Federal Manager's Daily Report

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An inspector general audit has said found inconsistencies in bill-paying practices under the VA program of allowing veterans to get care outside its facilities on a reimbursable basis, a program that itself is controversial because it is a form of contracting-out.

The IG said that the VA turned to contract help to assist in processing claims for such care “due to the rapid increase in the volume of claims” but did not assure that the same standards that the VA itself uses when processing such claims were followed.


It said that based on a statistical sample, 13 percent of the contracted claims decisions “did not align” with the VA’s own standards, noting that an internal review by VA management reached a similar conclusion regarding 18 percent of such decisions. It noted that inconsistencies “do not necessarily mean that the final claim decision was inaccurate” because for example a claim could be rejected for the wrong reason but the overall decision to reject the claim was correct.

Similarly, in some instances, contractor employees “attached the wrong authorization to claims. This action does not mean the final decision is wrong, but it is important because it could negatively affect the decision on other claims for which the authorization was intended or create a risk of paying an unauthorized claim.”

“How non-VA healthcare claims are processed can potentially shift the financial burden of health care from VA to veterans, and is ultimately VA’s responsibility even when it uses contractors . . . If claims are inaccurately processed and not approved by VA, there is a chance that the non-VA provider will bill the veteran for the care,” it said.

It said that the VA agreed with recommendations including requiring that both in-house and contracted claims decisions use the same standards.

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2021 Federal Employees Handbook