The federal government wrote duplicate checks to private doctors who treated veterans, costing taxpayers up to $128 million in extra payments over 5 years.
was implemented to $45 million in 2021, according to the OIG report. The program allows veterans to seek care from private doctors when the VHA can't provide the care they need.The OIG said it decided to audit Medicare's claims because"duplicate payments were a long-standing issue."
The HHS OIG's audit examined $19.2 billion in Medicare payments for 36 million claims for individuals who enrolled in Medicare and were eligible for VA services. About 90% of those claims were for doctor evaluations and visits, according to the OIG report. Specifically, the OIG found that the CMS and the VHA were not sharing enrollment, claims, and payment data with each other, as required by federal law.
The OIG recommended that CMS take the following four steps to fix the problem, which CMS has agreed to do, according to the report:so it can identify potential fraud, waste, and abuse under the Medicare program;
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