Opportunities To Increase VA Medical Care Cost Recoveries
Highlights
The Veterans Administration (VA) generally provides free medical care to eligible veterans. However, when a veteran requires treatment of injuries suffered on the job or as the result of another person's negligent actions, VA can recover the cost of the medical care provided from the responsible third party. VA can also recover the cost of care provided to nonveterans in an emergency and to patients later found to be ineligible for VA care. GAO reviewed VA methods for establishing medical care cost recovery rates. Specifically, GAO sought to determine whether: (1) the VA medical/surgical per diem rate was adequate to recover the cost of care provided to acute care patients; (2) the national average per diem rate generated the same total charges as would individual facility rates; and (3) the rates were revised in a timely manner.
Recommendations
Recommendations for Executive Action
| Agency Affected | Recommendation | Status |
|---|---|---|
| Veterans Administration | The Administrator of Veterans Affairs should, through the Chief Medical Director, develop separate medical care recovery rates for acute and nonacute medical/surgical and psychiatric care on a facility-by-facility basis. |
VA developed recovery rates for medical, surgical, and psychiatric care which exclude certain nonacute costs. VA decided not to use separate rates for each facility because it could complicate the billing process and may increase the number of contested bills.
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| Veterans Administration | The Administrator of Veterans Affairs should, through the Chief Medical Director, provide more specific guidance on costs to be included in private sector sharing agreement rates to ensure that they are consistent with factors used in developing per diem rates. |
Guidance was published in April 1986.
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| Veterans Administration | The Administrator of Veterans Affairs should, through the Chief Medical Director, direct VA medical centers to renegotiate sharing agreements before they expire. |
Although implementation of this recommendation should result in measurable savings, GAO was not able to project those savings on the basis of the work performed during the review, and to review the savings now would require a substantial investment of staff time.
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