VA on the hook for up to $6.5B in ER claims

A federal appeals court has ordered the U.S. Department of Veterans Affairs to pay for emergency care provided to veterans at non-VA facilities, according to NBC News.

The Sept. 9 ruling came from the U.S. Court of Appeals for Veterans Claims. In its ruling, the court ordered the VA to "readjudicate … reimbursement [denied] claims" for veterans' emergency care at non-VA facilities, and invalidated a department regulation that prohibited the VA from making the payments, according to NBC's news division.  

"All of this is unacceptable," the court added.

The ruling — which applies to claims filed since 2016 and those that will be filed by 2025 — comes after a report released in August by the VA's Office of Inspector General estimated that the department inappropriately denied or rejected claims affecting tens of thousands of veterans.

The inspector general estimated that the VA inappropriately denied or rejected 31 percent of claims for reimbursement of non-VA emergency care costs in the six months between April 1, 2017, and Sept. 30, 2017.

Former Coast Guardsman Amanda Wolfe, one of the plaintiffs in the case, told NBC News she was surprised to learn from the report how many veterans were affected by the issue and is "overjoyed" by the appeals court decision.

The VA told the news division the department, "is aware of this decision and reviewing it."

Overall, plaintiffs' lawyers estimated that the ruling could result in $1.8 billion to $6.5 billion in payments for veterans.


More articles on healthcare finance: 

Public comment period to close Sept. 27 for federal price transparency rule
Florida alliance ramps up efforts to protect state funding to 28 hospitals
Healthcare advocates back bill to cut Medicare prior authorization red tape

Copyright © 2024 Becker's Healthcare. All Rights Reserved. Privacy Policy. Cookie Policy. Linking and Reprinting Policy.


Featured Whitepapers

Featured Webinars