OIG Report Reveals VHA Improperly Billed For Service Conditions

Wednesday, August 23, 2017
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

On August 9, 2017, the U.S. Department of Veterans Affairs (VA) Office of Inspector General (OIG) reported that the Veterans Health Administration (VHA) improperly issued close to 1.7 million bills to veterans and third-party payers. Of the estimated 15.4 million bills issued by the VHA’s Consolidated Patient Account Centers in  2015, an estimated 1.66 million were improper bills for treatment of service-connected (SC) conditions, the OIG found.


Improper Billing.

The VHA is not allowed to bill for the treatment of SC conditions or for any treatment given to veterans who have an SC condition. A service connected condition is an injury or illness that was incurred or aggravated during active military service.

In total, the estimated improper bills involved more than $310 million in claims for payment. The VHA ultimately pocketed about $13.9 million from veterans and at least $13 million from other payers, the watchdog said. The vast majority of the estimated improper bills sent to veterans by the VHA (about 600,000) stem from improper claims for pharmacy copayments on medicine for SC conditions. In addition, about 740,000 of the improper bills sent to third-party payers are for medical treatments, the OIG said.

Click here to read the VHA’s OIG report in full.


What Gives with Recent Spate of "Fraud" by Government Itself?

Do you have any doubt that if this was a physician, medical group or private facility making this kind of mistake, they would be shut down for the "assumption" of fraud?  This is what the Zone Program Integrity Contractors (ZPICs) and Medicare Administrative Contractors (MACs) would immediately suspend payments to the provider.  This follows closely behind the allegations made against an official of the Florida Agency for Health Care Administration (AHCA) that she assisted a home health agency to defraud Florida Medicaid for about a billion dollars by taking bribes.

The standards used by CMS contractors for determining when the presumption of fraud is proven needs to be changed, if government agencies cannot even get it right.

For more information on how The Health Law Firm represents veterans, click here.


Contact a Health Law Attorney Experienced in the Representation of Veterans Administration (VA) Physician Representation and Military Physician Representation.

The attorneys of The Health Law Firm have represented physicians, psychologists, nurse practitioners, nurse and other health professionals working in Veterans Administration medical centers and clinics throughout the United States.  Representation has included personnel and employment issues, disciplinary action, investigations, peer review investigations, clinical privileges actions, fair hearings, National Practitioner Data Bank (NPDB) actions and appeals.

To contact The Health Law Firm, please call (407) 331-6620 or (850) 439-1001 and visit our website at www.TheHealthLawFirm.com.


Sources:


Wilson, Daniel. “Watchdog Says VHA Improperly Bills For Service Conditions.” Law360. (August 9, 2017). Web.

Wheeler, Lydia. “Watchdog: Federal agencies made $132B in improper payments.” The Hill. (August 11, 2017). Web.


About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law. He is the President and Managing Partner of The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone: (407) 331-6620.


KeyWords: Legal representation for VA physicians, legal representation for government physicians, Veterans Administration (VA) attorney, VA hospital attorney, Veterans Administration physician representation, military physician representation, legal representation for military health care professionals, legal representation for VA nurses, VA physician defense attorney, legal representation for government personnel and employment issues, legal representation for disciplinary actions, legal representation for peer review investigations, health care defense attorney, legal representation for health care professionals, Florida health law defense attorney, The Health Law Firm, reviews of The Health Law Firm, The Health Law Firm attorney reviews

“The Health Law Firm” is a registered fictitious business name of and a registered service mark of The Health Law Firm, P.A., a Florida professional service corporation, since 1999.
Copyright © 2017 The Health Law Firm. All rights reserved.

8/23/2017

Like this blog? Add your public comments:

Items in bold indicate required information.