Government Accountability Office report on continued failure with VA emergency care benefits despite 2014 report

This is news article was written by the journalist with KARE 11 out of Minnesota in September 2017. The report which also has a video component can be found here.

This was a follow up to a 2014 Government Accountability Office report that the errors were causing veterans to pay for emergency care out of their pocket, or traveling long distances to avoid VA emergency room costs.

This report is from 2014, but the problems with this program still exist. Read the full 2014 report here.


The following text is an excerpt from the first page of the 2014 report.


What GAO Found

The Veterans Millennium Health Care and Benefits Act (Millennium Act) authorizes the Department of Veterans Affairs (VA) to cover emergency care for conditions not related to veterans’ service-connected disabilities when veterans who have no other health plan coverage receive care at non-VA providers. However, GAO identified a number of instances where VA staff who processed claims did not comply with applicable requirements of the Millennium Act, its implementing regulations, or VA policies when they denied the claims. Specifically, at the four VA facilities included in this review, GAO found 66 instances of noncompliance among the 128 denied claims reviewed, which led some claims to be inappropriately denied. VA facilities subsequently reconsidered and paid 25 of these claims.

GAO also found that VA facilities may not be notifying veterans as required that their Millennium Act claims have been denied. Eighty-three claims out of 128 that GAO reviewed lacked documentation that the veteran was notified of the denial or of his or her appeal rights. These findings suggest that veterans whose claims have been inappropriately denied may have been held financially liable for emergency care that VA should have covered, and they may not be aware of their rights to appeal these denials.

GAO also found that, as a result of weaknesses in VA’s oversight of Millennium Act claims, VA facilities are at risk for inappropriately denying such claims. For example, agency oversight activities do not focus on compliance with all applicable requirements but rather on the timeliness of claims processing. In addition, VA has limited assurance that deficiencies relating to Millennium Act claims processing identified during reviews are corrected because it only conducts limited follow-up with VA facilities. Moreover, VA does not collect adequate data for monitoring the appropriateness of Millennium Act claim denials. This lack of data hinders VA’s ability to track patterns as to why Millennium Act claims are denied and identify areas where communications with veterans and non-VA

Full report can be found here