DCCUMNT RESUME 03497 [A2653844] (Treatment of Ineligible Veterans in VA Hospitals]. HRD-77-149; P-133044. September 19, 1977. 3 pp. enclosure (3 pp.). Report to ax Cleland, Administrator of Veteran Affairs, Veterans Administration; by Gregory J. Ahart, Director, Human Resources Div. Issue Area: Health Programs (1200); Health Programs: Reimbursement Policies and Utilization Controls (1208). Contact: Hunman Resources Div. Budget. Functicn: Veterans Benefits and Services: Hospital and Medical Care for Veterans (703). Organization Concerned: Veterans Administration: VA Hospital, Houston, TX; Veterans Administration: VA Hospital, Alexandria, LA. Congressional Relevance: House Ccmmittee on Veterans' Affairs; Senate Ccmmittee on Veterans' Affairs. Authority: Federal Claims Collection Act of 1966b 31 U.S.C. 951). Indebtedness referrals from two Veterans Administration (VA) hspitals were sent to the General Accounting Office for collection of claims against persons who were ineligible for medical treatment. Findings/Conclusions: Claims for 32 cases from the Houston, Texas, VA hospital and two cases from the Alexandria, Louisiana, VA hospital for the eriod from January 1970 to March 1977 totaled about $137,609. In 26 of these cases, the same patients had been admitted to the hospital or the outpatient clinic more than once, and in two cases the same patient had teen treated in excess of 100 times. Of the 8 persons whc has only a single incidence of hospital admission before being found ineligible, the shortest length of stay was 20 days. Two of the persons were treated in the hospital for over 100 days. The time it took to determine eligibility of patients was excessive. Recommendations: The admitting procedures for VA hospitals should be reviewed and changed to preclude readmission of persons previously determined to be ineligible for hospital or -outpatient care. An evaluation should be conducted to determine how to reduce the length of time required tc determine patient eligibility. (SW) UNITED STATES GENERAL ACCOUNTING OFFICE WASHINGTON, D.C. 205.4 HUMAN RtDOURCI DIV .lCN B-133044 The Honorable Max Cleland Administrator of Veterans Affairs Veterans Administration Dear Mr. Cleland: In accordance with the Federal Claims Collec ion Act of 1966, (31 U.S.C. 951) indebtedness claims are referred to the General Accounting Office for collection when an agency has exhausted its collection procedures. Our Claims Division has recently received indebtedness referrals from Veterans Administration (VA) hospitals in Houston, Texas, and Alexandria, Louisiana, for medical treatment to persons who were subsequently found to not be eligible for VA medical benefits. Several of these cases are claims against persons who had been found ineligible for medical treatment during previous stays in VA hospitals. In addition, to determine eligibility the time it takes seems to us to be excessive. In a My 10, 1977, letter to the Director Service, a copy of which is enclosed, we of Internal Audit reported similar findings at the Hines, Illinois VA hospital. We are bringing the Houston and Alexandria cases to your attention since this practice may be widespread in the VA health care system. PATIENT READMITTED SUBSEQUENT TO BEING DECL ED INELIGIBLE Thirty-two cases from the Houston VA hospital and two cases from the Alexandria VA hospital were referred to GAO for collection for various hospital stays within the period from January 1970 to March 1977. The amount of the claims totaled about $137,609. In 26 of these cases, the same patients had been admitted to the hospital or the outpatient clinic mre than once and in two cases the same patient K' en treated in excess of 100 times. Below are s 'f persons who had been declared ineligible for VA m -t were readmitted for treatment. --Patient A was admi the Houston VA hospital on November 24, 1972, 2 discharged on December 3, 1972. Patient was readmitted on January 8, 1973, for HRD- 77-149 (990591) B-133044 9 days. Patient then had 27 outpatient visits between January 24, 1973, and August 27, 1976. VA had determined the patient'E ineligibility on February 15, 1973. Subsequent to this determination the patient received care during 23 outpatient visits. The patient was not billed until Stember 29, 1976, and has as yet not been located. The total charges for care received were $1,861. --Patient B as admitted on June 29, 1976, and discharged on June 30, 1976. Patient was then admitted on September 13, 1976, for one day and was treated duri' 116 outpatient visits between July 1, 1976, ad October 23, 1976. VA had determined ineligibility on September 7, 1976. Total carges for care received were $4,742. --Patient C was admitted on May 31, 1976, and discharged on June 24, 1976. Be was readmitted on July 6, 1976, for 48 days and treated as an outpatient on September 7, 1976. VA had determined ineligibility on July 8, 1976. The total charges for care received were $8,005. EXCESSIVE TIME NEEDED TO DETERMINE ELIGIBILITY )f the 8 persoiLs who had only a single incidence of hospital admissicn before being found ineligible the shortest length of tay was 20 days. Two of the persons were treated in the hospital fcr over 100 days. It seems to us that a hospital admission unit o. other responsible service should be able to determine a person's eligibility in considerably less than 20 days time. This would result in the hospital being able to quickly discharge or refuse admittance or treatment to ineligible persons who were not in emergency or life threatening situations. This usuage of excessive time to determine eligibility is also evident from analyzing the data involving the ineligible cases who received multipie treatments. Patient cases used in the above examples demonstrate the time problem. Patient A had almost three months between original admission and VA's determination of ineli- gibility. Patient B had over two months, and Patient C had about 5 weeks between admission and determination of ineligibility. We -2- B-133044 believe eligibility could be determined in ample time to prevent the hospital