VA Health Care

Copayment Exemption Procedures Should Be Improved Gao ID: HRD-92-77 June 24, 1992

The Department of Veterans Affairs (VA) is supposed to collect a fee, or a copayment, whenever it provides health care to veterans with incomes above a certain level. Vietnam veterans, however, are exempt from this requirement when being treated for medical conditions possibly related to Agent Orange exposure. The six medical centers GAO visited are not adequately evaluating the copayment status of Vietnam veterans claiming exposure to Agent Orange. This situation may be resulting in lost copayment revenues and unequal treatment of Vietnam veterans. Five of the centers routinely exempt all veterans who claim exposure without determining the validity of such claims. The other center routinely requires all veterans who claim exposure to comply with the copayment requirements, potentially depriving them of exemptions to which they are entitled. GAO estimates that the 159 centers could have collected as much as $2 million more in copayments in 1989 had physicians determined that treated conditions were unrelated to Agent Orange exposure.

GAO found that: (1) the VA guidance does not adequately inform medical centers about policies for evaluating the exemption status of Vietnam veterans claiming Agent Orange exposure; (2) some medical centers routinely exempt veterans without requiring examinations, and some medical centers do not involve physicians in determining whether medical conditions resulted from Agent Orange exposure; (3) the VA software program for medical care application prevented centers from properly determining Agent Orange-related copayment waivers; (4) many veterans who received Agent Orange exemption status for non-related conditions had incomes that would have required them to make copayments for their medical care; and (5) VA could have potentially collected $1.9 million in 1989 from veterans improperly exempted for Agent Orange exposure.

Recommendations

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