A VA OIG report shows the Obama-led VA administration of the Veterans Choice Program found massive overpayments, tardy payments, and erroneous payments.
Quietly before Christmas, VA OIG released its report into the administration of the VA Choice Program and its administrators Health Net Federal Services and TriWest Healthcare Alliance Corporation. The report addressed an audit for the period between November 1, 2014, to November 30, 2016. IG found VA overpaid program administrators by $39 million, made 224,000 payments in error, and made another 1 million payments late.
A quick search suggests no major news media outlet covered it directly other than RT.
For some background, President Obama and Congress pushed through VA Veterans Choice Program after VA was caught engaging in outright fraud to increase employee bonuses that caused countless veteran deaths nationwide. The program to this point has largely been a failure due in large part to VA’s failure to properly administer the program.
RELATED: McCain Connection With TriWest
Many veterans believe the failures are intentional to justify maintaining status quo within VA. Meanwhile, certain insiders know VA is allowed to continue failing to further justify eroding the agency’s mission in favor of privatizing the agency, entirely.
The VA Fee Basis Claims System is supposed to administer the Veterans Choice Program through administrators. It has utterly failed to properly administer the program but instead used the failures in other areas to skim money away from Choice to other programs.
VA OIG Audit Of Veterans Choice Program Payments
Here is the executive summary:
Congress required that the OIG report on the accuracy and timeliness of VA payments for medical care provided under Choice. This report addresses payments processed through VA’s Fee Basis Claims System from November 2014 through September 2016. The Veterans Health Administration’s (VHA’s) Office of Community Care (OCC) contracted with Third Party Administrators (TPAs) to process claims and pay Choice medical providers. During the 23-month audit period, OIG sampled from a population of 2 million Choice claims. Of those claims, an estimated 224,000 were paid in error, and 1 million were processed in excess of the 30-day Prompt Payment Standard. The OIG determined weak internal controls over the payment process contributed to these errors. Also, the OCC did not establish clear written policies for Choice claim payments, ensure quality information was available to payment staff, use an information system that could adequately address overpayment of medical claims, establish monitoring activities to determine if payment controls worked, or accurately estimate staffing needs for claims processing. The OIG estimated OCC made $39 million in overpayments to TPAs. The OIG recommended that VHA management ensure systems used for processing medical claims from TPAs have the ability to adjudicate reimbursement rates accurately and issue written payment policies to claims-processing staff. The OIG also recommended that OCC establish expectations and obligations for TPAs that submit invoices for payment, develop sufficient claims-processing capacity to meet expected TPA claim volume, and ensure future TPA contracts contain timeliness standards for processing payments. The Executive in Charge, VHA, concurred and agreed that a full review of Choice payments and recovery of all identified overpayments is essential.