readmissions or treatment in outpatient facilities. RECOMENDATIOiS We recommend that the admitting procedures for VA hospitals be reviewed and changes made to preclude readmissions of persons previously determined to be ineligible for VA hospital or outpatient care. We also recommend that an evaluation be performed of ways in which the period of time needed to determine eligibility can be reduced. is you know, section 236 of the Legislative Reorganization Act of 1970 requires the head of a Federal agency to submit a written statement on actions taken on our recommendations to the ouse Committee on Government Operations and Senate Committee on Governmental Affairs not later than 60 days after the date of the report and to the ouse and Senate Committees on Appropriations with the agency's first request for appropriations made more than 60 days after the date of the report. We :e sending copies of this report to the Chairmen of the House and Sena:e ommittees on Appropriations, ouse Committee on Government Operations, Senate Committee on Governmental Affairs, and ouse and Senate Committees on Veterans' Affairs; and to the Director, Office of Management and Bldget. Sincerely yours, Directo Enclosure - 3 - ENCLOSURE I ENCLOSURE I UNITED STATES GENERAL ACCOUNTING OFFICE WASH INroN. T ,. P.25? May 10, 1977 Mr. Wallace E. Busbee Director, Internal Audit Service Veterans Administration Dear Mr. Busbee: In accordance with the Federal Collection At of 1966, indebtedness claims are referred to the General Accounting Office for collection when an agency has exhausted i';s collection procedures. Our Claims Division has recently received umerous indebtedness referrals from the BHnes, Illinois, VA hospital for medical treatment to persoihs who w.re subsequently found to not be eligible for VA medical benefits. Several of these cares are claims against persons who had been found ineligible for hospital benefits during a previous stay in ines. in addition, the time it takes to determine eligibility seems to us to be excessive. We are bringing these matters to your attention because an evaluation of thc admitting procedures at ines seems to be necessary. We believe, moreover, that you may wish to determine whether these practices are widespread in the VA system. PATIENTS READMITTED SUBSEQUENT TO BEING DECLARED INELIGIBLE Thirty cases were referred to GAO for collection from the ines VA hospital for hospital stays from November 1972 to June 1976. The amount of the claims tt.led about $89,D000. In 14 of these cases, the same patient had been admitted to the hospital or the outpatient clinic more than once and in one case the same patient had been treated eight times. These claims totaled about $20,000. Below are several examples of persons who were readmitted for treatment and have een declared ineligible for VtA medical care. ENCLOSURE I ENCLOSURE I -Patient A was admitted to ines VA hospital on Februarv 1i; 1976, and was discharged February 17, 1976. The charge was S408. The patient was subsequently readmitted on February 19 for 6 days; March 30 for 8 days; outpatient visits on April 9 and 16; readmitted on April 22 for 9 days and again on May 9 for 3 days. The charges for these 4 readmissions and two outpatient visits was $2,718. --Patient B was first admitted to Bines VA hospital on April 11, 1974, for a period of 122 days. The charge was $10,736. About 18 months after his Zischarge and about 22 months after his original admission the patient ws readmitted on February 18, 1976, for 20 days at a cost of $2,040. -- Dtient C was first treated at the ines VA outpatient clinic on February 21, 1975. The charge was $30. On March 14, 1975--three weeks later--he was admitted tc the hospital for 8 days. Subsequently he also returned to the outpatient clinic for further help on March 28; April 11; May 2; May 23; June 13; and July 11, 19;5. The cost for these subsequent visits and hospital stay was $887. --Patien D was admitted to ines VA hospital for 10 days on May 12, 1975, at the cost of 880. On uly 3, 1975, he was readmiitted for 4 days; on August 21, 1975, he was readmitted for 21 days; and finally on December 1, 1975, he was readmitted for 18 more days. The cost of his subsequent admissions was $4,386. EXCESSIVE TIME NEEDED TO DETERMINE ELIGIBILITY Of the 16 persons who had only a single incidence of hospital admission before being found ineligible, the shortest length of stay at ines was 14 days. Two of the rersons were treated in the hospital for over 50 days. ENCLOSURE I ENCLOSURE I The averaoe for this entire roup was about 28 days. It seems to us that the hospitals admission unit or other responsible service should be able to determine a person's eliqibi:itv in considerably less than two eeks time. This would result in the hospital being able to uickly discharge or refuse admittance to ineligible persons who were not in emeroencv or life threatening situations; This roblem of excessive time needed to determine eiicibilitv is also evident from anavzinc the data involving the 14 ineliible cases who received multiple treatments. The shortest er.iod of elapsed time between a first and second treatment was 6 a s. In 9 of the 14 cases more than month elapsed between the date of the original admission and the date uf. t.e first readmission. One case had an eaosed time of about 22 months between the first two admissions. we believe el.iibilitv could be determined in ample time to revent these reedmissions or treatment in outPatient facilities. RECOMM.ENDATI ONS We recommend that the admittin? procedures at the Hines VA hospital be evaluated and chances made to reclude readmis- sions of persons previouslv determined to be ineligible for VA hospital care. We also recommend, that the evaluation develop wa's in which the period of time needed to determine elicibilitv can be reduced. Sincerely rs George D. Peck Assistant Director cc: Dr. 6Jhn D. Chase
Treatment of Ineligible Veterans in VA Hospitals
Published by the Government Accountability Office on 1977-09-19.
Below is a raw (and likely hideous) rendition of the original report. (PDF)