The Department of Veterans Affairs spent an estimated $13 billion to care for veterans whose health coverage was already paid for by Medicare — a case of the taxpayer paying twice, according to research published Tuesday.
"They pay once to Medicare Advantage plan to deliver all Medicare-covered service and they pay again to the VA to deliver comprehensive care to the same veterans," said Amal Trivedi, a doctor with the VA and on the faculty with Brown University in Providence.
But Medicare says the $13 billion projection identified in the study, published in the Journal of the American Medical Association, is far too high.
Spokesman Brian Cook said Medicare attempts to reduce managed-care payments to private insurance companies if veterans enrolled in those programs use them less frequently, for example, because they seek treatment from the VA.
Federal law prohibits the VA from recouping expenditures from Medicare-funded health programs. The VA issued a statement Tuesday saying that even if the law were changed, allowing reimbursement would only add administrative complexity that would impede care.
"As an example, VA would have to comply with Medicare rules and policies for Veterans, which would leave VA administering two systems of care: Medicare's and VA's," the statement says.
But without that reimbursement "the government has made two payments for the same services," the medical study concludes.
Researchers examined records for 1.3 million veterans who were enrolled simultaneously with the VA program and the Medicare Advantage managed-care program between 2004 and 2009.
They found that the number of veterans enrolled in both programs increased during that time frame from 486,000 to 925,000.
In addition, the amount of VA medical care provided to those patients grew from $1.3 billion to $3.2 billion.
Kenneth Kizer, a co-author of the study and director of the Institute for Population Health Improvement at University of California-Davis Health System, said he first became aware of the issue when he was VA undersecretary for health in the 1990s. But Kizer said the study shows the problem has worsened.
Researchers found that veterans remained enrolled in both Medicare Advantage and with the VA for about three years on average. Veterans who are entitled to VA care are also entitled to Medicare after age 65.
Contributing: Kelly Kennedy