Sen. Chuck Grassley, R-Iowa, is pressing the Department of Veterans Affairs on why the agency lost out on as much as $805 million that could have been used to serve veterans.
The department’s “bureaucratic right hand didn’t know what the left hand was doing, and our veterans have paid the price,” Grassley asserted in an April 17 letter to VA Secretary Denis McDonough.
“The VA hasn’t kept its promise to make swift improvements that would bring millions of dollars back to the agency and allow it to maximize funding for veterans’ health care,” Grassley told The Daily Signal on Thursday. “I’ll keep pushing the VA to get into gear and ensure no further reimbursements are left unclaimed.”
The Department of Veterans Affairs covers the initial cost of receiving local community health care when a veteran doesn’t have access to a VA facility.
If such a veteran has private health insurance, the VA is supposed to bill the insurer for reimbursement. The recovered money is supposed to support the Veterans Health Administration, the subagency of the VA that oversees more than 1,300 health care facilities.
However, the VA Office of Inspector General issued a May 2022 report that concluded the department failed to seek reimbursement from private insurers in 54% of billable instances between 2017 and 2020. The failure caused the VA to miss out on more than $217 million in reimbursements over those three years alone.
If the VA fails to properly bill private insurers, the report said, “it will miss opportunities to increase its funding for all veterans.”
The inspector general’s report recommended corrective actions to address billing errors by the Department of Veterans Affairs. At the time, the VA agreed to implement the recommendations by March 2023.
But more than a year later, the inspector general’s recommendations haven’t been addressed, and the VA continues to miss out on millions in reimbursements that could be used to serve veterans, Grassley argued.
In his letter last month to McDonough, Grassley asked how the VA would implement the inspector general’s recommendations. He also requested a detailed analysis of how much money the VA has failed to recover from insurers.
The inspector general’s report found that the revenue operations section of the VA’s Office of Community Care knew about problems that prevented it from collecting reimbursements. “Revenue Operations has not taken corrective action adequate to resolve these workload concerns or staffing challenges,” it said.
“This is unacceptable,” Grassley wrote to McDonough.
In 2022, the inspector general also called for the VA to “maximize” opportunities to bill private insurers; to “strengthen information system controls” for accuracy in claims; and to assess whether resources are adequate.
The VA agreed with those suggestions and the March 2023 deadline to take actions that has come and gone, Grassley noted.
VA press secretary Terrence Hayes said the agency’s job is to “deliver world-class health care and benefits to our nation’s veterans and we always strive to do so while being good stewards of tax dollars.”
“We appreciate the inspector general’s review and recommendations to improve processes, which help make VA better,” Hayes told The Daily Signal in a written statement. “While this IG report specifically focused on events from April 2017 to October 2020, we continue to provide training of staff and refine all processes to ensure we maximize opportunities for reimbursements from private insurance.”
Between 1.3 million and 2.4 million billable claims—or 54% —paid between April 20, 2017, and Oct. 31, 2020, weren’t submitted to private health insurers for reimbursement before filing deadlines expired, the inspector general’s audit found. As a result, the VA lost more than $217 million.
The total could balloon to $805 million later in 2022 without corrective action, the audit warned.
“According to the OIG [Office of Inspector General], the recommended fixes still haven’t been implemented by the VA, running the risk that this elevated amount may have been realized,” Grassley wrote to McDonough.
