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Lawmakers urge VA to fix rejected emergency care claims that wrongly cost vets $53 million

ANDREA VILLARI/STARS AND STRIPES

By NIKKI WENTLING | STARS AND STRIPES Published: August 12, 2019

WASHINGTON — Thirty-five members of Congress on Monday urged the Department of Veterans Affairs secretary to redo medical claims for thousands of veterans who were stuck with bills that the VA should’ve paid.

The group of lawmakers, which included Republicans and Democrats, wrote to VA Secretary Robert Wilkie following the release of what they described as a “damning report” last week from the VA Office of Inspector General. The IG discovered the VA wrongfully rejected thousands of emergency-care claims during a five-month period in 2017, affecting an estimated 17,400 veterans who were stuck with varying medical bills that totaled $53.3 million.

“Facing a medical emergency can be stressful for any patient; however, the financial toll on veterans when VA erroneously denies or rejects payment can also be devastating,” the lawmakers wrote. “Nonpayment can bankrupt and destroy veterans’ credit histories. These administrative errors can remain with veterans for the rest of their lives.”

They asked Wilkie for a thorough explanation of how the VA plans to follow through with 11 recommendations made in the IG report. They also asked Wilkie to communicate with veterans whose claims were inappropriately rejected and re-adjudicate the claims the agency should’ve paid.

The VA issued a statement Monday that the agency was reviewing the sample of claims highlighted in the IG report and planned to notify the affected veterans about their options.

The lawmakers criticized the VA for its failure to fix the problems earlier. In 2014, the Government Accountability Office detailed similar issues outlined in the new IG report.

“This is not new territory for the VA,” the lawmakers’ letter reads. “More than five years ago, GAO found that VA’s weak oversight of emergency care claims adjudication could lead to inappropriate denial of claims. It is disappointing the department has not done enough to improve.”

The VA said Monday that it had identified a majority of the IG's concerns and more than a year ago started "numerous efforts" to fix them. Those actions included increasing employee training and changing claims-processing guidelines to provide better quality and accuracy.

The IG found VA supervisors provided incentives for employees to quickly decide claims, including overtime pay and telework privileges. The culture, which “created systemic pressure to favor speed over accuracy,” led to staff incorrectly rejecting 31% of veterans’ emergency care claims from April 1, 2017 to Sept. 30, 2017.

If the VA fails to correct the problems, the IG report projected an estimated $533 million in medical costs could inappropriately fall to veterans during the next five years.

In addition to the bad decisions by VA staff, veterans whose claims were rejected didn’t receive complete and accurate information about their denial, limiting their ability to appeal, the IG wrote.

wentling.nikki@stripes.com
Twitter: @nikkiwentling

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Read the letter

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