VA wrongfully denied millions in veterans’ medical claims

Doctor Richard Stone

When I first heard of this topic, I was sitting in the VA waiting room. I honestly thought it was just a veteran upset with how the VA was treating him, and it wouldn’t be the first time. Being open-minded, I asked the vet if he thought that maybe some of the ER visits were unwarranted. When a vet needs help, sometimes the ER is the only choice. But that was not that wasn’t case.

I wanted to see if this veteran had a real story or just another Veteran barracks story. I looked up the report from the VA’s Office of the Inspector General is titled, “Non-VA Emergency Care Claims Inappropriately Denied or Rejected.” wow, it was a real thing. I couldn’t believe it The Department of Veterans Affairs wrongly denied or rejected millions of dollars in emergency care claims over five months, affecting tens of thousands of veterans, according to a watchdog report released this week.

Here is the report

In one recent six-month period, according to a report from the VA’s Office of Inspector General released last week, the VA left about 17,400 veterans to pay out-of-pocket for emergency medical treatment the government should have covered. The report said that between April 1 and September 30, 2017, veterans who got emergency care at non-VA facilities were forced to pay $53.3 million in medical bills they should never have had to pay.

The IG report came after a 2017 investigation by Minneapolis/St. Paul station KARE, in which whistleblowers told the NBC News affiliate that it was faster to deny claims than to approve them.

Since the end of September 2017, the last month of the period covered by the inspector general’s report, there have been many leadership changes within the VA, including three different directors of the office that processes emergency claims. The inspectors say the instability allowed problems to continue.

Nikki Wentling, writing in theStars and Stripes, August 7, says, “…VA supervisors pressured staff to decide claims quickly, and some staff members said they were encouraged to deny claims to maximize productivity. The culture, which ‘created systemic pressure to favor speed over accuracy,’ led to staff incorrectly rejecting 31% of veterans’ emergency care claims from April 1 to September 30, 2017. The errors affected an estimated 17,400 veterans who were stuck with a total of $53.3 million in medical bills that the VA should have paid, the IG reported.”

The IG’s report also said that communication on the status of claims was not clear, and backlogged mail meant that veterans missed deadlines to appeal or resubmit a rejection or denial. Could this get worse?

Earlier this year, the National Veterans Legal Services Program filed a class-action lawsuit related to the emergency care claims, and VA officials admitted it communicated false information about reimbursements to tens of thousands of veterans — misleading them about their eligibility for reimbursement. 

Examiners surveyed told investigators production expectations were too high, which “did not allow enough time to do a thorough and complete job of assessing claims.” Some said managers threatened to fire examiners who didn’t meet their goals. 

“Constant nonstop intimidation. The atmosphere is terrible. I think it is more that processors just rapidly slop claims through as fast as they can just to hit their numbers,” one examiner wrote. 

Veterans Health Administration head Dr. Richard Stone provided plans included in the Inspector General report to follow 11 recommendations in the report, including correcting the wrongly denied or rejected claims. 

As of the report’s release, all 11 recommendations were still open and not yet resolved. 

I have had nothing but good luck with the VA. Everyone has been helpful and those who didn’t want to step up and do their job I asked for a request to change. However, this is different. Things need to change.

We went to combat for this country, and our government needs to serve us now with answers.

Richard Stone Named Acting Veterans Health Administration Chief

Richard Stoneformer principal deputy undersecretary of health at the Department of Veterans Affairs, has been named acting head of the Veterans Health Administration, Military Times reported Tuesday.

Peter O’Rourke, acting VA secretary, announced Tuesday that Stone will serve as VHA’s executive-in-charge and succeed Carolyn Clancy, who will transition to a new position at VHA that is focused on research and development and innovation.

Stone will be the third interim chief to oversee the department’s health operations since David Shulkin stepped down from the Senate-confirmed post in February 2017.

Prior to his return to the department, Stone worked at Booz Allen Hamilton as vice president with oversight on military health issues.

He is a U.S. Army veteran who previously served as the military branch’s deputy surgeon general, deputy commanding general for the Army Medical Command and head of the operations cell of the Defense Health Agency’s transition team that performed business process reengineering work for 10 shared services initiatives.

Stone is a practicing dermatologist with civilian health care experience.FacebookTwitterLinkedInEmailShare

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