Stronger VA and DOD Actions Needed To Recover Costs of Medical Services to Persons With Work-Related Injuries or Illnesses

HRD-82-49: Published: Jun 4, 1982. Publicly Released: Jul 6, 1982.

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In response to a congressional request, GAO reviewed Veterans Administration (VA) and Department of Defense (DOD) efforts to recover the costs of medical services from workers compensation insurance in cases involving work-related injury or illness. Sample claims were traced to the facilities that provided the medical care to determine whether VA and DOD officials were aware of the claims and had sought reimbursement from workers compensation carriers or employers for the treatment provided.

GAO found that VA and DOD failed to recover the costs of most health care services provided to beneficiaries covered by workers compensation because: (1) liens were not filed in approximately two-thirds of the cases reviewed in which the facility should have been aware that a work-related injury had occurred; and (2) VA and DOD attorneys did not actively pursue recoveries after a lien had been filed. The agencies recovered less than 12 percent of the cost of care provided in the cases for which such costs could be estimated. In most of the cases reviewed, the facility was put on notice of the claim through a request for the individual's medical records by an attorney, an insurance company, a Workers' Compensation Appeals Board, or the individual. However, medical facilities frequently failed to notify the recovery unit of the potential claim. As a result, VA and DOD attempted to recover the costs of care provided in only slightly more than one-third of the nearly 150 cases in which the facility should have been aware that the injury was work related.

Recommendations for Executive Action

  1. Status: Closed - Implemented

    Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.

    Recommendation: The Administrator of Veterans Affairs and the Secretary of Defense should direct recovery offices in California to object to the application of the Gregory formula to VA and DOD liens.

    Agency Affected: Department of Defense

  2. Status: Closed - Not Implemented

    Comments: VA does not intend to monitor the project.

    Recommendation: The Administrator of Veterans Affairs and the Secretary of Defense should monitor the progress of the Medi-Cal pilot project in California to determine whether a similar contract could improve VA and DOD recoveries.

    Agency Affected: Department of Defense

  3. Status: Closed - Not Implemented

    Comments: VA does not intend to monitor the project.

    Recommendation: The Administrator of Veterans Affairs and the Secretary of Defense should monitor the progress of the Medi-Cal pilot project in California to determine whether a similar contract could improve VA and DOD recoveries.

    Agency Affected: Veterans Administration

  4. Status: Closed - Implemented

    Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.

    Recommendation: The Administrator of Veterans Affairs and the Secretary of Defense should revise regulations or written procedures to emphasize that Government representatives should actively participate in workers compensation settlements.

    Agency Affected: Department of Defense

  5. Status: Closed - Implemented

    Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.

    Recommendation: The Administrator of Veterans Affairs and the Secretary of Defense should revise regulations or written procedures to emphasize that Government representatives should actively participate in workers compensation settlements.

    Agency Affected: Veterans Administration

  6. Status: Closed - Implemented

    Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.

    Recommendation: The Administrator of Veterans Affairs and the Secretary of Defense should reemphasize the need for medical facilities to refer potential work-related cases to the recovery office and issue instructions requiring that all requests for medical records from an attorney, the Workers' Compensation Appeals Board, or an insurance company be referred to the recovery office for possible recovery action.

    Agency Affected: Veterans Administration

  7. Status: Closed - Implemented

    Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.

    Recommendation: The Administrator of Veterans Affairs and the Secretary of Defense should reemphasize the need for medical facilities to refer potential work-related cases to the recovery office and issue instructions requiring that all requests for medical records from an attorney, the Workers' Compensation Appeals Board, or an insurance company be referred to the recovery office for possible recovery action.

    Agency Affected: Department of Defense

  8. Status: Closed - Implemented

    Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.

    Recommendation: The Administrator of Veterans Affairs and the Secretary of Defense should direct recovery offices in California to object to the application of the Gregory formula to VA and DOD liens.

    Agency Affected: Veterans Administration

 

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