A-9609, MAY 26, 1925, 4 COMP. GEN. 999

A-9609, MAY 26, 1925, 4 COMP. GEN. 999

MEDICAL TREATMENT - VETERANS' BUREAU - REIMBURSEMENT TO STATES STATE HOSPITALS OR INSTITUTIONS MAY NOT BE REIMBURSED BY THE UNITED STATES FOR MEDICAL CARE AND TREATMENT OF ITS PUBLIC CHARGES WHO ARE ALSO BENEFICIARIES OF THE VETERANS' BUREAU PRIOR TO THE TIME THE VETERANS' BUREAU ASSUMES JURISDICTION AND CONTROL OF SUCH PERSONS AND AUTHORIZES THEIR HOSPITALIZATION.

DECISION BY ACTING COMPTROLLER GENERAL GINN, MAY 26, 1925:

THE UNITED STATES VETERANS' BUREAU HAS FORWARDED TO THIS OFFICE FOR DIRECT SETTLEMENT APPROVED VOUCHERS AGGREGATING IN AMOUNT THE SUM OF $6,010 IN FAVOR OF THE BUFFALO STATE HOSPITAL, REPRESENTING REIMBURSEMENT FOR HOSPITAL CARE FURNISHED INSANE, POOR, AND INDIGENT PATIENTS OF THE STATE OF NEW YORK FOR VARIOUS PERIODS BETWEEN JULY 1, 1920, TO JUNE 30, 1922:

THE FACTS APPEAR TO BE THAT ALL OF THESE PATIENTS WERE RECEIVING DISABILITY COMPENSATION UNDER THE PROVISIONS OF THE WAR RISK INSURANCE ACT DURING THE PERIODS COVERED BY THE PRESENT CLAIM, BUT THAT THEIR HOSPITALIZATION WAS NOT EXPRESSLY AUTHORIZED AS BUREAU BENEFICIARIES OR WARDS OF THE UNITED STATES GOVERNMENT UNTIL LATER, UNDER CONTRACTS BETWEEN THE BUREAU AND THE HOSPITAL. THE RATE ON WHICH THE CLAIM IS BASED IS $2 PER DAY, THE AMOUNT CHARGED TO OTHER INMATES OF HOSPITAL FOR THE SAME SERVICE.

THE PRESENT CLAIM, AS WELL AS OTHER CLAIMS NOW PENDING BEFORE THIS OFFICE, ARE THE RESULT OF CONFERENCES BETWEEN THE STATE AUTHORITIES OF NEW YORK AND REPRESENTATIVES OF THE UNITED STATES VETERANS' BUREAU BASED ON THE DECISION OF THIS OFFICE DATED OCTOBER 31, 1923, INVOLVING REIMBURSEMENT FOR HOSPITAL CARE FOR PERIOD COVERED BY RETROACTIVE AWARD OF DISABILITY COMPENSATION IN STATE INSTITUTIONS, WHEREIN IT WAS HELD IN PART AS FOLLOWS:

IN CASE NUMBER 1, THEREFORE, REIMBURSEMENT MAY BE MADE FOR MEDICAL AND HOSPITAL TREATMENT TO THE INSANE BENEFICIARY FROM DECEMBER 3, 1918, DATE OF ADMISSION TO THE STATE INSTITUTION, WHICH WAS ALSO WITHIN TWO YEARS PRIOR TO CLAIM FOR COMPENSATION. SUCH REIMBURSEMENT, HOWEVER, IS NOT TO BE BASED ON THE CONTRACT WITH THE INSTITUTION FOR ANY PERIOD PRIOR TO ITS EFFECTIVE DATE, BUT FOR SUCH PERIOD REIMBURSEMENT IS LIMITED TO THE AMOUNT ACTUALLY CHARGED FOR THE VETERAN'S TREATMENT AT A RATE NOT IN EXCESS OF THAT CHARGED FOR OTHER RESIDENTS OF THE STATE FOR THE SAME SERVICE. SUCH AMOUNT IS PAYABLE TO THE PERSON OR PERSONS WHO PAID FOR THE TREATMENT, AND THEN ONLY UPON THE SUBMISSION OF PROPERLY RECEIPTED BILLS. TO AUTHORIZE PAYMENT TO THE INSTITUTION IN ALL CASES MIGHT RESULT IN ITS BEING PAID TWICE FOR THE SAME SERVICE. PAYMENT MAY BE MADE TO THE INSTITUTION FOR PERIOD PRIOR TO THE EFFECTIVE DATE OF THE CONTRACT AND SUBSEQUENT TO THE DATE THE VETERAN BECOMES A BENEFICIARY OF THE BUREAU ONLY WHERE CLEAR EVIDENCE IS SUBMITTED THAT A BILL HAS BEEN RENDERED TO THE COMMITTEE OR OTHER PERSON RESPONSIBLE FOR THE INSANE VETERAN, AND THAT SUCH BILL HAS NOT BEEN PAID. ANY PERIOD OF TREATMENT WHICH THE STATE WOULD HAVE IN ANY EVENT GIVEN FREE SHOULD NOT BE PAID FOR BY THE GOVERNMENT.

