Foreign Medical Program for veterans overseas is having growing pains

WASHINGTON — As a 15-year resident of Panama, retired Army Staff Sgt. Esteban Blis said he often pays out of pocket for medical care, because many foreign doctors refuse to bill the U.S. government directly for treatment connected to his military injuries.

Blis, a medically retired, combat-wounded veteran, launched and runs “You Served, We Care Foundation,” a nonprofit that offers advocacy services to the tens of thousands of U.S. veterans living in Latin America.

But Blis, 57, admits that he has faced increasing challenges and delays in obtaining medical care and reimbursements through the Foreign Medical Program, which is run by the Department of Veterans Affairs.

“More doctors, pharmacists and hospitals want their payment up front, because they don’t want to have to file the paperwork and then wait months to get paid through FMP,” Blis said.

Higher demand by veterans overseas for VA health care coverage, combined with greater scrutiny of the Foreign Medical Program, is leading to new pressures on the 30-year-old program.

The Foreign Medical Program paid out $128 million in claims reimbursements to eligible veterans in fiscal year 2024, compared to $35 million in 2018, according to a report from the Government Accountability Office.

With more than 80,000 veterans living abroad, the Foreign Medical Program serves as a critical resource for veterans with service-connected illnesses and injuries, the GAO said.

“I have had experience using the Foreign Medical Program, and almost none of it is good,” said Bill Morgan, a disabled Air Force veteran living in Italy.

“There is no way to check the status of a claim or access any FMP records online. I have on several occasions tried calling, and was placed on hold for over an hour,” Morgan said.

Rep. Pat Harrigan, R-N.C., recently introduced the Foreign Medical Program Integrity and Improvement Act, which aims to prevent fraud in the growing program, improve payment protections and update technology to speed up reimbursements.

Accepted claims to the Foreign Medical Program jumped from roughly 64,000 in 2018 to more than 160,000 by 2024, exposing gaps in tracking and capacity, Harrigan said.

“The Foreign Medical Program exists for one reason — to ensure that veterans living overseas can access the care they’ve earned,” Harrigan said. “Instead, we’ve seen claims explode, fraud risk increase, and a system that hasn’t kept pace with reality.”

In Panama, the suspension in 2024 of medical providers from the program over fraud allegations has led to greater challenges for veterans using the program, said Blis and other veterans in Panama.

Esteban Blis, an Army veteran who runs a foundation supporting U.S. military veterans living in Latin America, attended a ceremony in July with Army Major Gen. Hope C. Rampy at Fort Knox, Ky. Rampy presented Blis with a coin in recognition of his advocacy work for veterans. (U.S. Army Human Resources Command)

The VA named and suspended 50 providers from the Foreign Medical Program amid an investigation by the Justice Department.

Some veterans who live in Panama complain about losing a provider and difficulties finding a medical practice willing to use the Foreign Medical Program.

“When a provider who understands VA [Foreign Medical Program] billing disappears from the system — whether because of a fraud suspension, administrative burden or simply fatigue with delayed payment — a service-disabled veteran does not just pick another doctor,” said Vaughn Barker, a service-connected disabled veteran living in Panama.

“Too often, veterans face a hard choice: pay out of pocket, postpone care or let a service-connected condition get worse,” Barker said.

Veterans can file their own reimbursement claims if their provider will not submit them.

Morgan, who retired to Italy with his wife, said he was able to see a doctor of his choosing in Milan for treatment of tinnitus. But he filed the paperwork for reimbursement for a medical device.

“The FMP did cover 100% of the treatment for that service-related condition. But it took nearly two years of constant pushing from my end to accomplish that particular feat,” Morgan said. “They tell me they are working to make the system better, but I am not holding my breath.”

Morgan said he continues having problems with reimbursement for a 2025 doctor visit and examination, despite contacting the program and resubmitting the claims.

The VA is taking steps to improve claims processing through the Foreign Medical Program, strengthen security, and make the system more responsive to veterans.

In 2025, the VA transitioned overseas veterans with U.S. bank accounts away from paper checks to direct deposit. It is on track this year to implement international direct deposit in the top 30 countries, including Panama, with the highest billing volumes.

The VA also has replaced outdated software for claims processing and introduced a modernized platform to improve tracking, and flag erroneous or duplicate billings.

Yet the program’s success depends on a provider’s ability to navigate billing and documentation requirements, Barker said.

Mandates for itemized billing, clinical summaries, and translation can be burdensome for some foreign clinics and solo practices, he said.

Billing offices struggle with coding standards, and physicians often fail to adequately link treatments to a veteran’s specific service-connected condition, Barker said.

“Many well-intentioned foreign providers ultimately exit the program due to financial and operational strain,” he said.

The 2025 GAO report had similar conclusions. The performance audit was conducted between November 2023 and February 2025.

The report found that some foreign medical providers do not want to wait months to be paid, according to the GAO report.

“With significant growth in the program in recent years, ensuring the program provides valid and timely payments to qualifying veterans or their providers is important,” according to the report.