Veterans Choice Program Contractors Overpaid By $100 Million In Bulk Payments
An IG report released this week showed VA contractors administering the Veterans Choice Program were overpaid $100 million from March 2016 to March 2017.
Bulk payments made to the third party administrators (TPAs) amounted to $66.1 million in duplicate payments and $35.3 million resulting from three other payment errors. Under the framework at the time, the two TPAs were Health Net Federal Services and TriWest Healthcare Alliance Corporation.
Problems with the use of TPAs has persisted since the inception of the program, lending weight to arguments against full privatization. Though, agency healthcare horror stories still persist meaning veterans should still retain some autonomy when selecting their preferred healthcare providers.
According to the IG report summary, in italics below:
The VA Office of Inspector General (OIG) audited the Veterans Health Administration’s (VHA’s) Office of Community Care (OCC) to determine the accuracy of bulk payments made to third party administrators (TPAs) under contracts that include care provided through the Veterans Choice Program. The OIG found about $66.1 million in duplicate payments and $35.3 million in three other payment error types, for a total of $101.4 million in estimated overpayments to the TPAs from March 4, 2016, to March 31, 2017.
The Veterans Choice Program allows veterans to obtain care within their community and is administered under contracts with two TPAs, Health Net Federal Services and TriWest Healthcare Alliance Corporation. The TPAs perform a variety of administrative services, including paying claims from healthcare providers.
In 2016, the OCC implemented a method to process health care claim payments to TPAs on an aggregated basis, referred to as bulk payments. This process did not have effective internal controls in place to detect improper claims. Because of ineffective internal controls, the OCC failed to identify improper claims being submitted by the TPAs.
The OIG recommended that VHA continue to support processes to prevent duplicate payments and ensure that controls are in place to prevent duplicate payments to TPAs through all current and future payment methodologies for community care. The OIG further recommended that OCC and VA’s Office of General Counsel continue to work collaboratively with all relevant government authorities to determine a process for reimbursement of overpayments by TPAs.
This is the second OIG report on OCC’s process for paying claims under the Veterans Choice Program. The prior audit report, Audit of the Timeliness and Accuracy of Choice Payments Processed Through the Fee Basis Claims System (Report No. 15-03036-47, December 21, 2017), addressed claims processed through the Fee Basis Claims System.
Unfortunately each VA is run independent of the others, they pick and choose who gets care and how much money they will allow for each treatment or diagnosis. Many Veterans we’re forced to get off pain meds by going for alternative treatments such as chiropractic care, acupuncture, biofeedback, etc. Many times it was helpful, but they were only allowed a certain number of treatments, then you need another authorization which takes weeks to months. In the mean time the Veterans we’re in pain again and without medication.
To be honest, I had allies at the VA who truly did everything they could to assist getting the Vets the care they needed. Not everyone was bad, nor where I worked. Many of the contracted employees were forced to take so many calls per hour, or got bonuses based on numbers. The bottom line was numbers for the VA and the contractors. How many Vets can the VA deny care for and save a buck. How many Vets can the contractors schedule an appointment for. Oops, you didn’t know you had an appointment because you didn’t get a call or letter? Ok, we will reschedule and bill again for that.
I hope more contractors will speak out and lay bare the truth so the Vets have full disclosure when suing the VA. I personally am not a litigious type to go after a company, but this is our government rolling over those who served our country up to and including giving their life. You have every right to hold their feet to the fire and demand change by suing them. I hope the contractors are also sued because the orders came from the top, and they are overdue to be accountable for their greedy actions.
thanks to Lindas coment on the va it is a con on the vets choice is b.s just to make you wait longer for treatment or may be you will die!!!!!!! they dont want to do their job thats apparent its simple run it like medicare see who you need to get treatment simple done . but you got to give them kickbacks to cons I say set us free dump the va get real doctors that care and know how to treat people and tell donald to stop running his mouth about choice or may be he should use it or the va then it might change we are not getting good care not even close
Shut it down already!!! WTF!!!
Remember veteran’s can now file class action lawsuit against the VA.
An example was given. Veteran’s can sue the VA for not processing veteran’s disability claims in a timely manner.
