Stronger VA and DOD Actions Needed To Recover Costs of Medical Services to Persons With Work-Related Injuries or Illnesses

In response to a congressional request, GAO reviewed Veterans Administration (VA) and Department of Defense (DOD) efforts to recover the costs of medical services from workers compensation insurance in cases involving work-related injury or illness. Sample claims were traced to the facilities that provided the medical care to determine whether VA and DOD officials were aware of the claims and had sought reimbursement from workers compensation carriers or employers for the treatment provided.

GAO found that VA and DOD failed to recover the costs of most health care services provided to beneficiaries covered by workers compensation because: (1) liens were not filed in approximately two-thirds of the cases reviewed in which the facility should have been aware that a work-related injury had occurred; and (2) VA and DOD attorneys did not actively pursue recoveries after a lien had been filed. The agencies recovered less than 12 percent of the cost of care provided in the cases for which such costs could be estimated. In most of the cases reviewed, the facility was put on notice of the claim through a request for the individual's medical records by an attorney, an insurance company, a Workers' Compensation Appeals Board, or the individual. However, medical facilities frequently failed to notify the recovery unit of the potential claim. As a result, VA and DOD attempted to recover the costs of care provided in only slightly more than one-third of the nearly 150 cases in which the facility should have been aware that the injury was work related.

Recommendations

Our recommendations from this work are listed below with a Contact for more information. Status will change from "In process" to "Open," "Closed - implemented," or "Closed - not implemented" based on our follow up work.

Director: Robert A. Peterson Team: General Accounting Office: Human Resources Division Phone: (202) 275-6207