VAOIG Review of Pacific Islands Health Care System

Review of Outpatient Fee Payments at the VA Pacific Islands Health Care System 03/17/2010. This review was conducted at the VA Pacific Islands Health Care System (PIHCS) at the request of Senator Daniel Akaka, Chairman of the Senate Veterans’ Affairs Committee. The objective of our review was to determine the extent and causes of improper payments for PIHCS’ outpatient fee care program. Our review found that PIHCS improperly made duplicate payments for 13 percent of outpatient fee claims, which resulted in overpayments of $49,571 (or less than 1 percent of total outpatient fee expenditures). The error rate at PIHCS was significantly lower than the national error rate identified in a previous VA Office of Inspector General (OIG) audit. VA’s Management Quality Assurance Service (MQAS) had previously identified the duplicate payment issue at PIHCS during a financial management review, and our results support that PIHCS managers have been taking appropriate steps to prevent further duplicate payments. Since June 2008, PIHCS managers have provided training for fee staff on avoiding duplicate payments and notified local providers of proper billing requirements. We recommended that the Acting Under Secretary for Health ensure that PIHCS management initiates recovery of the duplicate overpayments identified by this review. The Under Secretary for Health agreed with the recommendation and monetary benefits in the report and reported that VHA plans to recover the duplicate overpayments identified by this review by April 30, 2010. We consider VHA's corrective actions acceptable and will follow up on their implementation. VAOIG