ER Bills

Benjamin KrauseAn appeals court just concluded VA knowingly used an invalid regulation to justify denying payment for uncovered non-VA ER bills, since 2009.

In a recent court decision, the US Court of Appeals for Veterans Claims just held VA was violating federal law using an unlawful interpretation of statute. That statute required VA to pay for all uncovered costs related to veterans’ emergency room (ER) services.

VA surreptitiously interpreted the statute to justify denial of payments to veterans with insurance that would cover part but not all of emergency room visits.

The interpretation resulted in veterans getting stuck with enormous bills following emergency room visits. According to the National Law Journal article, VA stuck veteran Richard Staab with uncovered portion of his bill of $48,000. The interpretation VA used apparently penalized veterans with health insurance:

In December 2010, Staab suffered a heart attack and one or more strokes and was transported to a non-V.A. hospital where he underwent emergency open heart surgery. He was discharged in June 2011. Staab sought reimbursement of his expenses that were not covered by Medicare—approximately $48,000. In December 2013, the Board of Veterans’ Appeals denied Staab’s request for reimbursement of the non-V.A. medical costs.

ER BILLS DECISION LANGUAGE

“After Congress amended [38 U.S.C] section 1725 in 2009, however, the Secretary’s regulation became wholly inconsistent with the statute, and the Secretary declined to remedy this inconsistency,” Greenberg wrote.

“Congress intended that veterans be reimbursed for the portion of their emergency medical costs that is not covered by a third party insurer and for which they are otherwise personally liable, and because the regulation does not execute the language of the statute or the intent of Congress, it is invalid and will be set aside by the Court.”

READ IT: 38 USC 1725

According to an attorney in the case, Bart Stichman, “This is a major win for veterans, and their families.” He continued, “This practice has violated federal law since at least 2009. The court’s ruling means the V.A. will have to amend the unlawful regulations it should have amended in 2009 and do right by these veterans.”

This is obviously not the first and only time VA has schemed against veterans by interpreting statutes in clear contradiction to the language of the statute.

What do you think will happen to the legal team that created the regulation?

Source: http://www.nationallawjournal.com/id=1202754751024/Veterans-Affairs-Improperly-Rejected-Vets-Emergency-Medical-Reimbursements

namnibor
Looks like we know where that $20 Million from yesterday’s article of the VA wanting to establish a new archive will be going. Paying ER Bills it should have been paying all along. BasTURDs! Meanwhile, VA employees have received Performance Bonuses on the very backs of exploiting Veterans and interpreting the regulations the way it only benefits the VA…shame on you, VA. “What do you think will happen to the legal team that created the regulation?” They will receive a… Read more »
crazy elf
crazy elf

It’s about time the court system calls out the VA on something!
I agree, namnibor. That $20 million “Dayton Ohio Renovation” is going to be placed on hold for awhile!
Only I’ll bet the VA will ‘contest’ that ruling. Under some other “rule” they’ll make up!

Don Avant

If the law was broken, why are people NOT GOING TO JAIL????? Somebody call the FBI…

Mary Rouse
Mary Rouse
So I call the va hotline number, because it’s after hours and you need permission to go to the Er , or we call his primary at the va. They say go to the ER. My husband is that sick and has over 28 diseases causes by Exposer. So we go usually he is admitted for 3-5 days just to get stable. Well since he has Medicare, age 62. They won’t pay any co- pays. We owe thousands. His credit… Read more »
91Veteran
91Veteran
Mary, the VA claims that if you call them within 72 hours of going to the ER, they will pay the bill. I would hold them to that. I would call the VA within 72 hours, document the first and last name of who I talked to, time and date, and then follow up with a letter to the patient advocate showing who you called and when…then hold them to paying the bill. Every VA hospital has a billing office.… Read more »
91Veteran
91Veteran
I forgot to add…every VA hospital tells you when you call that if this is an emergency, to hang up and dial 911. Why do that if the VA refuses to pay the bill, or notify the veteran to call within 72 hours? The VA spends millions on weight loss and other little low cost programs and pamphlets to make it appear they care for veterans, yet refuse to provide pamphlets or education in this. Like the Choice Champions. Hire… Read more »
Mary Rouse
Mary Rouse
So I am commenting again because I am so pissed off. We also have had to go to outside hospitals to get real medical services. Such as cancer center. They don’t pay those co pays either. We have been fighting the VA system for 10 years. What happened to the government. When my dads dad came back from WW1, he had been hit with mustard gas. He died young 52, at our VA. He was honored. When my Dad came… Read more »
crazy elf
crazy elf

