The Office of Community Care, part of the Veterans Health Administration (VHA), manages programs that allow veterans to receive medical care from non VA providers. This audit evaluated whether VHA paid for non-VA acupuncture and chiropractic care that was not authorized or supported by medical documentation. The audit team also assessed whether VHA followed guidance for reauthorizing the care.
The team found that VHA paid for care that was not authorized, including for more visits than allowed and for treatments not allowed by standards for care. For example, some acupuncturists billed for more than two rounds of needle insertions when only two rounds were allowed. VA’s automated system for processing claims did not prohibit unauthorized visits or unallowable treatments in claims submitted by non-VA providers.
Further, VHA paid acupuncture and chiropractic claims that lacked appropriate supporting medical documentation. The unsupported payments persisted because VHA staff did not retroactively review documentation samples for deficiencies. The audit team estimated that improper payments for acupuncture and chiropractic care amounted to about $136.7 million during fiscal years 2018 and 2019.
The audit team also found that VHA did not always follow guidance when reauthorizing acupuncture and chiropractic care. Not documenting assessments of prior treatments before authorizing additional care may interfere with veterans’ treatment.
The OIG made six recommendations to the under secretary for health related to adding automated payment system controls, auditing the payment process, retrospectively auditing non-VA medical documentation, making continuing education material related to medical documentation available to non-VA providers, following the Office of Community Care’s Field Guidebook, and documenting clinical justification for non-VA care.