News: Medicare paid $128 million in duplicate payments to providers for VA care, OIG says

CDI Strategies - Volume 17, Issue 18

Over five years, Medicare paid providers about $128 million already paid by the Veterans Administration (VA), the Health and Human Services (HHS) Office of Inspector General (OIG) reported from their audit. The OIG said that CMS has not implemented controls that would address duplicate payments for services that individuals with Medicare and the Veterans Health Administration (VHA) are provided, HealthLeaders reported.

The auditors compared claims data from the VA and Medicare, covering 36.3 million claims for Medicare beneficiaries who also received VHA benefits from VA community providers between 2017 and 2021.

“Because CMS did not develop an interagency process, CMS did not establish an internal process (such as claims processing system edits) to address duplicate payments for medical services authorized and paid for by VHA,” the OIG said in their report. “Furthermore, CMS guidance to providers on VA’s responsibility to pay for medical services did not clarify that a provider should not bill Medicare for a medical service that was authorized by VHA.”

In their report, the OIG recommended that CMS create a data-sharing agreement with VHA and build an interagency process that would move VHA enrollment, claims, and payment data into the CMS Integrated Data Repository, which would better help them identify potential fraud, waste, and abuse. They also suggested CMS establish an internal process that would address duplicate payments of this nature and create guidance for providers to make sure they do not bill Medicare if the medical service is authorized by VHA. CMS agreed and stated it would take up these recommendations.

Editor’s note: To read HealthLeaders’ coverage of this story, click here. To read the OIG report, click here.

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