All of you are pretty bright. Brain storm and let’s figure how best to determine what top veteran’s issue’s, we can file class action lawsuit against the VA.
I have contacted an attorney requesting a class action lawsuit against the VA concerning the Disruptive Committee.
If the attorneys office declines, I will contact other attorneys. Hopefully I will find someone to help veteran’s, who have been accused and punished by the Disruptive Committee.
Every veteran that has been accused of disruptive behavior and then punished.
Had all of their Civil, Human and Constitutional rights Stripped away by the illegal VA Disruptive Committee.
The VA Disruptive Committee is acting as part of our Justice department and these employees are not qualified to practice law in the United States.
This disruptive committee has no therapeutic value at all for veteran’s. What it does do is, make these veteran’s scape goat’s for the employees who are willing to harm veteran’s.
Does anyone have any suggestions on whom will handle these type’s of class action lawsuit against the VA.
Ben, could you do some research on this matter and through your contacts find out how best to file class action lawsuit against the VA.
You mean that money is supposed to BE for something?
I thought it was the gravy train, ya know!~~!
I worked for one of the private contractors. I was horrified by the treatment I witnessed the VA subject our Veterans to. I was also horrified by the disorganization I endured while employed by the private contractor. I was outspoken about the mishandling on both sides, the VA and my employer. I made enemies because I am first and foremost a patient advocate, and our Veterans were my priority. No one listened to me and I was laid off along with hundreds of others, and management was asked to stay on being promised a large raise and bonus. Some of the things I was forced to deal with were VA doctors refusing to provide service for Veterans with cancer, VA doc’s telling AIDS Veterans they were cured, denying behavioral health services for Veterans who were raped by their CO, or being told not to tell what happened. I was astonished at the number of our military women who had been raped but said nothing or were coerced into silence. Men too, but predominately women. Our company did not train employees to do their jobs, so we were flailing in the dark, each doing something different. No wonder we were overpaid on some, never paid on others. I could go on and on, but now that the contractors are no longer in a lengthy contract with the VA, I fear for the Veterans treatment by the VA. Our government is so corrupt, we should just allow our Veterans to go to whomever they need to see and send the bill to a central payor. Removes all the underhanded greedy middlemen and gives the Veteran a REAL choice. God Bless anyone who served, and I will NEVER stop fighting for you.
You know that stench of a VA Fiduciary?
“Man admits stealing $145K in VA benefits intended for military widow”
By: Karen Jowers 45 minutes ago
“An Oceanside, California, man has pleaded guilty to stealing $145,035 that was intended for a military widow.
Michael Vanden Brink, 57, admitted in federal court Sept. 5 that he collected a military widow’s benefits for nearly 10 years after she died. The widow, who died on June 30, 2004, at her home in Oceanside, had been receiving Dependency and Indemnity Compensation benefits since 1972.
DIC is a benefit paid to eligible survivors of service members who died in the line of duty, or eligible survivors of veterans whose death resulted from a service-related injury or disease. The benefit is paid by the Department of Veterans Affairs.
Information was not available on which branch of service the widow’s husband served in. She was identified only as H.C.C. for privacy reasons, said Special Assistant U.S. Attorney Jeffrey Hill, in the Southern District of California.
Brink is not a relative of the deceased widow, Hill said. However, Brink shared a joint bank account with her, and her monthly DIC benefits were paid into that joint bank account. Information about the nature of their relationship was not available.
As part of his plea agreement, Brink has agreed to pay $145,035 to the VA. He will be sentenced on Dec. 10, and faces up to 10 years in federal prison and a fine of up to $390,060.
According to the plea agreement, Brink informed the bank of the widow’s death, but he didn’t notify the bank that the monthly DIC deposits should stop. Instead, he continued to receive the monthly deposits until Feb. 26, 2014, and was the only owner of the bank account. Brink received monthly bank statements.
He acknowledged that he knew he wasn’t entitled to the money and that it belonged to the United States, according to the plea agreement.
The theft was discovered as the result of “proactive database matching, which cross-references all VA payees against the Social Security Administration’s death records,” Hill said.
“For almost a decade, this defendant stole thousands of dollars intended to help the families of our brave men and women in uniform,” said U.S. Attorney Adam Braverman. “This prosecution demonstrates the commitment of the United States Attorney’s Office to protecting the integrity of programs for our veterans and their families.””
