Military Health Care

Recovery of Medical Costs From Liable Third Parties Can Be Improved Gao ID: NSIAD-90-49 April 19, 1990

Pursuant to a congressional request, GAO evaluated the effectiveness of the Department of Defense's (DOD) medical cost recovery in third-party liability cases.

GAO found that: (1) 8 of the 13 Army and Navy medical facilities it studied did not identify and report more than half of the potential third-party liability cases because they lacked standard procedures; (2) some Air Force and Navy installations did not identify and report cases involving treatments at civilian facilities; (3) due to Civilian Health and Medical Program of the Uniformed Services (CHAMPUS) guidelines, military installations did not report significant CHAMPUS medical costs to service legal offices; (4) CHAMPUS allowed its contractors to exclude some potential third-party liability cases; (5) service legal offices complied with regulations in conducting third-party liability recoveries, but the services' regulations were inconsistent; (6) some states passed no-fault insurance laws that hampered DOD liability to conduct recoveries; (7) service legal offices and military medical facilities had little incentive to recover costs; (8) 6 of the 13 military facilities did not have adequate or complete records to indicate which cases they had reported to service legal offices; (9) service legal offices did not adequately record the reasons for discarded claims; and (10) the lack of internal controls prevented accurate overall evaluations of recovery effectiveness.


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