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Department of Veterans Affairs, Office of Inspector General
Michael J. Missal, Inspector General

Report Summary

Title: Audit of VHA's Medical Care Collections Fund Billing of VA-Provided Care
Report Number: 11-00333-254 Download
Issue Date: 8/30/2012
City/State: Palo Alto, CA
Jackson, MS
Albany, NY
Decatur, GA
St. Louis, MO
Martinsburg, WV
Dayton, OH
Tucson, AZ
VA Office: Veterans Health Administration (VHA)
Report Author: Office of Audits and Evaluations
Report Type: Audits, Reviews & Evaluations
Release Type: Unrestricted

We conducted this audit to determine the extent VHA’s Medical Care Collections Fund program identified third-party billing opportunities for VA-provided medical care. Our previous audit on Non-VA provided medical care determined VA missed opportunities to increase third-party revenue by $110.4M annually or $552M over 5 years. VHA advised it improved its collections by 43%, from 1.3B in FY 2007 to $1.8B in FY 2011. However, our review of VA-provided care identified further opportunities to improve. Specifically, VHA lacked an effective review policy on unbilled care, did not adequately monitor insurance ID procedures, and needed increased training for staff. We estimated VHA missed opportunities to increase third-party revenue by at least $152M annually. Without actions to improve billing processes, VHA could miss an estimated $760M over the next 5 years. The Under Secretary for Health agreed with our finding, recommendations, and monetary benefits.