Full Article: “https://www.militarytimes.com/pay-benefits/2018/09/07/man-admits-stealing-145k-in-va-benefits-intended-for-military-widow/”
Has anyone looked into “which Veterans actually received consent from Almighty VA Administrators to even use the CHOICE Program?” Im hearing its the good ole boys-that actually got consent. I’m sure the policy referring Veterans to “alternate pain therapy through CHOICE, was to Drs. that work for VA and hold interests in all the Rehab programs that popped up suddenly after VA stopped treating pain. Of course VA gets kick backs from these referrals. And these Rehab Centers have learned well how to over bill for services, because they were VA employees.
I couldn’t get the necessary $20,000.00 Surgery from my CHOICE back Dr. because some other Administrators denied the procedure 2 days before to be done. Specialist even attempted to make phone calls to said Administrators with documented proof of needed Surgery, with necessary referrals from VA itself, no RETURN PHONE CALLS TO SPECIALISTS. Is it any wonder why outside providers don’t want to accept CHOICE, they are stonewalled, denied procedures for Veterans and now no payments?
Betcha a few of the upper echelon individuals working at these “TPA’s” have had their “overseas accounts” get richer!
How about making it possible to give “thumbs up” on these comments? EVERYONE has the same ideas when it comes to either “incompetent individuals” getting away with taxpayers monies. Or, it “was on purpose these reprobates are getting away with stealing taxpayers monies!”
Everything is back to how it was before Choice started, seeing it ends the end of Sept. Can’t get in in less than 30 days? Call outside care (they’re running the show now) and they’ll tell you to get a consult from your PCP, but you’ll more than likely get a phone call like I did that says “We can squeeze you in on so and so date”, a couple days before the 30 day limit. Back to the SSDD. When I go to my last Choice appt. next week, I’m going to see if I can work out a price just to just keep seeing them. The call the VA and get a recording-leave a message, they call you and leave a recording, call back and get a recording-leave a message hasn’t changed either…
So much talk telling us about this “problem” that just keeps happening while growing exponentially. There are two reasons why this is happening… Gross incompetence or gross corruption across the board. This agency is bleeding out taxpayer dollars that is supposed to be helping veterans, but is going “somewhere else”. There is obviously no oversight or accountability that is working to prevent this, apparent by evidence that is just keeps happening, along with the fact that the VA just keeps receiving more money to squander and divert God knows where… Somebody with legal enforcement authorization should be following these money trails of “overpayments” to see where they lead. I bet it won’t be any surprise where they lead either… Meanwhile, veterans, and legitimate providers trying to help them end up losing in the end. Disgraceful!
Choice failed me. I’m back to driving 2 hrs every 2 months for treatments for 8 service connected disabilities, 2 from exposure to mustard gas, losing the use of organs and the loss of organs. I voted for President Trump and still support him, but him touting the choice program as a success for veterans is a disgrace. I don’t find it odd that 3rd party administrators got paid double, yet my choice provider never got paid.
I’m still fighting appeals after decade of having to re file, been disabled for years and unable to work, yet still at 70%.
My last visit to my local va clinic, which is a little over 30 minutes away, I met a young vet, early 20’s, fit, aware, he asked me about va care, he was enrolling, I told him about my experiences, then he told me about how the army/va was handing out 100% ptsd full disability, like candy to combat arms soldiers, guaranteed for 5 yrs.
Older veterans with disabilities are facing a heavier burden,and being burdened unfairly.
Hurry up and wait, then hurry up and die.
The VA employees are making these mistakes. The VA employees seem to always be making mistakes when it comes to money.
Veterans are said to be over payed and the veteran’s are paying a big price for employees mistakes.
The VA goes after those veteran’s, whom had an employee (not do their jobs properly) and the result is the veteran’s are forced to pay the money back.
How many veteran’s have committed suicide after the forced them to pay for a VA employees mistake.
Why are these employees held accountable for making these mistakes. They should be fired for incompetence or they should have (their), pay checks garnished.
Why are veteran’s being used as scape goat’s for the employees making the mistakes.
