VA fails to pay outside ER claims

The Department of Veterans Affairs, which provides healthcare services to millions of former military veterans and their families, apparently failed to cover the costs of many of their charges when they received emergency services outside of the VA system, according to a government report.

A Government Accountability Office (GAO) survey of 128 outside ER claims submitted to VA facilities in Washington, D.C., Virginia, Vermont, Texas and South Dakota concluded that the VA rejected half of those claims, even though it is financially bound to pay them.

Under federal regulations, the VA has to cover the cost of uninsured patients, patients enrolled in VA healthcare services and those who recently received treatment from the VA system. A federal law enacted in 1999 also allows for coverage of disabled veterans at private hospital ERs if the nearest VA facility is some distance from their homes or the site where the patient experienced a medical emergency.

Many veterans are heavy users of hospital emergency services because of their personal circumstances, suggesting that the VA regulatly handles outside ER claims.

However, the GAO report found that VA staff failed to promptly date-stamp claims, sent claims to the wrong payment office or routed them to the wrong VA facility. In some cases, staff erroneously concluded that the veterans were not qualified to have their claims covered.

"They were sloppy," Randall Williamson, the supervising GAO investigator for the report, told the USA Today. The GAO concluded that this prompted many providers to collect the sums directly from the patients.

The VA has since paid 25 of those unpaid claims that came under GAO scrutiny, according to USA Today.

The GAO's investigators concluded that the large number of unpaid claims by the VA "raises concerns about the extent to which other VA facilities nationwide may be inappropriately denying claims."

In addition to the claims problem, at least one VA facility has also come under scrutiny in recent months regarding the quality of care it rendered.

To learn more:
- here's the GAO report (.pdf)
- read the USA Today article