Department of Veterans Affairs (VA) officials use a manual, paper-based system to process payments to private sector doctors that is so slow and inefficient care providers often go unpaid while multiple low-skill government clerks print, scan and stamp records and letters.
The system functions so poorly private-sector doctors have begun declining VA patients, so VA officials — many of whom fear using non-government care providers jeopardizes their union-backed government jobs — now claim more bureaucrats are needed to oversee the outsourcing effort.
The Daily Caller News Foundation reported earlier this month the Philadelphia claims processing office was filled with employees who allegedly watched TV all day, were paid overtime to do their work at night, and frequently brought their children to work.
The House Committee on Veterans’ Affairs wrote to VA Under Secretary of Health David J. Shulkin May 24 saying TheDCNF’s findings were consistent with what the Government Accountability Office (GAO) found across the department’s entire operation for paying private doctors who treat veterans when they can’t get timely treatment at a government facility.
The VA system forces such doctors and other care providers to file anywhere from 25 to 75 pages of documentation in order to be reimbursed. The documentation must be filed in paper format. VA employees then feed the pages into consumer-grade scanners that only take a few pages at a time.
Snail mail is also used to communicate with the doctors about the reimbursements. Doctors often say they never get the letters.
“These allegations paint a picture of a dysfunctional, inefficient, and mismanaged organization… community care is facing a serious problem with delinquent payments discouraging provider participation,” House Veterans’ Affairs Committee Chairman Jeff Miller told Shulkin. “When was the last time … department leadership visited the Philadelphia Non-VA Purchased Care Support office, and what was their assessment?”
In TheDCNF’s story, multiple employees said the mostly black employees “ganged up” on a “white lady” they encountered in a parking lot and threatened her profanely until she called the police. (RELATED: Fired Fed Claims Co-Workers Spent Days Watching Movies, Attacking ‘White Ladies’)
A February GAO report found the VA only paid 66 percent of doctors within a month of entering them into the system, while Medicare and Tricare manage to pay 99 percent of doctors in that time. Even then, “data likely overstate [VA’s] performance because they do not account for delays in scanning paper claims, which account for approximately 60 percent of incoming claims.”
A doctor’s office told GAO auditors it sees 17 times more Medicaid patients than veterans, yet equal staff hours are required overall to obtain payment from VA as for Medicaid. VA officials have blamed the private sector care providers for not providing required documentation for payments. (RELATED: Veterans’ Health Derailed By VA Skipping Out On MILLIONS In Doctor Bills)
GAO said it was told by VA officials it doesn’t “have the capacity to accept medical documentation electronically from the providers.” The VA “cannot automatically adjudicate claims” which “staff told us can slow claims processing, make errors more likely, and delay claims payment,” GAO said.
Even so, VA officials have pointed to “staffing shortages” as the problem that needed addressing. (RELATED: Feds Put Credit Card Felon In Charge of Major VA Purchasing Program)
Virtually every doctor’s office interviewed by GAO said they encountered “poor customer service” and rude employees, including one who told auditors that “at one point, they had been hand delivering paper medical documentation with paper copies of the related claims to their VA claims processing location, but VA staff at this location still routinely rejected their claims for a lack of medical documentation.”
The department has no online claims status portal, yet three out of five VA claims offices refused to take phone calls from doctors. The GAO report said other offices left doctors’ offices on hold for an hour or lectured them for calling.
In documents obtained by TheDCNF, claims-processing employee Yolanda Cobia provides an on-the-ground account. A doctor’s office employee called a manager, Marion Toole, to complain about being screamed at by multiple VA employees after “the entire office heard Brandi and Patricia being rude,” but Toole blamed the doctor’s office, saying “she calls in too much!” Cobia wrote.
The problem was not customers calling to inquire about overdue payments, but rather “the lack of work being done within this office and the manager and her clique taking runs through the neighborhood,” she said.
Previous initiatives by the VA to expedite services to veterans by relying on technology–potentially making clerk jobs unnecessary–have mysteriously failed.
VA spent $127 million over a nine-year period beginning in 2000 for an IT system to streamline outpatient scheduling, then terminated the initiative without completing it, according to the GAO.
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