Improvements Needed to Reduce Duplicate Payments by VHA and Medicare and Ensure VHA Has Authorized Community Medical Services

The VA Office of Inspector General (OIG) conducted this review to determine whether community care providers are receiving potential duplicate payments for the same healthcare services from VHA and Medicare and to determine whether VHA paid any of these claims without authorization. In this review, the VA OIG collaborated with the Department of Health and Human Services (HHS) OIG—which is currently conducting its own review of duplicate Medicare payments—to better understand duplicate payments and confirm that they had occurred. The VA OIG determined that VHA and Medicare made potential duplicate claim payments for community care services that were authorized by VHA. Because VHA and the Centers for Medicare and Medicaid Services do not share healthcare claims data, neither agency is aware of claims paid by the other agency. Without an interagency system, the risk of duplicate payments is increased, and it may be difficult to determine which agency should pay the claim and which agency can collect overpayments.The OIG made three recommendations to the under secretary for health, including working with the Centers for Medicare and Medicaid Services to establish a data-sharing agreement with VA to limit duplicate claim payments. The OIG also recommended identifying overpayments made for care provided to dual-eligible veterans that were not authorized by VHA and ensure documentation of care is completed or that VA seeks reimbursement for any unauthorized care. Finally, the OIG recommended making sure all nonemergent community care is preauthorized and that documentation for all authorizations is complete and properly stored before services are provided.