Here’s something else just out. 14 April 2016
By “TownHall dot com”

“Congress Still Wasting Taxpayers’ Money”
by Cal Thomas

It’s about that “alleged monetary sequester” we’ve been hearing about. Which everyone knows Congress is not following through on! Their using a different name to push through more spending our (government) $$$$$$$$$ doesn’t have!

crazy elf
crazy elf

Wasn’t Shinazi heading up the VHA for a short time? Maybe this is one of the top reasons he got the hell outta dodge!? Saw the writing on the wall, so to speak!?

namnibor

@crazyelf…I also wonder if that’s the unspoken reason Gen. Hickey suddenly resigned. She saw the ship’s impending sinking and got hell out of dodge? THAT still has my brain buzzing because it’s the most tight-lipped the VA has been about anything around a scandal in a while.

91Veteran
91Veteran
What do I think will happen to the legal team who created the regulation? Absolutely nothing adverse. In fact, I would not be surprised if VA employees received bonuses based on how much money they illegally denied veterans. Which raises the question, with all of these “mistakes” made by the VA, when in their history has there ever been a “mistake” favoring veterans? Seems every ” mistake” made has screwed veterans as thoroughly as possible. On another topic, there are… Read more »
namnibor
@91veteran– That’s all indeed good that some private sector Dr.’s had credentials yanked from over-prescribing opioids and cocktails. What’s not okay in private medical sector is the backlash is akin to the VA, if a person legitimately needs even low doses of said meds as well as any of the benzo category, the knee-jerk response is even if many meds had been tried in past and a given patient is doing best they can (quasi-stabilized), they are ceasing prescribing said… Read more »
91Veteran
91Veteran
I don’t disagree with anything you said nam. My point is doctors like Houlihan and Kostenko acting irresponsibly, the medical establishment over-reacting causing harm to patients who need the medicine or as you said, cutting them off cold turkey, and at the same time ignoring the harm caused in the case of the VA, possibly rehiring him. In the end, it is the patient that suffers whether it’s the VA or civilians, because of lousy oversight. In the CBS news… Read more »
namnibor
We are on exactly the same page, 91veteran. What I was trying to convey is what you stated eloquently in that the Dr.–>Patient Relationship has become that of a drive-up fast food window but even more impersonal…until their own liability is on the line then they will act like recommending much more expensive alternatives are their way of “caring about patient”, when to the wise, it’s clearly not about we patients at all. Greed on all levels is killing this… Read more »
Veteran
Hello, I have recently had the VOC REHAB counselor tell me that the VA will not pay for an MBA, or to start a business. They contended that in all their years only one self employment track has been approved, and it’s because it’s not a successful rout for veterans. I do not belive they are interpreting the regulation correctly her either. I believe they are taking the path of least resistance, and are preventing Veterans from maintaining a gainful… Read more »
namnibor

@Veteran-
If you have not yet done so and can swing it, definitely purchase Benjamin’s VA Voc. Rehab Guide/Book. He went through all that and through that fighting the VA to actually adhere to THEIR very rules and regs is the very reason why he does the advocacy work he does and more currently. Hope that helps you. You can send him an email as well, the link/icon is on page.

Stephen LeMaster

Complete BS. I got Ch 31 to pay for my MBA (2012 – 2014). This counselor is just being lazy. Escalate your concerns. You might also want to get Ben’s book. I bought it to perform due diligence prior to my application. It helps — especially if you follow the directions strictly.

Darrell
Darrell

I’ve had more than one ER visit outside of the VA and always had to pay the difference between what my insurance paid, VA always told me they would not pay a dime.

Last time was 2014 and my insurance, Medicare!

Dennis
Dennis

It’s abusive medical care is all I can say. Veterans complain about it, but who listens? Who cares? It ain’t no telling how many more things that they’re fudging us on. The list is probably a mile or two long. I’m down right tired of being scared to death of VA medical care!…..Not worth fighting and dying for!

Dennis
My oath to uphold and defend the Constitution of The United States of America had no time limit as I recall. I do not recall anyone saying it would be easy, non fatal, or fun. I took that oath and I will not stop using the tools given me by that same Constitution to persistantly and without surrender do my part as the army of citizens that will defeat them. I wont back down until my last breath, and I… Read more »
kenny gonterman
kenny gonterman

I’m eating out of the same bowl. So I’m digging in harder an danbutting

malakieusn
malakieusn

So how do I get the VA to pay for the past due in collection emergency room bills I have now? They keep denying them. With this court ruling, they should be but who do I need to talk to to get this done now?

