Military Health CareRecovery 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.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: Team: Phone: