Military Personnel: Better Debt Management Procedures and Resolution of Stipend Recoupment Issues Are Needed for Improved Collection of Medical Education Debts
Highlights
Military physicians and other health care professionals are needed to support operational forces during war or other military conflicts and to maintain the well-being of the forces during nonoperational periods. These professionals also provide health care services to military retirees and dependents. The Department of Defense (DOD) acquires its health care professionals primarily through two programs--the Armed Forces Health Professions Scholarship Program and the Financial Assistance Program--with which it recruits and trains military health care providers who fill medical specialty positions. These programs offer participants reimbursement for tuition, books, fees, other education expenses, and a stipend, which is a fixed amount of money given to the participants on a monthly basis, in return for an active duty service obligation. Recruiting and retaining highly qualified health care professionals, however, is becoming more challenging for each of the military services. The added stresses of repeated deployments and the general perceptions of war, along with the potential for health care providers to earn significantly more money outside of DOD, have caused some professionals to choose to separate themselves from military service, even after DOD has paid for all or part of their medical education. Because DOD medical training programs can take years and are a costly investment, DOD is negatively affected both financially and operationally when individuals do not fulfill their active duty obligations. The Conference Report accompanying the National Defense Authorization Act for Fiscal Year 2008 directed the Comptroller General of the United States to report to the congressional defense committees by April 1, 2008, on the number of Health Professions Scholarship Program or Financial Assistance Program participants who do not enter active duty following completion of the program of studies for which they were enrolled, including the extent to which the military services have sought and received reimbursement for stipends or annual grants paid. Accordingly, we examined the extent to which (1) participants in the Health Professions Scholarship Program or Financial Assistance Program fail to enter active duty service, as obligated; (2) DOD has procedures in place to recoup expenditures paid under the Health Professions Scholarship Program or Financial Assistance Program to participants who failed to meet their contractual obligations; and, (3) DOD has specifically sought and received reimbursement for stipends.
Recommendations
Recommendations for Executive Action
| Agency Affected | Recommendation | Status |
|---|---|---|
| Department of Defense | To help strengthen debt collection procedures, the Secretary of Defense should direct the Under Secretary of Defense, Comptroller, and the service secretaries to clarify the roles and responsibilities of Defense Financial and Accounting Service (DFAS) and the services for initiating the debt recoupment collection process and revise the DOD Financial Management Regulation as necessary. | In April 2008, we reported that, while DOD has established procedures to recoup medical education expenditures from participants who fail to complete their education or serve their active duty service obligation, confusion existed between the military services and DFAS as to who was responsible for initiating the debt recoupment actions. According to DFAS officials, the services were supposed to not only issue the initial bill, invoice, notice, or demand for payment letter, but also attempt to collect on the debt and to take appropriate follow-up action before transferring the debt. However, responsible officials from the Army, Navy, and Air Force all told us that they do not attempt any... initial collection of funds because they have neither (1) the debt collection authorities that DFAS has, nor (2) the resources to dedicate to this task. We recommended that the roles and responsibilities for initiating the debt recoupment collection process be clarified and the DOD Financial Management Regulation be revised as necessary. In September 2010, DOD updated a chapter within its Financial Management Regulation entitled Management and Collection of Individual Debt to more clearly state the roles and responsibilities of both the services and DFAS in debt collection actions. This policy guidance clarification should help put DOD in a better position to more consistently and thoroughly collect reimbursements across the services.
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| Department of Defense | To help strengthen debt collection procedures, the Secretary of Defense should direct the Director, Defense Finance and Accounting Service, to follow the established regulation requiring transmittal letters as part of debt recoupment packages transferred from the military services. | We reported that, at least for debt recoupment packages from a certain Air Force organization, the Defense Finance and Accounting Service (DFAS) had not been adhering to established procedures where those packages were concerned. The DOD Financial Management Regulation requires the military services to prepare and submit a debt transmittal letter to DFAS to process the delinquent debts. Use of the transmittal letter helps control the transmission of debt cases and to identify all attached debt case files by name, social security number, and monetary amount. However, DFAS officials noted they accepted hand-carried Air Force debt packages without transmittal letters which came from an...
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| Department of Defense | To help strengthen debt collection procedures, the Secretary of Defense should direct the Director, Defense Finance and Accounting Service, to establish a procedure to periodically communicate with the services the status of debt recoupment packages that DFAS has officially accepted and established within its Defense Debt Management System so that any discrepancies among the services' records can be reconciled in a timely manner. | In April 2008, we reported that both Defense Finance and Accounting Service (DFAS) and service officials explained that little communication occurs between them concerning the status of the recoupment effort after DFAS accepts and records a debt package in its Defense Debt Management System. Officials from each of the military services said that they would like to know more about the status of the debts sent to DFAS. Service officials indicated that they could benefit from more frequent and clearer communication. Therefore, we recommended that the Director of DFAS establish a procedure to periodically communicate with the services the status of debt recoupment packages that DFAS had...
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| Department of Defense | To provide greater assurance that the correct legal sums of money are recouped from program participants who do not fulfill their active duty service obligations and to fully disclose debt collection expectations, the Secretary of Defense should direct the Under Secretary of Defense for Personnel and Readiness, in coordination with the Under Secretary of Defense, Comptroller, the Assistant Secretary of Defense for Health Affairs, and DOD General Counsel, to review and determine whether stipends are legally eligible for recoupment and clearly communicate this determination to the services and DFAS. | In April 2008, we reported that the Defense Finance and Accounting Service (DFAS) and the Services were not in agreement as to whether stipends paid under the Health Professions Scholarship Program or the Financial Assistance Program could be recouped from those who fail to complete either the program or their active duty commitment. We recommended that a review and determination be made as to whether stipends were legally eligible for recoupment and to clearly communicate this determination to the Services and DFAS. In order to clearly communicate whether stipends were legally eligible for recoupment, a table was added to the DOD Financial Management Regulation Volume 7A Chapter 2 based...
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| Department of Defense | To provide greater assurance that the correct legal sums of money are recouped from program participants who do not fulfill their active duty service obligations and to fully disclose debt collection expectations, the Secretary of Defense should direct the Assistant Secretary of Defense for Health Affairs and the service secretaries to determine whether specific language needs to be included in program participants' service agreements in order to accurately reflect the policy regarding recoupable expenses, once that determination is made, and include specific language in the agreements if found to be necessary. | In April 2008, we reported that the Defense Finance and Accounting Service (DFAS) and the Services were not in agreement as to whether stipends paid under the Health Professions Scholarship Program or the Financial Assistance Program could be recouped from those who fail to complete either the program or their active duty commitment, and there was confusion regarding the possibility of recouping stipends. We recommended that the Secretary of Defense direct the Assistant Secretary of Defense for Health Affairs and the service secretaries to determine whether specific language needed to be included in program participants' service agreements in order to accurately reflect the policy...
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