Improving Controls over Third-Party Insurers

• Significant internal control weaknesses and inadequate management oversight limit VA's ability to maximize revenue from private insurance companies (third-party insurers).
• VA lacks policies and procedures for management oversight at medical centers and at the Veterans Health Administration level.


• VA has few standardized reports to support management oversight.


• GAO found
  
  • coding, billing, documentation, and other errors at 18 case study medical centers that accounted for hundreds of millions of dollars in unbilled amounts; and
  
  
  • a 69 percent failure rate VA-wide related to the requirement for initial follow-up on unpaid third-party insurer bills.

^ Back to topWhat Needs to Be Done

• VA should take actions to maximize third-party revenue, including actions to establish procedures to ensure that
  
  
  • all amounts that should be billed to third-party insurers are billed in an accurate and timely manner,
  
  
  • follow-up on unpaid bills is performed in a timely manner,
  
  
  • reasons for adjustments to decrease any third-party billings are documented, and
  
  
  • management oversight of medical center billings and collections and VA-wide assessments are performed.

    Highlights of GAO-08-675 (PDF)

^ Back to topKey Reports

VA Medical Centers

VA Health Care

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