Timely Establishment of Medical Care Recovery Rates Could Increase Recoveries

Gao ID: HRD-84-32 February 13, 1984

GAO summarized the results of its review of the Office of Management and Budget's (OMB) role in the establishment of the Veterans Administration's (VA) medical care recovery rates.

VA is authorized to recover the reasonable value of medical services provided to certain patients treated at VA facilities and OMB is responsible for setting the rates used by VA in billing liable third parties. In addition, OMB must approve rates for care provided by the Department of Defense (DOD) and the Department of Health and Human Services (HHS). The rates used by all three agencies should go into effect at the beginning of the fiscal year. Although OMB has made significant progress in reducing delays in establishing per diem rates, the rates still take effect after the beginning of the fiscal year to which they apply. GAO found that delays have reduced medical care recoveries by millions of dollars. Although an OMB directive requires the submission of proposed rates in March, only VA has been submitting its proposed rates in accordance with the directive. In addition, GAO found that VA could increase medical care recoveries while providing a more equitable basis for billings by establishing individual facility rather than national rates and by setting separate rates for acute and nonacute care.

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: David P. Baine Team: General Accounting Office: Human Resources Division Phone: (202) 512-7101


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