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Audit of VHA’s Alleged Improper Payments to Providers After Veterans’ Reported Deaths

Report Information

Issue Date
Report Number
16-00252-137
VA Office
Veterans Health Administration (VHA)
Report Author
Office of Audits and Evaluations
Report Type
Audit
Recommendations
2
Questioned Costs
$0
Better Use of Funds
$0
Congressionally Mandated
No

Summary

Summary
In September 2015, OIG received an allegation that the Veterans Health Administration (VHA) paid non-VA care (NVC) providers for services that could not have been rendered to about 4,200 deceased veterans listed in Social Security Administration’s Death Master File. To investigate the allegation, we reviewed payment records documenting outpatient and inpatient claims worth about $15.5 million to determine whether, and to what extent, improper payments were made from FYs 2011 – 2015. We substantiated the allegation and found VHA improperly paid for 12 of the 25 billed NVC outpatient services reviewed, totaling about $810 in improper payments. These improper payments occurred because NVC authorization clerks failed to update the end dates on veterans’ NVC authorizations to reflect their dates of death, as required by VHA policy. However, we did not substantiate that VHA made improper payments for inpatient services because the services had been rendered before the veterans’ dates of death. For the 60 billed NVC inpatient services reviewed, we determined the veterans’ dates of death in the Death Master File were incorrect and/or the payment records did not reflect the last dates the veterans received care. Although we did not find a systemic issue, we estimated VHA annually makes about $101,000 in improper payments to NVC providers for deceased veterans. VHA could improperly pay NVC providers about $505,000 for outpatient services over the next 5 years unless it ensures NVC authorizations for deceased veterans are updated in accordance with VHA policy. We recommended that the Under Secretary for Health recover the improper payments identified and ensure VA medical facilities update NVC authorizations for deceased veterans as required by VHA policy. The Under Secretary for Health concurred with our report and provided an acceptable action plan.

Open Recommendation Image, SquareOpenClosed and Implemented Recommendation Image, CheckmarkClosed-ImplementedNot Implemented Recommendation Image, X character'Closed-Not Implemented
No. 1
Closed and Implemented Recommendation Image, Checkmark
to Veterans Health Administration (VHA)
We recommended the Under Secretary for Health recover the reported improper payments for outpatient services that could not have been rendered to deceased veterans.
No. 2
Closed and Implemented Recommendation Image, Checkmark
to Veterans Health Administration (VHA)
We recommended the Under Secretary for Health ensure medical facilities adhere to VHA Procedure Guide 1601F.02 and update non-VA care authorization end dates for deceased veterans.
Total Monetary Impact of All Recommendations
Open: $ 0.00
Closed: $ 505,000.00