United States Government Publishing Office publisher pbl distributor dst United States Government Accountability Office author aut Government Organization text government publication eng GAOREPORTS Legislative Agency Publications gao legislative 2010-08-12 U.S. Government Printing Office 2004-02-20 monographic deposited born digital 25 p. GA 1.13:GAO-04-322R https://www.govinfo.gov/app/details/GAOREPORTS-GAO-04-322R P0b002ee180381d6a f:d04322r DGPO 2010-08-12 2011-03-24 GAOREPORTS-GAO-04-322R machine generated eng fdlp REPORT GAOREPORTS-GAO-04-322R GAO-04-322R Financial management Financial statement audits Health care services Internal controls Strategic planning Health insurance Health care costs Collection procedures Performance measures DOD Third Party Collections Program Correspondence A09346 Like the private health care industry, the cost of providing health care services to the Department of Defense's (DOD) active duty personnel, their dependents, retirees, and survivors and their dependents has increased dramatically over the past decade. In fiscal year 2003, DOD reported that more than 8.7 million Military Health System beneficiaries were eligible to receive health care at a cost of about $27.2 billion per year--up from a reported 8.2 million eligible beneficiaries at a cost of $15.6 billion in fiscal year 1997. To the extent that DOD beneficiaries have private health insurance coverage, DOD is authorized to bill insurance companies under the Third Party Collections Program. As such, DOD has the opportunity to defray the rising cost of providing health care to an increasing number of eligible beneficiaries. In October 2002, we reported that the three military treatment facilities (MTFs) we visited did not always bill and collect from private insurers for care that was reimbursable to the government. At all three facilities, we identified control weaknesses that resulted in instances where these MTFs had not identified all patients with third-party insurance and sometimes did not bill those insurers even when they were aware such coverage existed. Consequently, opportunities to collect millions of dollars of reimbursements from insurers for medical services provided were forgone. Concerned that there were additional MTFs that also did not effectively bill and collect for reimbursable services, Congress requested that we expand our audit to provide some perspective on the amount of such services that were not billed and collected across all of DOD's MTFs. However, after determining that it was not feasible to develop a DOD-wide estimate of missed collection opportunities, as agreed and explained in more detail later, we are providing a perspective on the amount of services not billed and collected across all of DOD's MTFs based on work performed by DOD's service auditors at 35 of the largest MTFs reporting collections. This report also provides information on (1) specific control weaknesses and other issues that impair DOD's ability to increase collections, (2) the department's ongoing efforts to improve the third-party billings and collection function, and (3) our assessment of DOD's use of performance metrics to manage third-party collections at its MTFs. https://www.govinfo.gov/content/pkg/GAOREPORTS-GAO-04-322R/html/GAOREPORTS-GAO-04-322R.htm https://www.govinfo.gov/content/pkg/GAOREPORTS-GAO-04-322R/pdf/GAOREPORTS-GAO-04-322R.pdf GAO-04-322R https://www.govinfo.gov/app/details/GAOREPORTS-GAO-04-322R Correspondence GAO-04-322R; Military Treatment Facilities: Improvements Needed to Increase DOD Third-Party Collections; Financial management Financial statement audits Health care services Internal controls Strategic planning Health insurance Health care costs Collection procedures Performance measures DOD Third Party Collections Program Volume 100 Page 82 100 Stat. 82 Volume 110 Page 2024 110 Stat. 2024 Volume 114 Page 1654 114 Stat. 1654 Public Law 104-191 Public Law 106-398