The overpayment rate increased starting in 2019, it added, following enactment of a law expanding eligibility for the VA’s community care program. Image: Jonathan Weiss/Shutterstock.com
By: FEDweek StaffLack of coordination on payments between the Medicare program and the VA’s program for veterans care outside its facilities allowed for up to $128 million in duplicative payments from those programs over a recent five-year period, an audit has found.
Issues with duplicative payments for care of veterans through VA community care programs were first pointed out as long ago as 1979 by the GAO, the IG’s office at HHS pointed out. The new report focused on that department’s component the Centers for Medicare and Medicaid Services (CMS) in coordinating with the VA.
“CMS did not establish a data-sharing agreement with VHA for the ongoing sharing of data between the two agencies and did not develop an interagency process to include VHA enrollment, claims, and payment data in CMS’s data repository. Inclusion of these data, which is required by federal law, would have allowed CMS to compare VHA claims data with existing Medicare claims data to identify duplicate claims paid for by both Medicare and VHA,” it said.
Also, the CMS “did not establish an internal process (such as claims processing system edits) to address duplicate payments for medical services authorized and paid for by VHA. Furthermore, CMS guidance to providers on VA’s responsibility to pay for medical services did not clarify that a provider should not bill Medicare for a medical service that was authorized by VHA,” it said.
The IG produced its $128 million estimate after matching Medicare Part A and B payments for individuals eligible for both Medicare and VHA benefits who received services from VA community care providers over 2017-2021. The review found nearly 300,000 duplicative payments to providers who billed both programs. While nine-tenths of the claims related to professional services such as physician’s evaluation and management visits, the 1 percent of claims related to inpatient hospital care accounted for more than half the cost. Outpatient visits and other forms of care accounted for the rest.
The rate increased starting in 2019, it added, following enactment of a law expanding eligibility for the VA’s community care program.
It said that CMS management agreed with the recommendations to better coordinate with the VA on sharing information and coordinating records of payments, although adding that “a long-term solution to address duplicate payments will take time.”
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