What We Actually Know About HR 5723 and VA Fraud Investigations (And What’s Just Speculation)
The VA is investigating fraud in private DBQs. An AI tool will scan over a million claims going back to 2010. HR 5723 creates the legal framework. Veterans are panicking.
Here’s the problem: Nobody actually knows what’s going to happen. Not the YouTubers covering this story. Not the VSOs. Not me. But I’m seeing a lot of speculation being presnted as fact.
Let’s separate what we actually know from what we’re all guessing about.
What We Actually Know (The Complete List)
These are facts, not speculation:
- The VA is developing an AI tool to scan private DBQs for fraud indicators
- The tool will review 1+ million private DBQs going back to 2010
- Expected operational by September 2025 (end of fiscal year)
- HR 5723 creates legal framework requiring criminal conviction to change final decisions
- The OIG identified specific fraud indicators: 100-mile rule, copy-paste language, template alterations, missing signatures, blind exams
That’s it. Everything else is educated guessing.
What Nobody Actually Knows
Here’s the knowledge gap everyone’s filling with certainty:
- How the tool actually works in practice
- What triggers investigation vs. just a flag
- How many false positives there will be
- What protections exist during investigations
- What happens to veterans caught in the system
- Whether you can provide additional evidence if flagged
The VA hasn’t released this information. Anyone claiming to know is speculating.
What HR 5723 Actually Says
Section 2(c)(1):
“The Secretary may not, pursuant to an investigation of the Inspector General, reopen or change a final decision…”
Section 2(c)(2) – The Exception:
“Paragraph (1) shall not apply in any case in which… an individual is convicted by a court of competent jurisdiction of a crime relating to fraudulent activity…”
Translation: To lose your benefits, you must be convicted of fraud in criminal court.
Not investigated. Not flagged. Not suspected. Convicted.
That requires: Investigation → Referral to prosecutors → Criminal charges → Trial → Conviction beyond reasonable doubt.
The AI doesn’t just flag your claim and your rating disappears.
The Fraud Indicators (What They Actually Mean)
The OIG identified these red flags:
- Provider 100+ miles away for in-person exam
- Copy-paste language across multiple DBQs
- Template alterations, different fonts
- Missing or inconsistent signatures
- “Blind exams” – provider never saw veteran
- Evidence contradicts other medical records
- Refused C&P exams
- 100% rating with no treatment records
Important: These are investigative triggers, not proof of fraud.
Having a provider 100 miles away doesn’t mean you committed fraud. It means additional review. The VA still has to prove you knowingly submitted false information with intent to defraud – a criminal legal standard.
Where You Actually Stand
High Risk:
- You knowingly submitted fabricated evidence
- You used a provider under criminal investigation
- You refused C&P exams on shady advice
- You know you committed fraud
Low Risk:
- You used legitimate providers
- You attended all C&P exams
- You documented real symptoms honestly
- You can stand behind everything you submitted
No Risk:
- You told the truth
- Your evidence matches reality
The Key Legal Concept: Intent
Fraud requires proving intent to deceive.
If you went to a provider you believed was legitimate, answered honestly, attended your C&P exam, and documented real symptoms – you didn’t commit fraud, even if the provider has problems.
The provider might face prosecution. But without proving you intended to defraud the VA, you’re not criminally liable.
The False Positive Problem
AI makes mistakes. It may flag legitimate claims from veterans who:
- Used specialists 100+ miles away for legitimate reasons
- Did telehealth for mental health (standard practice)
- Have symptom variability that looks like contradictions
These veterans didn’t commit fraud. But they might get flagged anyway.
What happens then? Nobody knows. The bill doesn’t specify protections, timelines, or process.
This uncertainty is the real concern for veterans who documented honestly.
What Actually Protects You
Truth Is Your Shield
If you documented honestly, you didn’t commit fraud. An investigation might be stressful, but if every statement was true, there’s no crime to prosecute.
Documentation Shows Patterns
Real disabilities fluctuate. Honest documentation shows natural variability, specific details, consistency with medical treatment, and patterns over time.
Fraudulent evidence shows perfect consistency, generic descriptions, and contradictions with daily life.
Medical Records Tell the Story
If your 2018 private DBQ gets flagged but you have 2015-2025 treatment records showing the same condition at similar severity – that corroborates your claim.
Consistent treatment over years is hard to fake.
Cooperation Demonstrates Good Faith
If flagged and innocent: respond to requests, attend exams, provide additional evidence, be transparent.
Innocent people cooperate. Guilty people evade.
What You Can Do Right Now
If You Have an Active Claim:
- Review your evidence – Can you stand behind every statement?
- Attend all C&P exams – Anyone telling you to skip them is giving dangerous advice
- If you used a questionable provider – Get additional evidence from other sources
If Your Claim Is Already Decided:
- Maintain regular medical treatment – Creates a treatment history that corroborates your rating
- Keep your own records – Track symptoms as they occur, including good days and bad
- Review your claim file – Know what’s in there
- Don’t panic, but be aware – Your claim might get flagged. That doesn’t mean you committed fraud.
The Uncomfortable Realities
Some veterans did commit fraud. Not many, but not zero. It hurts everyone – takes resources from legitimate claims, creates political ammunition for VA funding cuts.
Some providers are predatory. DBQ mills that pump out boilerplate evaluations set veterans up for scrutiny.
The VA created this market. If VA doctors completed DBQs, this private industry wouldn’t exist.
False positives will happen. Veterans who did nothing wrong will face stress and bureaucratic delays. We don’t know what protections exist for them.
What Happens If You’re Flagged (Best Guess)
Nobody knows for certain, but likely scenario:
- You receive notification of review
- You’re asked for additional evidence or to attend an exam
- Investigation takes months
- Most cases don’t result in prosecution
- You can respond and provide context
Most likely outcome for honest veterans: Flag triggers review → Additional evidence requested → You provide current treatment records → Investigation closes → Rating unchanged.
But this is educated guessing. The VA hasn’t specified the actual procedure.
The Bottom Line
The VA is investigating fraud. They’re building AI tools. HR 5723 requires criminal conviction to change final decisions.
Beyond those facts, the rest is speculation.
If you documented honestly, you’re protected by the truth. The investigation might be stressful. You might get flagged. But if you told the truth, there’s no fraud to prosecute.
That’s reality: Truth protects you. Lies expose you. Everything else is speculation until the VA provides details about how this actually works.
About this article: I’m a 100% P&T Navy submarine veteran (1988-1992) who documented thousands of pages of evidence over 30+ years of advancing disabiity. I’m neither a lawyer nor VSO. I’m just a veteran who wants straight information out there instead of speculation presented as fact.