A new report has revealed the federal government made duplicate payments to doctors amounting to as much as $128 million of taxpayer funds for the treatment of veterans.
From 2017 to 2021, private doctors treating veterans were paid twice – once by Medicare and once by the Veterans Health Administration (VHA) – for the same services in nearly 300,000 cases, according to a report by the Health and Human Services Office of Inspector General released Monday.
“These duplicate payments occurred because [Centers for Medicare & Medicaid Services] CMS did not implement controls to address duplicate payments for services,” the report read. “If CMS had developed an interagency process to include VHA enrollment, claims, and payment data in CMS’s data repository and had established an internal process that used these data, Medicare could have saved up to $128 million in payments for claims for medical services that VHA authorized and paid for during our audit period,” the HHS OIG concluded. (RELATED: VA Wasted $10 Million In Unwarranted Medical Exams, Reports VA Watchdog)
The federal government wrote duplicate checks to doctors who provided care for veterans, costing taxpayers as much as $128 million in extra payments, according to a new watchdog report https://t.co/FqBYxPHDmB #10TV
— 10TV (@10TV) April 27, 2023
The number of veterans receiving care through the VHA increased during the period of 2017-2021 with a significant increase following the implementation of the Veterans Community Care Program (VCCP) in June 2019, the report stated. The VCCP expanded a previous service, known as Veterans Choice Program, which allowed for veterans to seek medical treatment outside of the VA on an exception basis. These programs were implemented to address significant delays in healthcare treatment and limited access to facilities faced by the 9 million veterans enrolled in the VHA, the report explained.
Out of those 9 million, 5.6 million were eligible for both Medicare and VHA benefits in the 2020 fiscal year. For those with dual coverage, VHA is solely responsible for paying for the VCCP services it has authorized, while Medicare payments are supposed to only cover services not authorized by the VA. Any service covered by another government organization and paid for by Medicare is considered an overpayment, according to the report.
In order to address the overpayment issues for those with dual coverage, the HHG OIG has recommended the CMS establish a comprehensive data-sharing agreement with VHA for the ongoing sharing of data; establish an interagency process to integrate VHA enrollment, claims, and payment data to identify potential fraud, waste, and abuse under the Medicare program; establish an internal process to address duplicate payments; and issue guidance to providers on not billing Medicare for a medical service that was authorized by VHA, the report concluded.