oversight

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)

                         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