Duplicate Payments for Medical Services by VA and Medicare Programs

A review was performed to determine the number of duplicate payments made by the Veterans Administration (VA) and the Medicare programs for certain services provided to veterans eligible for both programs. The review, which was performed in Florida and California, dealt with three VA medical service categories: unrestricted outpatient medical care, contract hospitalization with prior VA authorization, and kidney dialysis treatment. The review also briefly surveyed duplicate payments by VA and Medicaid programs.

A sample of about 800 dual-eligible veterans and about 4,600 claims revealed: (1) duplicate Medicare payments involving 153 veterans and 433 claims, amounting to more than $72,000, before voluntary refunds by providers totaling about $31,000 were deducted; (2) misapplied deductibles involving 77 veterans amounting to more than $3,100; and (3) duplicate Medicaid claims involving 11 veterans and 27 claims amounting to about $1,700. It was estimated that duplicate payments, after deducting voluntary refunds and misapplied deductibles, exceeded $242,000 in Florida and $236,000 in California in 1976 for the three VA categories reviewed. While the statistical sample from Florida and California could not be projected nationally, it was considered likely that the practices found during the review were occurring nationally since both programs operate under national guidelines.

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.

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