VA shouldn't have rejected $716M in health claims for vets, inspector general says

A new report from the U.S. Department of Veterans Affairs' Office of Inspector General estimates that the VA inappropriately denied or rejected claims affecting tens of thousands of veterans.

The 80-page report, released Aug. 6, outlines findings from an audit of non-VA emergency care claims, covering the six months between April 1, 2017, and Sept. 30, 2017.

In the report, the inspector general estimated that the VA inappropriately denied or rejected 31 percent of claims for reimbursement of non-VA emergency care costs during the audit period.

"The billed amount of inappropriately processed claims from April 1 through Sept. 30, 2017, that were denied or rejected was large in the aggregate — an estimated $716 million — and presented potential undue financial risk to an estimated 60,800 veterans," the report states.

Veterans who receive emergency care at non-VA facilities may file claims for reimbursement of care costs, and a rejection or denial of claims can leave them on the hook for some or all costs, according to the inspector general. Veterans may appeal claims denials.

However, the inspector general found that processors were not effectively monitoring appeals and estimated that without corrective actions, "these errors could result in $533 million in improper underpayments to claimants over five years."

The inspector attributed errors to various factors, such as insufficient quality controls as well as a culture at the VA that created "pressure for timely production."

Read the full report here.


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