- The American Federation of Government Employees (AFGE) has sent a letter to VA leadership proposing an investigation into $90 million of improper payments made to the third-party contractors of the Veteran’s Choice program.
The inquiry from AFGE describes questionable billing practices, including double billing and the use of improper payment rates, by two official VA third-party administrators (TPAs), Health Net Federal Services and TriWest Healthcare Alliance.
The letter expressed additional concerns because VA provided a contract extension to Health Net and TriWest through September 2018 to manage Veteran’s Choice Program payments.
"The questionable practices used by third-party administrators of the VA Choice Program, TriWest and HealthNet, including double billing and improper payment rates, have directly harmed veterans and undermined the capacity of the VA health care system to provide them with the exemplary care that they have earned with their service," said AFGE National President J. David Cox.
AFGE specifically wants House and Senate VA leaders to review payment mismanagement of the VA Choice program that were previously reported in a VA OIG memo
VA-OIG reviewed Choice program data in September 2017 and found several payment errors including duplicate claims payments, pass-through-errors where TPAs received higher payments than providers, and unadjusted payment rates based on Medicare or contracted services.
“Making accurate and timely payments in the Choice Program has proven to be a significant challenge for VA, and, based on our pending audit work, identified payment errors total in the tens of millions of dollars,” VA-OIG said in its memo.
“VA has taken steps recently to address issues that resulted in the overpayments to date, including automating more of its payment processing system going forward, but it appears likely that this process will continue to be a challenge.”
The VA and the Choice program previously encountered other administrative snags in the past that impeded veterans’ access to healthcare.
Government Accountability Office (GAO) reports found that veterans waited an average of 24 days to receive care at a Veteran’s Choice program facility and can wait as long as three years to submit appeals for healthcare benefits.
The proposed investigation from AFGE follows an effort from VA leaders to implement solutions that improve payment and claims administrative efficiency.
The VA recently announced a push for new IT investments to add speed and efficiency to their claims administrative process. The agency said it plans to work alongside TPAs and additional stakeholders to improve claims transparency, align performance goals, and ultimately improve the payment process for community providers.
“It is vital to the health of our network of providers that we provide payment in a timely and consistent fashion,” said VA Secretary Dr. David J. Shulkin. “Our outside providers are an essential part of our network and we need to improve our system of payments for their services.”