Inappropriate Billing by the Veterans Administration for Electron Microscopy Services to Non-Veterans

HRD-77-148: Published: Sep 16, 1977. Publicly Released: Sep 16, 1977.

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Three Veterans Administration (VA) hospitals in Florida were evaluated to determine how much of the electron microscopy services were performed on non-veteran patient specimens in calendar year 1976 and whether fees were collected for the services.

About 55 percent of the electron microscopy services performed in calendar year 1976 by the diagnostic units at the Miami, Tampa, and Gainesville VA hospitals were on specimens from non-VA patients in community hospitals. The VA hospitals had written agreements for sharing services with some of the non-VA hospitals, but were performing most of the electron microscopy services without benefit of a sharing agreement. The three VA hospitals lost about $102,000 in revenue in 1976 because they either did not bill community hospitals or they billed at rates less than those required by VA regulations. In some instances, billings were not made even though sharing agreements establishing reimbursement procedures and rates had been negotiated. In addition, some community hospitals that had received free services from VA billed either Medicare or their patient's private insurance companies for the studies.

Recommendation for Executive Action

  1. Status: Closed

    Comments: Please call 202/512-6100 for additional information.

    Recommendation: The Administrator of Veteran Affairs should reemphasize to all VA medical facilities the need to follow established statutory and regulatory requirements for recovering the cost of all medical services furnished to non-VA patients. He should also direct all VA medical facilities which furnished electron microscopy or any other services to or on behalf of non-VA patients in 1976 to establish the appropriate unit costs and to bill the patients or medical facilities for those services.

    Agency Affected:

 

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