A report identified duplicate payments by matching claims for the same or overlapping service dates for the same service. Image: T. Schneider/Shutterstock.com
By: FEDweek StaffLack of coordination between the VA’s health care branch and the Medicare program is continuing to allow for duplicative payments to providers who bill both programs for the same service, an inspector general audit has said.
A report said that although the problem has been recognized for decades, the Veterans Health Administration and the Centers for Medicare and Medicaid Services have “not yet developed a data-sharing agreement or process to prevent or identify duplicate claim payments” for VA-covered services from community providers outside the VA’s own facilities.
The report said that a review team “identified duplicate payments by matching claims for the same or overlapping service dates for the same service and for claims submitted by different inpatient hospitals or by the same home health agency.” The two agencies do not have that capacity, however, because they “do not have access to the other agency’s claims data to determine whether a claim has already been paid by the other agency.”
While it estimated that only 1 percent of claims under two VA programs were duplicates of claims submitted to Medicare, of those claims the VA paid $103 million and Medicare $80 million in one program and the VA paid $204 million and Medicare $164 million in the other.
“Without an interagency system, the risk of duplicate payments is increased, and it is difficult to determine which agency should pay the claim and which agency can collect overpayments,” it said, adding that where duplicate payments are discovered and recouped, the recovered money typically goes to Medicare, so long as the VHA had authorized the care.
It said the VA generally agreed with its recommendations to establish a data-sharing agreement, identify payments for care that the VA had not authorized, and making sure that all non-emergency community care is preauthorized.
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