Need to figure out how veteran’s can file a Class Action lawsuits against the VA for wrongs employees are committing mistakes and the veteran’s are being (PUNISHED), for what VA employees did or did not do.
We veteran’s have been given a big tool to fight back. By now being allowed to file Class Action lawsuits against the VA.
Put on your thinking caps and ask yourself, what is or has the VA done to veteran’s.
That maybe used to help veteran’s. We have the power as veteran’s to fix a lot of what the VA is wrongly doing, as long as other veteran’s are going through the same thing.
These are not mistakes.
WG ..Your right they want people to think they are incompetence, But it’s all in the money looting plan..LOL..And watch they won’t do a Damn thing about it..
Fucking thieves….IT was NOT a mistake
I agree Windguy, also aurora colo, and another contractor caught with kickbacks of 2m. And, it appears, they got rid of choice 30 in the new and approved VA Mission Act, but kept choice 40 that disqualifies most veterans. Privatize VHA and open the closed doors at VA, let Army Corps build hospitals, if there needed.
The contractors are making these mistakes and it’s not by accident. They didn’t realize they OVERCHARGED Veteran care by multi-million dollars!?? This whole scheme has been rigged to let private sector make money on the backs of Veterans. You don’t think these 2 corporations knew what they were doing? It’s despicable!
Yet the blame goes toward the VA!? The federal government (VA) has it’s own audits to monitor issues like this and the government uncovered private sector thievery. The private sector doesn’t monitor anything and therefore lacks any of the quality controls the VA has. That’s why the public learns any of VA mistakes because we monitor with intent to correct. Private sector hires lawyers to hide their malfeasance!
It is worse than that. Not only were they overpaid because of cooked books, they must have cooked the books to show payments to providers that never happened. I filed an SF 95 Claim to recover $2,150.00 which was never paid to my authorized provider. Next month I have to file in District Court. No response from the VA yet.
I think if I was over paid by several hundred thousands of dollars i would notice. So that tells me the contractors must be relative of our Congressional Representatives. They are the only ones that have no clue as to the difference between $100 and $10000000000000
All the over payments to Health Net Federal Services and TriWest Healthcare Alliance Corporation and yet the providers are still not being paid.
I have ZERO Choices when using this program. Its been nearly 6 months in a search for mh care outside the VA. NO One excepts the CHOICE program payments specifically Tri West in my area. So where EXACTLY is MY Choice here?? I have a provider. But she will NOT take Tri West. This is beyond ridiculous. So many appts I need that aren’t available thru my VAMC’s. No help here in Kentucky.
Wow. I didn’t know about the mental health issues, but I know Tri-West ran up over $80,000 OWED to my acupuncturist in Berea for months.
You are right, Jim Davis. I am one of those same acupuncturist that Healthnet still owes! When we would call Healthnet they told us that we had to list all the claims that were unpaid on their form. I had to hire additional employees to take care of this as the claims were so many my regular employees cannot handle it. It cost me to relist all these treatments on their form and then they took their darn good time paying him anyway! Healthnet still owes us money and we are still trying to collect it! No wonder that Choice Program ran out of money! The overpayment funds that caused THE CHOICE PROGRAM TO RUN OUT OF MONEY are in Healthnet and Tri West’s bank account!
How convenient for the third party not to mention or disclose to the VA or it’s financial oversight committee thst an error of this magnitude had occurred, in the meantime it’s business as usual for this company, holding 100,000,000.00 in it’s account, have the company reimburse the VA and if necessary find another company that has a true record of do business the correct way
The VA requires a taxpayer appointed fiduciary because the dumbfucks cannot handle their finances *unless* that $$$$ is flowing towards their greedy-assed snouts, but paying contractors? Timely payments? Veteran’s credit destroyed because they go after the Veteran for nonpayment of the VA and Choice? When they DO pay, they OVERPAY?
But god forbid any Veteran attempts to claim once cent over in travel pay!
All for the Vets.
Other news: John McCain is still dead.
Not to mention Generalissimo Francisco Franco….
You know this shit doesn’t happen by error or accident. Follow the money trail and it’ll lead you to the rule-making or legislative source, non-partisan/bi-partisan, colorless, but oh so odiferous.
So is General Giap and Uncle Ho The senator will feel right a home
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