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VA Health Care: Better Procedures Needed to Maximize Collections From Health Insurers

HRD-90-64 Published: Apr 06, 1990. Publicly Released: May 04, 1990.
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Highlights

Pursuant to a congressional request, GAO reviewed whether the Department of Veterans Affairs (VA): (1) collections from health insurers exceeded health care costs; and (2) had effective procedures to identify insured veterans and bill insurers and collect amounts owed.

Recommendations

Matter for Congressional Consideration

Matter Status Comments
Given the substantial benefit to the government possible through maximizing insurance collections, Congress should ensure that VA has the resources necessary to fully implement its recovery efforts. If adequate resources are not available through the budget process, Congress should consider amending 38 U.S.C. 629 to allow VA to keep a portion of the amounts collected from insurers to defray its administrative costs.
Closed – Implemented
P.L. 101-508 included language which authorized the Medical Care Cost Recovery Fund. VA deposits all collections into this working capital fund and uses a portion of the funds to meet collection expenses.

Recommendations for Executive Action

Agency Affected Recommendation Status
Department of Veterans Affairs The Secretary of Veterans Affairs should ensure that all medical centers bill insurers for outpatient care they provide to insured veterans. In addition, the Secretary should ensure that each medical center has effective procedures for: (1) identifying all veterans with health insurance; and (2) billing insurers for all episodes of inpatient and outpatient care provided to insured veterans.
Closed – Implemented
VA has issued requirements that all medical centers bill third-party insurers for outpatient care. In addition, the agency has provided training to all relevant staff on improved procedures for identifying and billing insurers.
Department of Veterans Affairs The Secretary of Veterans Affairs should ensure that all medical centers bill insurers for outpatient care they provide to insured veterans. In addition, the Secretary should ensure that each medical center has sufficient resources to fully implement its identification, billing, and collection procedures.
Closed – Implemented
P.L. 101-508 provided the funds needed to identify and bill insurers.

Full Report

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Topics

Administrative costsBilling proceduresHealth care cost controlHealth insuranceHospital care servicesInsurance claimsMedical expense claimsReimbursements to governmentVeterans benefitsVeterans hospitals