Healthcare organizations have been billing veterans for care that should have been paid by the Department of Veterans Affairs, according to a report that followed a whistleblower’s accusation about the problem and hundreds of millions of dollars in wasteful spending at the department.
The report, issued last week by the Office of Special Counsel, uncovered a “gross waste of funds” and that the VA had “failed to timely reimburse community healthcare providers, which resulted in some of those providers terminating services for [v]eterans and referring [v]eterans to collection agencies for nonpayment.”
The Veterans Affairs Department performed its own investigation into the whistleblower’s claims and “largely substantiated” all of the claims that were made.
Hundreds of veterans had their bills referred to collection agencies, according to the results of the investigations, largely in the VA’s mid-Atlantic region.
When it is unable to provide the required or necessary care, the VA refers veterans to private healthcare organizations for treatment. But those bills are supposed to be covered by the VA. The number of veterans who have been referred to private doctors has grown significantly in the past few years, after an investigation uncovered veterans waiting too long for treatment from a VA physician.
The VA said that only 51% of the claims it received between 2014 and 2018 were “clean” and not in need of additional information from either the doctor or the patient.
Among the recommendations proposed to the VA are:
- Employ automated solutions for providers to submit claims to improve payment timeliness
- Conduct a nationwide education campaign to teach healthcare organizations how to submit claims to the VA
- Develop a strategy to resolve unpaid claims and clear the unpaid claims backlog
- Ensure that VA payment centers have adequate staff to handle the volume of claims needed to be processed