The US federal government wrote duplicate checks to private doctors who treated veterans, costing taxpayers up to $128 million in extra payments over 5 years, a new report by a federal watchdog revealed in April.
Private doctors were paid twice in nearly 300,000 cases from 2017 through 2021 involving veterans who were eligible for Veterans Health Administration (VHA) and Medicare benefits, according to the report by the Health & Human Services Office of Inspector General.
The doctors were paid by Medicare for medical services that the VHA had authorized and already paid for, the OIG reported after it conducted a 5-year audit.
Duplicate Medicare payments have doubled from $22 million in 2019 when the Veterans Community Care Program was implemented to $45 million in 2021, according to the OIG report. The program allows veterans to seek care from private doctors when the VHA can’t provide the care they need.
Roughly 1.9 million veterans every year receive government-paid healthcare from private doctors.
The OIG said it decided to audit Medicare’s claims because “duplicate payments were a long-standing issue.”
The problem dates back to a 1979 General Accounting Office (now the Government Accountability Office) report that found Medicare and the Department of Veterans Affairs (VA) VHA made duplicate payments of more than $72,000 for certain medical services provided to veterans, the OIG reported.
The HHS OIG’s audit examined $19.2 billion in Medicare payments for 36 million claims for individuals who enrolled in Medicare and were eligible for VA services. About 90% of those claims were for doctor evaluations and visits, according to the OIG report.
The OIG found “these duplicate payments occurred because CMS did not implement controls to address duplicate payments for services provided to individuals with Medicare and VHA benefits.”
Specifically, the OIG found that the CMS and the VHA were not sharing enrollment, claims, and payment data with each other, as required by federal law.
If CMS had access to that information, the agency could have compared the VHA claims data with existing Medicare claims data to identify duplicate claims, the OIG claimed.
The OIG recommended that CMS take the following four steps to fix the problem, which CMS has agreed to do, according to the report:
Integrate VHA enrollment, claims, and payment data into the CMS centralized claims data system so it can identify potential fraud, waste, and abuse under the Medicare program;
Issue guidance to medical professionals on not billing Medicare for a medical service that was authorized by the VHA;
Establish a comprehensive data-sharing agreement with the VHA; and
Establish an internal process (such as system edits) to address duplicate payments.
“CMS previously informed us [OIG] that establishing a long-term solution to address duplicate payments will take time,” the OIG reported.
Christine Lehmann, MA, is a senior editor and writer for Medscape Business of Medicine based in the DC area. She has been published in WebMD News, Psychiatric News, and The Washington Post. Contact Christine at [email protected] or via Twitter @writing_health.
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