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Home News Audit of Non-VA Inpatient Fee Care Program (8/18/2010)

Audit of Non-VA Inpatient Fee Care Program (8/18/2010)

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This audit assessed the accuracy of payments made for pre-authorized inpatient fee service and assess the efficiency of processing fee service claims. We found that VA Medical Centers (VAMCs) improperly paid 28 percent of inpatient fee claims during the 6 month period of January 1, 2009–June 30, 2009. The improper payments occurred because VHA’s policies for determining eligibility for inpatient fee care did not provide adequate guidance on how to determine eligibility for inpatient fee care or were not understood by fee staff. Other payment errors occurred because fee staff did not have accurate and timely information to determine correct payments, and the VAMC did not have sufficient controls to detect clerical errors. We estimate that VHA made net overpayments of $120 million on inpatient care for veterans in FY 2009 or $600 million in improper payments over the next 5 years. For each of our sample items, we found sufficient VAMC medical documentation to convince us that the veteran received the services paid for by VHA. Efforts are needed to reduce the cost associated with processing claims and the time it takes to process claims by improving processing efficiencies. Inefficiencies occurred because of the Fee Program’s decentralized structure and its labor-intensive payment system. VHA and OIG agree there will be general cost savings and efficiencies realized with consolidating the Fee Program’s claim processing system and achieving economies of scale. The specific cost savings depends on the actual consolidation strategy VA selects and on how well VA implements the chosen strategy. We have conservatively used the lowest projection of program inefficiencies to estimate cost savings of $26.8 million in FY 2009 and to estimate cost savings of $134 million over the next 5 years.nrIn the audit report, we made six recommendations to establish guidance on how to determine eligibility, reduce improper payments, and improve claims processing efficiencies for inpatient fee care. nrnr

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The issuance or replacement of military service medals, awards and decorations must be requested in writing.

Requests should be submitted in writing to the appropriate military service branch division of the NPRC. Standard form (SF 180), available through the VA, is recommended to submit your request. Generally, there is no charge for medal or award replacements. For more information, or for the mailing address of the military branch office to submit your request to, call 1-86-NARA-NARA (1-866-272-6272) or visit the NPRC website at