Summary: Pursuant to a congressional request, GAO reviewed whether the Department of Veterans Affairs (VA): (1) collections from health insurers exceeded health care costs; and (2) had effective procedures to identify insured veterans and bill insurers and collect amounts owed.
GAO found that: (1) VA collected only about one-third of the health care costs for medical services it provided to insured veterans; (2) VA failed to identify veterans admitted for inpatient care who had private insurance policies; (3) two-thirds of VA medical centers failed to verify administrative and medical records or contact employees about insurance coverage; and (4) some medical centers missed billings because internal controls were inadequate to detect billing errors and notify staffs of veterans discharged. GAO also found that: (1) some centers did not bill for any outpatient care, which amounted to $1.6 million during the first 6 months of fiscal year 1988; (2) VA did not have adequate resources available to collect all health care costs from insurers; and (3) medical centers would not commit the resources needed to collect the costs unless they received a portion of the collections.
