In a report that likely will add to the controversy over the VA’s program of using outside providers for some veterans’ care, an inspector general audit has found that the department is in effect overpaying those providers by failing to recapture some of the costs it is billed.
The report addresses the Veterans Choice Program which allows veterans to receive care from local providers if they cannot receive the health care they need from a VA facility or within certain wait time or distance criteria. Those providers then bill the VA but if the veterans have private insurance, the VA has the right to submit to those insurance companies claims for the treatment of conditions unrelated to the veteran’s military service.
Auditors found that some 1.3 million of 2.4 million billable community care claims paid between April 20, 2017, and October 31, 2020, were not submitted to private health insurers before filing deadlines expired. As a result, the VA “did not collect an estimated $217.5 million that should have been recovered from private health insurers, a figure that could grow to $805.2 million by September 30, 2022, if these problems are not corrected,” the report said.
Factors contributing to the delays in billing included that the VA’s billing and revenue collection process was not synchronized with insurers’ filing deadlines, claims being denied because they were incomplete, and “pending workload volume and staff shortages” in the VA component responsible for the billing. Although that office “was broadly aware of challenges to its process to bill and collect revenue from private insurers, its responses were not sufficient to correct these issues.”
It said management agreed with its recommendations to prioritize processing to meet insurers’ filing deadlines, assure that the VA has complete and accurate information for seeking reimbursement, and assess whether additional staff are needed.
Federal employee unions representing VA employees have long decried the Choice program as a form of privatization, an issue that likely will gain additional attention in the time ahead due to recent recommendations by the VA to close some of its facilities while realigning and opening others, which unions contend will increase reliance on outside providers. Those recommendations now are before a special commission in a process similar to the former DoD base closings process in which the commission’s final recommendations will take effect unless blocked by Congress.
Source: Fedweek.com
Comentarios