From the U.S. Government Accountability Office, www.gao.gov Transcript for: Improvements to VA's Millennium Act Emergency Care Benefit Would Better Serve Veterans Description: Audio interview by GAO staff with Randall Williamson, Director, Health Care Related GAO Work: GAO-14-175: VA Health Care: Actions Needed to Improve Administration and Oversight of Veterans' Millennium Act Emergency Care Benefit Released: March 2014 [ Background Music ] [ Narrator: ] Welcome to GAO's Watchdog Report, your source for news and information from the U.S. Government Accountability Office. It's February 2014. When veterans who have no other health care coverage receive emergency care from a non-VA provider, the Department of Veterans Affairs is authorized to cover that care, even for non-service-related conditions. A team led by Randall Williamson, a director in GAO's Health Care team, recently examined VA's management of these benefits. GAO's Sarah Kaczmarek sat down with Randall to talk about what they found. [ Sarah Kaczmarek: ] How's VA doing in managing Millennium Act Emergency Care Benefits? [ Randall Williamson: ] The bottom line here is that VA has a lot of room to improve in its implementation and oversight of the Millennium Act Emergency Care Benefit. Regarding implementation, basically we found that claims processing staff at the 4 facilities that we visited did not comply with many program requirements when they denied these claims. In the area of oversight, we found that VA's oversight of Millennium Act claims processing was lacking. The impact is, of this is that VA facilities are often at risk for inappropriately denying these claims. Finally, there is some communication issue between VA and non-VA providers who provide emergency care to veterans under this program, which in some cases have resulted in late payment from the VA and a misunderstanding among non-VA providers of key program elements. [ Sarah Kaczmarek: ] Now, you mention your team found problems with VA inappropriately denying claims. Can you talk about what you found? [ Randall Williamson: ] That's right. As I just mentioned, we found a number of issues related to non-compliance in claims processing. At the 4 facilities, we reviewed 128 Millennium Act Emergency Care claims that had been denied in fiscal year 2012. From that sample, we found 66 instances of non-compliance with requirements. Here are a few examples. VA facilities did not date stamp and properly scan claims when they received them. Now that's important because claims must be received from non-VA providers within 90 days of the episode of care. Otherwise, these claims are automatically denied. In addition, we found that VA facilities had automatically denied claims related to motor vehicle crashes, assuming instead that veterans were fully covered by auto insurance or another third party. [ Sarah Kaczmarek: ] Let me ask you, then. How's VA doing in terms of making sure veterans understand their eligibility for benefits? [ Randall Williamson: ] VA currently has a number of ways to educate veterans. For example, VA has written benefit materials posted on its website. Also, there are VA staff available at the facility or by telephone to answer their questions. However, in interviews we had with key stakeholders both inside and outside VA, there were indications that many veterans had limited knowledge of their Millennium Act Benefit and its requirements. Now, this suggests that these methods are not that effective. VA could conduct surveys of veterans or organize focus groups with veterans so VA can better understand where the gaps in knowledge are and better tailor their education and outreach efforts. VA could also require a facility to conduct evaluations about where gaps in benefit knowledge may exist. The facilities we have visited do not conduct any such evaluations of the veterans they serve. [ Sarah Kaczmarek: ] Given the breadth of the problems here, what's GAO recommending be done? [ Randall Williamson: ] We have a large number of recommendations, 12 actually. A number of these will address ways to achieve compliance with program requirements. Several of our recommendations are also designed to help VA improve oversight over how well its facilities are processing claims under the program. Finally, we propose ways the agency could collect better data on denied claims and improve veterans' understanding about their eligibility for program coverage. [ Sarah Kaczmarek: ] Finally, for veterans and taxpayers, what's the bottom line here? [ Randall Williamson: ] In this case, the report highlights the negative effects that inappropriately denied claims and lack of knowledge about the benefits under the program can have on veterans. In many cases, for example, veterans may be stuck paying large emergency care bills that VA should've covered, or they could've put themselves in serious health risk for delaying immediate emergency care. [ Background Music ] [ Narrator: ] To learn more, visit GAO.gov and be sure to tune into the next episode of GAO's Watchdog Report for more from the Congressional watchdog, the U.S. Government Accountability Office.