A recent investigation has found more than $53.3 million in medical bills for veterans improperly rejected by Veterans Affairs officials and lawmakers are asking for an explanation.
According to a report from the VA’s Office of Inspector General released last week, in one recent six-month period, about 17,400 veterans were left with unpaid for emergency medical treatment the government should have covered. Medical bills totaling $53.3 that veterans who got emergency care were forced to pay at non-VA facilities between April 1 and Sept. 30, 2017, should never have had to pay.
The report also found $716 million in improperly processed payments in cases involving veterans who sought medical care outside the department’s health system during the spring and summer of 2017.
“It is critical that VHA staff process claims for non-VA emergency care in an accurate and timely fashion,” the report stated. “Inappropriately denied or rejected non-VA emergency care claims present a risk of a substantial, undue financial burden on veterans.”
In interviews and surveys, employees told inspectors they were “verbally directed or encouraged to deny non-VA emergency claims to meet production standards.”
Investigators found cases of claims being incorrectly rejected because the paperwork was filed too late, because of errors in outside-care eligibility, and because processors missed clinical records ordering the outside care.
According to the report, about 31 percent of denied or rejected emergency care claims had been inappropriately processed due to the policy of offering incentives like overtime pay for processing claims quickly and without concern for accuracy.
During three different facility visits, inspectors also found that there was a massive backlog in sending bills to patients, even time-sensitive ones that narrowed the window in which they could appeal a denial, and “stacks of unsent claims decision letters printed between one and two months prior.”
Since the end of September 2017, the last month of the period covered by the inspector general’s report, there have been many leadership changes within the VA, including three different directors of the office that processes emergency claims. The inspectors say the instability allowed problems to continue.
Responding to the report, VA officials said they have already put numerous fixes in place to deal with the problems from two years ago and should implement the rest of the Inspector General’s recommendations later this year.
They also promised to review patient cases as far back as April 2016 to ensure that veterans improperly denied medical coverage are helped. Letters informing those veterans of possible avenues of appeal or redress will be sent out in the coming months.
However, lawmakers in their letter said they want more details of that promise, to ensure similar mistakes aren’t made in the future.
They also asked department officials to report “whether VA is appropriately resourced—in terms of staffing and technology—to implement requirements associated with emergency care claims adjudication.”
Inspector General officials said if proper fixes aren’t fully implemented, the unexpected costs to veterans seeking outside care could grow to more than $500 million over the next five years.