Duplicate Payments for Medical Services by VA and Medicare Programs

HRD-80-10: Published: Oct 22, 1979. Publicly Released: Oct 22, 1979.

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A review was performed to determine the number of duplicate payments made by the Veterans Administration (VA) and the Medicare programs for certain services provided to veterans eligible for both programs. The review, which was performed in Florida and California, dealt with three VA medical service categories: unrestricted outpatient medical care, contract hospitalization with prior VA authorization, and kidney dialysis treatment. The review also briefly surveyed duplicate payments by VA and Medicaid programs.

A sample of about 800 dual-eligible veterans and about 4,600 claims revealed: (1) duplicate Medicare payments involving 153 veterans and 433 claims, amounting to more than $72,000, before voluntary refunds by providers totaling about $31,000 were deducted; (2) misapplied deductibles involving 77 veterans amounting to more than $3,100; and (3) duplicate Medicaid claims involving 11 veterans and 27 claims amounting to about $1,700. It was estimated that duplicate payments, after deducting voluntary refunds and misapplied deductibles, exceeded $242,000 in Florida and $236,000 in California in 1976 for the three VA categories reviewed. While the statistical sample from Florida and California could not be projected nationally, it was considered likely that the practices found during the review were occurring nationally since both programs operate under national guidelines.

Recommendation for Executive Action

  1. Status: Closed

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

    Recommendation: The Administrator of Veterans Affairs and the Secretary of Health, Education and Welfare (HEW) should: (1) Continue to recover the duplicate payments which GAO identified in Florida and California; (2) find out how frequently duplicate payments are occurring throughout the Nation for all medical service categories available to eligible veterans; (3) better coordinate claims processing activities for patients who may be eligible for medical benefits from both programs; and (4) identify dual-eligible individuals when they become eligible for both programs, perhaps by issuing unique identification cards or by adding a digit to their enrollment numbers. If VA and HEW efforts show that the duplicate payment problem is widespread and involves significant dollar amounts, the Administrator of Veterans Affairs should: (1) consider changing VA provider numbers and procedure codes to make them compatible with the Medicare program and to facilitate the identification of duplicate billings and payments; (2) develop a standardized claim form which would require authorized providers to certify that no other Federal program would be billed for the same costs for the same services; (3) issue timely reminders and sanctions to providers when dual billing and dual payments are found; (4) and initiate procedures to fully consider the possibility of dual eligibility each time authorization for medical service outside the VA health care system is requested or renewed. In addition, the Secretary of HEW should direct the Administrator, Health Care Financing Administration, to require that Medicare intermediaries and carriers: (1) determine whether VA has authorized payment or already paid for services whenever dual eligibility is indicated; and (2) regularly sample batches of claims and compare the information with VA records to determine if eligibility information is correct and detect duplicate payments.

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