THE LAST SENTENCE OF THE QUOTATION HAD PARTICULAR REFERENCE TO PERIODS PRIOR TO DATE OF AUTHORIZATION OF HOSPITALIZATION BY THE UNITED STATES VETERANS' BUREAU, AND HAD NO REFERENCE TO PERIODS SUBSEQUENT TO AUTHORIZATION AND EXECUTION OF CONTRACTS BETWEEN THE BUREAU AND STATE INSTITUTIONS, AT WHICH TIME THE GOVERNMENT ASSUMED RESPONSIBILITY FOR CARE OF VETERANS AS WARDS OF THE GOVERNMENT UNDER THE PROVISIONS OF THE WAR RISK INSURANCE ACT. THAT DECISION WAS QUOTED WITH APPROVAL IN DECISION OF APRIL 24, 1924, 3 COMP. GEN. 798, AND CLAIM ALLOWED IN FAVOR OF LEGAL GUARDIAN OF AN INSANE VETERAN FOR CARE IN A STATE INSTITUTION FOR PERIOD PRIOR TO AUTHORIZATION OF TREATMENT BY THE VETERANS' BUREAU, BUT SUBSEQUENT TO THE RETROACTIVELY EFFECTIVE DATE OF THE AWARD FOR DISABILITY COMPENSATION, CITING 26 COMP. DEC. 485, 699; 27 ID. 774; 1 COMP. GEN. 230; 3 ID. 286, 365.

IN THE PRESENT CASE AND OTHERS PENDING BEFORE THIS OFFICE THE CLAIMS ARE NOT FILED BY ANYONE ON BEHALF OF THE BENEFICIARIES BUT DIRECTLY BY THE STATE INSTITUTION WHEREIN THE BENEFICIARIES WERE HOSPITALIZED. THESE PATIENTS WERE PUBLIC CHARGES OF THE STATE OF NEW YORK DURING THE PERIODS COVERED BY THE CLAIMS, AND IT IS STATED IN THE CONFERENCE REPORT MADE TO THE DIRECTOR OF THE UNITED STATES VETERANS' BUREAU UNDER DATE OF JANUARY 7, 1924, THAT BECAUSE OF THE POOR AND INDIGENT STATUS OF PATIENTS BILLS WILL NOT BE AND HAVE NOT BEEN SUBMITTED TO THE BENEFICIARIES OR ANYONE ON THEIR BEHALF, BUT THAT IF SO SUBMITTED THE RATE WOULD BE AT $2 PER DAY NOW CLAIMED, WHICH IS THE AMOUNT CALLED FOR BY THE SUBSEQUENT CONTRACTS AND IS NOT IN EXCESS OF THAT CHARGED TO OTHER RESIDENTS OF THE STATE FOR THE SAME SERVICE. IT IS REPORTED ALSO AS FOLLOWS:

IT WAS FURTHER REPORTED THAT THERE ARE APPROXIMATELY 1,000 CLAIMANTS IN STATE HOSPITALS, OF WHICH NUMBER 600 ARE IN THE HOSPITALS AT PRESENT WHOSE BILLS FOR HOSPITALIZATION HAVE NOT BEEN PAID FOR EITHER PART OR ENTIRE HOSPITALIZATION. THESE BILLS COVER A PERIOD OF APPROXIMATELY THREE TO FOUR YEARS. THERE ARE APPROXIMATELY 500 MEN WHOSE HOSPITALIZATION WAS AUTHORIZED AND WHOSE BILLS ARE BEING PAID AT PRESENT. IN 300 OF THESE 500 CASES HOSPITALIZATION WAS NOT AUTHORIZED FROM DATE OF ADMISSION BUT AS SOME SUBSEQUENT DATE. THESE 300 CASES ARE INCLUDED IN THE 1,000 CASES ENUMERATED, AND THAT NO PAYMENTS HAVE BEEN MADE ON ANY OF THE AUTHORIZED BILLS BEGINNING JULY 1, 1923, AS THE CONTRACTS FOR THE FISCAL YEAR WITH THE NEW YORK STATE HOSPITALS REMAIN UNAPPROVED.

THE OFFICE IS NOT ADVISED WHETHER ALL OF THESE CASES HAVE BEEN INCLUDED IN THE SEVERAL CLAIMS NOW PENDING BEFORE THE OFFICE.

