Pursuit's Take
CPACs improperly billed veterans and third-party payers and used an automated system that billed by default. CPAC controls need strengthening to ensure veterans and third-party payers are not billed for treatment of SC conditions.
Of about 15.4 million bills VHA issued during FY 2015, OIG estimated approximately 1.7 million (11 percent) were improper bills for the treatment of SC conditions. Of the 1.7 million improper bills, approximately 623,000 were to veterans and approximately 1.0 million were to third-party payers.
This occurred because CPACs did not provide billing staff access to Veterans Benefits Management System (VBMS), establish procedures for review of prescriptions, conduct comprehensive quality assurance reviews of SC determinations, and provide consistent training to VA medical facility staff.
As a result, OIG estimated that during FY 2015, VHA improperly issued bills totaling about $15 million to veterans and approximately $295.6 million to third-party payers for treatment of SC conditions. OIG also estimated VHA inappropriately collected approximately $13.9 million from veterans and at least $13 million from third-party payers for the improper bills.