United States Government Publishing Office publisher pbl distributor dst United States Government Accountability Office Health, Education, and Human Services Division author aut Government Organization text government publication eng GAOREPORTS Legislative Agency Publications gao legislative 2010-08-12 U.S. Government Printing Office 1997-10-17 monographic deposited born digital 47 p. GA 1.13:HEHS-98-4 https://www.govinfo.gov/app/details/GAOREPORTS-HEHS-98-4 P0b002ee180385521 f:he98004 DGPO 2010-08-12 2011-03-24 GAOREPORTS-HEHS-98-4 machine generated eng fdlp REPORT GAOREPORTS-HEHS-98-4 HEHS-98-4 Veterans benefits Cost sharing (finance) Health care cost control Health care programs Patient care services Managed health care Claims processing Government collections Veterans Insurance companies Medicare Program Medigap VA Medical Care Cost Recovery Program Federal Employees Health Benefits Program Letter Report HEHS Pursuant to a congressional request, GAO reviewed the Department of Veterans Affairs' (VA) efforts to recover from private health insurers the costs it incurs to provide health care services to veterans with no service-connected disabilities, focusing on: (1) those factors that limit VA's ability to recover more of its billed charges; (2) VA's ability to achieve its revenue targets by identifying factors that could decrease future recoveries and assessing the potential for VA initiatives to increase medical care cost recoveries; and (3) the way VA applies insurance payments to veterans' copayment liability for veterans in the discretionary care category.<p/>GAO noted that: (1) attaining VA's goal to increase recoveries from private health insurance from $495 million in fiscal year 1996 to $826 million in FY 2002 will be difficult; (2) for GAO's sample, most of the charges VA was unable to recover for bills submitted to private health insurers were appropriately denied or reduced by the insurers; (3) recoveries from private health insurance dropped for the first time in FY 1996 and have continued to drop during FY 1997; (4) several factors help explain the decreases and suggest that further decreases are likely, including: (a) the declining and aging of the veteran population, meaning that VA must serve a greater proportion of veterans to maintain its current workload and that more VA users will have secondary, rather than primary, health insurance coverage in the future; (b) veterans' increased enrollment in HMOs and other managed care plans, and decreased enrollment in fee-for-service plans, which reduces the number of veterans covered by insurance from which VA can reasonably expect to recover; (c) changes in how insurers process VA claims that could result in refunds to insurers of overpayments that VA estimates exceeded $600 million and could reduce future recoveries by over 20 percent; and (d) shifts in care from inpatient to outpatient settings that, while both needed and appropriate, could reduce private insurance recoveries and increase recovery costs; (5) VA has a number of initiatives to address some of these problems and to help it attain its recovery goals; (6) these include legislation to: (a) allow VA to retain recoveries from private health insurance and veteran copayments as an incentive to improve the identification and pursuit of recoveries; and (b) extend lapsing authority to recover the costs of services provided to veterans for conditions unrelated to their service-connected disabilities; (7) VA's initiatives would address some, but not all, of the factors affecting future recoveries; (8) however, considerable uncertainty remains about VA's ability to achieve its revenue goal; (9) VA was unable to provide an analytical basis for its recovery projections; (10) projected increases in VA's future recoveries were not supported by or attributed to improvements related to its planned initiatives; and (11) VA's General Counsel interprets the relationship between recoveries from private health insurance and veterans' copayments as requiring that a portion of insurance recoveries to be used to reduce veterans' copayment obligations. https://www.govinfo.gov/content/pkg/GAOREPORTS-HEHS-98-4/html/GAOREPORTS-HEHS-98-4.htm https://www.govinfo.gov/content/pkg/GAOREPORTS-HEHS-98-4/pdf/GAOREPORTS-HEHS-98-4.pdf GAO/HEHS-98-4 https://www.govinfo.gov/app/details/GAOREPORTS-HEHS-98-4 Letter Report GAO/HEHS-98-4; VA Medical Care: Increasing Recoveries From Private Health Insurers Will Prove Difficult; Veterans benefits Cost sharing (finance) Health care cost control Health care programs Patient care services Managed health care Claims processing Government collections Veterans Insurance companies Medicare Program Medigap VA Medical Care Cost Recovery Program Federal Employees Health Benefits Program Public Law 99-272 Public Law 101-508 Public Law 104-191 Public Law 104-262 Public Law 105-33