VA Health Care:

Verifying Veterans' Reported Income Could Generate Millions in Copayment Revenues

HRD-92-159: Published: Sep 15, 1992. Publicly Released: Sep 15, 1992.

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Pursuant to a congressional request, GAO reviewed the Department of Veterans Affairs' (VA) policies and procedures for making copayment decisions, focusing on: (1) whether VA accurately classified veterans who should copay for VA health care; (2) the potential lost copayments from misclassified veterans; and (3) VA use of tax records in determining veterans' copayment status.

GAO found that: (1) the Veterans Health Administration (VHA) misclassified 109,230 veterans as not owing copayments, but tax records showed incomes that exceeded income thresholds; (2) misclassified veteran incomes totalled over $4.7 billion from such sources as employment, pensions, investments, and miscellaneous sources; (3) most veterans had incomes that exceeded copayment threshold levels by $5,000 or more, including over 2,500 veterans who had total incomes of $100,000 or more; (4) the majority of the misclassified veterans were married and had no dependents, but their spouses' income often placed them over the income threshold; (5) misclassification of copayment status greatly reduced potential copayment revenues in 1990; (6) VHA could have billed as much as $27 million in copayments for care provided to the misclassified veterans; and (7) VHA missed an opportunity to reduce copayment losses because it did not implement an income-verification system, using tax records.

Matters for Congressional Consideration

  1. Status: Closed - Not Implemented

    Comments: Congress gave VA discretionary authority to use tax records to identify veterans who should make copayments.

    Matter: As part of this reauthorization, Congress should require VA to take appropriate steps to charge these veterans for all copayments owed for health care that VA provides.

  2. Status: Closed - Implemented

    Comments: This was made a requirement by P.L. 102-568.

    Matter: As part of this reauthorization, Congress should require VA to use federal tax records to identify veterans who should make copayments for VA health care.

  3. Status: Closed - Implemented

    Comments: This was made a requirement by P.L. 102-568.

    Matter: As part of this reauthorization, Congress should require VA to notify veterans, as soon as possible, that VA intends to verify veteran-reported income information using federal tax records.

  4. Status: Closed - Implemented

    Comments: On October 29, 1992, Congress passed P.L. 102-568, which extended VA's authority through September 30, 1997.

    Matter: Congress should extend VA authority to use tax records to verify veterans' self-reported incomes for determining copayment liability.

Recommendation for Executive Action

  1. Status: Closed - Implemented

    Comments: On May 28, 1993, VA issued VHA Directive 10-93-063. This directive provides initial policy and an overview of the income verification match program. The directive will be incorporated into a permanent issue.

    Recommendation: The Secretary of Veterans Affairs should direct the Chief Medical Director to ensure that sufficient policies, procedures, and resources are available to implement an income-verification system as soon as possible after VA tax records access authority is extended.

    Agency Affected: Department of Veterans Affairs

 

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