Steven Luke
Steven Luke
Funny thing. Denied Emergency Surgery May, 2012. They said I could have traveled. $ thousands in bills, bill collectors and ambulance service. During my July 2015 PCP physical, my doctor stated she’d schedule me a colonoscopy. I stated I had one in 2012 at a NON-VA Hospital. It was an emergency. She said, after reading my info on the computer, I see you used such and such doctor. Do you want the same one. I said as long as I… Read more »
Louis Joseph Apa
I am a veteran in the North Carolina area and am having ER bills threatening to sue by collection against me due to the Salem, Virginia VA bill processing office not paying my ER stay of 3 days in August 2015. They say they have my bills set to pay, then they send me a series of bill rejection letters with no supporting details on what is being rejected. Have meet with the offices March 30, 2016 to set this… Read more »
Timothy Ramos
Timothy Ramos
It’s sad that choice and tri west has made the fee basis program useless. With employees that know nothing about care for disabled. Now there is a network of providers have to be in for us to see them. No one has any clue why things are the way they are, and they just blame each other. Small example: my nurse has put in consults for massage, which is an approved pain management according to the VA. But they can’t… Read more »
wynwn
wynwn

Does anyone have any information as to whether this ruling has an impact on having to use medicare because VA refused ortho consults to a vet (at the time, 2013) 60% rated for ortho disabilities that led to 2 total knee replacements?

Mary Rouse
Mary Rouse

Thanks 91 Veteran I am going to print it and get all the bills from the ER visits ect. And fight this …… Why is it we always have to fight to get the correct things done….

91Veteran
91Veteran
Why do veterans always have to fight? Because Congress and the VA have found it to be much cheaper to deny a veteran and hope they go away. This has been an issue since 2009…7 years, which is why I mention Congress…who did nothing to fix this. It took a lawsuit by a veteran. One veteran cited in the article was stiffed for $48,000. Imagine how much money has gone to other things because veterans were forced to pay for… Read more »
Leslie Bowman
Leslie Bowman
I absolutely agree! The VA also does those fun things like: call specific number if you are away from VA hospital area and need to be seen by reg. Doctor. They authorize you, you go see Doctor, then they don’t pay Doctor you were approved to see by the VA, so you wind up being sent to collection because they, no you, didn’t pay the Doctor….. Then you have to go through hell trying to get “non-pay” removed from credit… Read more »
Leslie Bowman
Leslie Bowman

Why is it that the VA needs a 20 million dollar archive? So that they can look back and reflect on all of their good deeds? Or maybe that’s where they’re going to stash all of the Vets missing (according to Freedom of Information Act requests) records?
I’m so confused?

Seymore Klearly
Seymore Klearly
“Claremore Physician’s Assistant Sentenced To 90 Days For Deaths Of 2 Veterans” “http://www.newson6.com/story/31729407/claremore-physicians-assistant-sentenced-to-90-days-for-deaths-of-2-veterans” A couple of murder charges dropped to three misdemeanor assault and battery charges and the Physician’s Assistant get 90 day jail for the two murders and loss of his medical license. Kenneth Adams was a physician’s assistant at the Claremore Veterans Center. The reason for the dropped murder charges is because the longtime investigator Steven Pancoat with the department of veterans affairs wasn’t a cop and instead… Read more »
crazy elf
crazy elf

Here’s another one from:
“The Daily Caller News Foundation”
by Luke Rosiak, reporter
04/15/2016

“Despite Pledge, VA Secretary Blows Off Whistleblowers”

Or;

“VA Secretary Slights Whistleblowers At Troubled Hospital”

These concern the Puerto Rico VA Hospital.
How about veterans “…lying around on the grounds in their fecal matter for hours!”

Seymore Klearly
Seymore Klearly
Hey Elf, Did you catch the method of death the two veterans suffered. Adams, the PA, was on the Internet scouting women for dates when two veterans died. Jay Minter was scalded to death in a hot whirlpool and Louis Arterberry had a stroke and laid there with no care for nine hours. “It’s in the court records, [that] he was looking for a sexual liaison while my daddy was dying,” Louis’ daughter Glenna Hiseley said. Regarding the fake investigator… Read more »
crazy elf
crazy elf
@Seymore Yea, I read the article, w/video, over that fuckups shit. How the hell did the VA have a criminal for an investigator in the first place(?), is my question. Plus, this sounds like the way VA gets around prosecuting the worthless asswipe employees, from the director(s) on down. I believe the VA knew about Pancoats’ past! I believe they not only knew it, but knew the assistant would get off with a very light sentence. I believe also, VA… Read more »
Seymore Klearly
Seymore Klearly
Some big questions I have is: Where has the news coverage been on this case? Why is it only coming to light now with just one article? What happened at the VA regarding Kenneth Adams, the Physicians Assistant, responsible for the deaths of the two Veterans, Jany Minter and Louis Arterberry? Has Kenneth Adams, the Physicians Assistant, responsible for the deaths of the two Veterans, been off on paid Administrative Leave? Has Adams even been fired by the VA? Why… Read more »
Seymore Klearly
Seymore Klearly

An even bigger question is why did the Attorney General for Oklahoma Scott Pruitt step in and reduce the two charges of murder to just three misdemeanor assault and battery charges?