THE SUBMISSION OF THE DIRECTOR OF THE UNITED STATES VETERANS' BUREAU ON WHICH THE DECISION OF OCTOBER 31, 1923, WAS BASED EXPRESSLY EXCLUDED FROM THE SUBMISSION PATIENTS HAVING THE STATUS OF ,POOR PERSON" OR "INDIGENT PERSON" AND INCLUDED ONLY THOSE WHOSE RELATIVES OR ESTATES WERE CALLED UPON TO BEAR THE EXPENSES OF HOSPITAL TREATMENT UNDER STATE STATUTES. THAT IS TO SAY, THOSE PERSONS WHO HAD BEEN DETERMINED TO BE PUBLIC CHARGES ON THE STATE OF NEW YORK WERE NOT CONSIDERED BY THE DIRECTOR AT THAT TIME AS COMING WITHIN THE TERMS OF THE PROVISIONS OF THE WAR-RISK INSURANCE ACT, PROVIDING FOR HOSPITAL TREATMENT, PRIOR TO THE ACTUAL DATE OF AUTHORIZATION OF THE TREATMENT BY THE BUREAU. HENCE THE DECISION REFERRED TO CONSIDERED ONLY THOSE CASES WHERE REIMBURSEMENT WAS CLAIMED BY THE RELATIVES OR ESTATE OF THE BENEFICIARIES.

THE INSTANT CASES PRESENT THE QUESTION WHETHER THE STATE OF NEW YORK MAY BE RELIEVED OF PAST OBLIGATIONS TO CARE FOR ITS PUBLIC CHARGES, AS DEFINED BY ITS OWN LAWS, BY RECOGNIZING SUCH PATIENTS AS WARDS OF THE UNITED STATES GOVERNMENT FROM THE EFFECTIVE DATE OF THEIR DISABILITY COMPENSATION AWARD BUT PRIOR TO EXPRESS AUTHORITY BY THE BUREAU FOR HOSPITALIZATION AND EXECUTION OF CONTRACTS.

PRIOR TO JUNE 7, 1924, DATE OF WORLD WAR VETERANS' ACT, THERE WAS NO EXPRESS STATUTORY PROVISION AUTHORIZING REIMBURSEMENT FOR COST OF MEDICAL TREATMENT PROCURED FOR OR ON BEHALF OF BENEFICIARIES THROUGH PRIVATE SOURCES PRIOR TO AUTHORIZATION BY THE UNITED STATES VETERANS' BUREAU. EMERGENCY CASES AND WHERE THE CLAIMANTS WERE IGNORANT OF THEIR RIGHT TO GOVERNMENTAL TREATMENT, THIS OFFICE AND THE FORMER OFFICE OF COMPTROLLER OF THE TREASURY CONSISTENTLY AUTHORIZED REIMBURSEMENT FOR TREATMENT PROCURED THROUGH PRIVATE SOURCES. THE CASES HAVE HEREINBEFORE BEEN CITED. THESE DECISIONS WERE INTENDED TO RELIEVE BENEFICIARIES WHO WERE ACTUALLY REQUIRED TO PAY FOR SUCH TREATMENT AND DID NOT AND COULD NOT RELIEVE STATE INSTITUTIONS FROM PAST OBLIGATIONS TO CARE FOR ITS PUBLIC CHARGES UNDER ITS STATUTES.

SECTION 202 (9) OF THE WORLD WAR VETERANS' ACT OF JUNE 7, 1924, 43 STAT. 620, PROVIDES IN PART AS FOLLOWS:

* * * PROVIDED, THAT WHERE A BENEFICIARY OF THE BUREAU SUFFERS OR HAS SUFFERED AN INJURY OR CONTRACTED A DISEASE IN SERVICE ENTITLING HIM TO THE BENEFITS OF THIS SUBDIVISION, AND AN EMERGENCY DEVELOPS OR HAS DEVELOPED REQUIRING IMMEDIATE TREATMENT OR HOSPITALIZATION ON ACCOUNT OF SUCH INJURY OR DISEASE, AND NO BUREAU FACILITIES ARE OR WERE THEN FEASIBLY AVAILABLE AND IN THE JUDGMENT OF THE DIRECTOR DELAY WOULD BE OR WOULD HAVE BEEN HAZARDOUS, THE DIRECTOR IS AUTHORIZED TO REIMBURSE SUCH BENEFICIARY THE REASONABLE VALUE OF SUCH SERVICE RECEIVED FROM SOURCES OTHER THAN THE BUREAU.

THIS STATUTE GAVE RECOGNITION AND APPROVAL TO THE PRIOR DECISIONS AND AUTHORIZED CONTINUANCE OF THE PRACTICE, BUT IT WILL BE NOTED THE DIRECTOR IS AUTHORIZED TO REIMBURSE ONLY THE BENEFICIARY, AND THE STATUTE COULD NOT BE HELD TO RELIEVE A STATE OF ITS OTHERWISE LAWFUL PAST OBLIGATIONS FOR CARE OF ITS PUBLIC CHARGES PRIOR TO THE DATE THE VETERANS' BUREAU ASSUMES JURISDICTION AND CONTROL OF SUCH PERSONS AS BENEFICIARIES AND AUTHORIZES THE HOSPITALIZATION.

IN THE ABSENCE OF A STATUTE DEFINITELY AUTHORIZING PAYMENT FROM GOVERNMENT FUNDS FOR PERIODS OF HOSPITALIZATION PRIOR TO THE DATE THE VETERANS' BUREAU ASSUMED JURISDICTION AND AUTHORIZED HOSPITALIZATION, SUCH PAYMENT IS NOT AUTHORIZED.