Cost of VA Medical Care to Ineligible Persons Is High and Difficult To Recover

HRD-81-77: Published: Jul 2, 1981. Publicly Released: Jul 13, 1981.

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GAO reviewed the extent to which the Veterans Administration (VA) has strengthened its administrative controls to preclude providing medical care to persons who were found not to be properly entitled to veterans' benefits.

Despite recommendations previously made by GAO to improve eligibility determinations, VA has done little to prevent or minimize the abuse of medical benefits by ineligibles. Individuals who are not legally entitled to VA benefits receive medical care in VA facilities before and after VA determines they are ineligible. During a 27-month attempt to collect $15 million in costs incurred as a result of providing medical care to ineligible persons, VA collected $1.2 million and wrote off $6.5 million of the remaining debts as uncollectible. A major cause of this problem of providing care to ineligibles is the VA policy of not denying care to individuals pending positive determination of their legal entitlement to VA benefits. No centrally maintained file exists on individuals who have been determined ineligible for VA benefits. An improved information and notification system is needed to reduce the incidence of ineligible medical care and to eliminate duplicative paperwork in determining eligibility. VA does not have an effective system for billing and collecting debts from ineligible persons who receive medical care or an accurate account of all the care provided to ineligibles. VA has not taken collection actions on all of the moneys it is owed and, where such actions have been taken, it has failed to send out timely bills which has decreased the likelihood of its recovering the costs of care provided. Recently enacted legislation may not significantly improve VA collection of medical debts since many ineligibles are transient with limited financial resources.

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 the Veterans Administration should direct the Chief Benefits Director to instruct medical centers to promptly bill ineligible individuals for all care provided.

    Agency Affected: Veterans Administration

  2. 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 the Veterans Administration should direct the Controller to reconcile the quarterly report on medical accounts receivable to insure it agrees with the general ledger account.

    Agency Affected: Veterans Administration

  3. Status: Closed - Not Implemented

    Comments: The eligibility issues are being reviewed by the GAO Accounting and Financial Management Division in Chicago.

    Recommendation: The Administrator of the Veterans Administration should direct the Chief Benefits Director to update Beneficiary Identification and Records Locator Subsystem records to the extent possible based on available veterans' claims folders.

    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 the Veterans Administration (VA) should direct the Chief Benefits Director to direct the regional offices when assisting medical centers to make certain that they provide the centers with decisions on whether individuals with other than honorable discharges are entitled to VA benefits.

    Agency Affected: Veterans Administration

  5. Status: Closed - Not Implemented

    Comments: This issue is being examined by the GAO Accounting and Financial Management Division.

    Recommendation: The Administrator of the Veterans Administration (VA) should direct the Chief Medical Director to establish a formalized system in which VA medical centers close to each other are notified when an individual has been determined ineligible for VA benefits.

    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 the Veterans Administration should direct the Controller to analyze the quarterly report periodically to identify and take corrective actions on centers which are not disposing of debts promptly.

    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 the Veterans Administration should direct the Chief Benefits Director to instruct medical centers to complete applications for medical benefits and records of examination, including all available service information and indications as to whether prompt medical care is needed.

    Agency Affected: Veterans Administration

  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 the Veterans Administration should direct the Controller to provide a copy of the reconciled report to the Department of Medicine and Surgery for analysis to identify and to take corrective actions on an as-needed basis.

    Agency Affected: Veterans Administration

  9. 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 the Veterans Administration should direct the Chief Benefits Director to require medical centers to actively follow up on their requests for eligibility determinations.

    Agency Affected: Veterans Administration

  10. 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 the Veterans Administration (VA) should direct the Chief Medical Director to provide care to individuals whose eligibility cannot be verified at the time of application only if, upon examination, VA physicians determine that prompt medical care is needed. If there is no need for prompt medical attention, VA personnel should inform the individual that further care cannot be provided until his or her eligibility can be determined.

    Agency Affected: Veterans Administration

 

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