairs




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of Veterans Affairs




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of Veterans Affairs




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Appendix III: Comments from the Department
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Page 62                                      GAO-12-540 Veterans’ Benefits
Appendix IV: GAO Contact and Staff
                  Appendix IV: GAO Contact and Staff
                  Acknowledgments



Acknowledgments

                  Daniel Bertoni, (202) 512-7215 or bertonid@gao.gov.
GAO Contact
                  In addition to the contact named above, individuals making key
Staff             contributions to this report were Jeremy Cox, Assistant Director; James
Acknowledgments   Bennett; Susannah Compton; Paul Desaulniers; Shelia Drake; Alex
                  Galuten; Douglas Manor; Nelson Olhero; Martin Scire; Wayne Turowski;
                  Walter Vance, and Gregory Whitney




                  Page 63                                         GAO-12-540 Veterans’ Benefits
Related GAO Products
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             VA Enhanced Monthly Benefits: Recipient Population Is Changing and
             Awareness Could be Improved. GAO-12-153. Washington D.C.:
             December 14, 2011.

             VA’s Fiduciary Program: VA Plans to Improve Program Compliance and
             Policies, but Sustained Management Attention is Needed. GAO-10-635T.
             Washington, D.C.: April 22, 2010.

             VA’s Fiduciary Program: Improved Compliance and Policies Could Better
             Safeguard Veterans’ Benefits. GAO-10-241. Washington, D.C.: February
             26, 2010.

             Veterans’ Benefits: Improved Management Would Enhance VA’s Pension
             Program. GAO-08-112. Washington, D.C.: February 14, 2008.

             Medicaid Long Term Care: Few Transferred Assets before Applying for
             Nursing Home Coverage; Impact of Deficit Reduction Act on Eligibility Is
             Uncertain. GAO-07-280. Washington D.C.: March 26, 2007.

             Medicaid: Transfer of Assets by Elderly Individuals to Obtain Long-Term
             Care Coverage. GAO-05-968. Washington D.C.: September 2, 2005.




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             Page 64                                          GAO-12-540 Veterans’ Benefits
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