Wouldn’t that have been the job of the prosecutor and the courts to decide?

Seymore Klearly
Seymore Klearly
Hey Elf, Here is another article on another case of deficient care at at Claremore Veterans Center. “Oklahoma veteran attacked in Claremore Center” “http://kfor.com/2014/07/25/oklahoma-veteran-attacked-in-claremore-center/” “Another gentleman came into my grandfather’s room while he was asleep and they got into a scuffle is the way it was portrayed to me.” said Morrison’s grandson and guardian, Steve Morrison According to the administrator at the Claremore Vet Center, an on-site doctor checked Morrison each day for three days following the attack and saw… Read more »
Seymore Klearly
Seymore Klearly
Hey Elf, Here is a little more on the Veterans deaths at Claremore another article and a copy of the the Grand Jury Indictment that the Attorney General for Oklahoma disregarded and change to misdemeanors. “Former Employee Of Claremore Veterans Center Named In Murder Indictment” “http://www.newson6.com/story/22490472/former-physician-assistant-at-claremore-veterans-center-named-in-indictment” Indictment “http://ftpcontent.worldnow.com/griffin/NEWSon6/PDF/1306/kenneth_adams_indictment.pdf” “The men lived at the Claremore Veterans Center. Monday a grand jury handed down an indictment against the man who was supposed to be caring for them. Kenneth Adams, 60, faces two… Read more »
Seymore Klearly
Seymore Klearly
Hey Elf, Just a few more articles on the Oklahoma VA and the corruption there including the VSO American Legion. “Fired Oklahoma Veterans Affairs investigator is charged with 26 counts” “http://newsok.com/article/5413642” “EL RENO — Prosecutors are accusing the fired chief investigator of the Oklahoma Veterans Affairs Department of being such a fraud that he even faked the college diplomas on his office wall. Prosecutors on Friday filed 26 criminal counts against Steven B. Pancoast Jr., 41, of Mustang. Pancoast was… Read more »
crazy elf
crazy elf
@Seymore Yep, the Legion is just one more fake VSO. Just like the DAV, Wounded Warriors and a bunch more! Their all in bed with VA and our “alleged Constitutional Republic” government! I have absolutely NO respect for any of them. From this moment on! Here in Florida, the Legion is, in my opinion, a fake ass conglomerate of fake ass military wannabes! None, or very few, of them ever went anywhere to “Fight for the Freedoms” we hold dear!… Read more »
Paul Zdunek (zmann)
Paul Zdunek (zmann)
Several months ago I posted that the VA is getting away with incompetence, abuse in interpreting laws and down right disrespect and mistreatment of Vets who served in WWII, Korea, Vietnam, and the Middle East Theaters because we as Veterans allow them too. I suggested that the only way to alter the culture of the current system is to organize and march onto Washington and for those who cannot travel march onto their local VA districts within the national VA… Read more »
Sandy Hale
Sandy Hale
THE ONLY WAY TO HURT THE VA AND THEIR CORRUPT EMPLOYEES IS TO HIT THEM WHERE IT HURTS….. THE WALLET. Its useless to protest for better treatment or faster claim times or any of that because all they have done and all they will ever do is throw more money at the VA which they will spend on themselves and put in their own pockets. They will form committes to study it and those committees will hold meetings in Hawaii… Read more »
Sandy Hale
Sandy Hale
VA verses NON-VA FACILITIIES 1) VA allows their employees access to civilian internet on their government computers where employees spend all their time on FACEBOOK, Porn sites, being shills to VA websites like this or whatever the hell they want to do. Civilian non-VA facilitiy computers are locked out of the internet and employees can only access company websites and use company software, thus avoiding this type of wasting of employee time. 2) VA allows their employees to access medical… Read more »
Steven C. Luke

Yes, they told me; “We have the power to change your credit and repair any damages from the VA actions”!

Kara Crick
Kara Crick

Interesting post . Speaking of which , if your company wants a VA 21-0845 , We came across a sample document here “https://goo.gl/pLhwtk“.

wpDiscuz