Honorable Charles W. Boustany Jr., M.D.
Testimony of the Honorable Charles W. Boustany, Jr., M.D.
Hearing of the House Veterans’ Affairs Subcommittee on Health: Assessing the VA’s Ability to Promptly Pay Non-VA Providers
June 3, 2015
Chairman Benishek, Ranking Member Brownley and Subcommittee Members:
Thank you for providing me the opportunity to submit written testimony to the Subcommittee for this important hearing. It is of vital importance that Congress seeks solutions to the problem of delayed payments within the Department of Veterans Affairs (VA).
For years, Louisiana veterans have been subject to the VA’s inability to timely and properly process and pay claims. The VA has proved particularly negligent with regard to claims for emergency medical services rendered by non-VA providers. As you know, veterans may end up liable for the cost of these emergency services when the VA refuses to process and pay their claims. Pursuant to P.L.113-146, the Veterans Access, Choice, and Accountability Act (VACAA) of 2014, the Veterans Health Administration’s Chief Business Office Purchased Care (CBOPC) was placed in charge of claims processing for emergency medical services. Prior to VACAA becoming law, this responsibility rested at the Veterans Integrated Service Network (VISN) level. Because claims were processed at each of the 21 VISNs individually, there were staggering differences in claims processing rates around the nation. In transferring claims processing authority to a centralized system, VACAA demanded the VA improve its performance in this area.
Before VACAA’s passage, VISN 16, the network that oversees health care for veterans in Louisiana, Mississippi, Arkansas, Oklahoma and portions of several other states, admitted to years of inappropriate practices including denying veterans’ claims for false reasons such as “not timely filing of medical records” when providers had sent those records to the VA via certified mail. A team of senior VA staff was sent to VISN 16 to further investigate, and it was also discovered that VISN 16 staff had written hundreds of thousands of letters to veterans and providers, but had simply never sent those letters to their intended recipients. This behavior is inappropriate and unacceptable. Members of the investigatory team sent to VISN 16 are current CBOPC staff, and I was hopeful that after seeing firsthand what Louisiana veterans were dealing with, the CBOPC would make it a priority to improve the VA’s claims processing practices.
In March, I requested information on the current state of the backlog of emergency medical service claims from the CBOPC. The information I received is extremely disappointing. For claims originating out of VISN 16, the VA reported processing only 14% of claims within 30 days. Timely processing rates in some other parts of the country are even worse.
Moreover, when my office asked the CBOPC if they could provide data on the percent of inappropriately denied claims that were overturned to be re-adjudicated, we were told the CBOPC is “not able to provide data pertaining to that question. Information regarding clinical appeals and overturned denials is not available in our data sets.” The VA repeatedly states they are committed to clearing the backlog and improving claims processing operations, but how can they begin to rectify these issues if they are not keeping track of the veterans they have wronged?
One veteran in my district, Mr. Al Theriot, waited more than two years to see his emergency room and ambulance bills paid. The VA only contacted him after he went on television twice and Senator Vitter and I wrote the VA secretary demanding an explanation. The VA lost his medical records twice without apology. Mr. Theriot’s claim has since been resolved; however no veteran should have to appear on television to force the VA to do its job. He and thousands of other veterans deserve better customer service after risking their lives for our freedom and safety.
As mentioned earlier, the VA states in many cases such as Mr. Theriot’s that they have not received the medical records necessary to process a claim, and subsequently denies that claim under the classification of “not timely filing of medical records.” Because the VA does not allow electronic submission of medical records, providers had no way of proving the documents were actually being sent. As such, many providers resorted to sending the records by certified mail to confirm receipt by the VA. However in some instances, the VA continues to deny records were received.
This raises the disturbing question: When a health care provider is able to demonstrate via certified mail that required medical records were received by the VA, yet the VA denies receiving them, what has happened to those records? It seems highly unlikely that hundreds of certified mail carriers are repeatedly losing these documents. After being delivered to the VA, are the records filed away, never to be scanned and processed for review? Are they thrown away or shredded? How can the VA guarantee these records have not fallen into the wrong hands if they claim the documents were never received despite providers having proof they were? Medical records contain personal health information, and each time these documents are “lost,” a veteran’s privacy is being compromised.
If VA employees are refusing to scan and process medical records received, Congress must consider punishing bad actors, modernizing equipment to allow providers to send electronic records or allowing the VA to contract with a third party to carry out claims processing.
Attached to my testimony, you will find detailed information from two, of the many, Louisiana hospitals that struggle to collect payment from the VA for services rendered to our veterans. You will also find the information sent to my office by the VA regarding the status of the backlog as of March 26, 2015. The data shows a nationwide backlog of more than $878 million for non-VA emergency medical claims. This is absolutely unacceptable.
Louisiana veterans should not have to fear a trip to the emergency room will plunge them into unsustainable debt, nor should they fear that the VA is mishandling their private medical records and compromising their personal information. The VA must end the inappropriate practices that have led to this unacceptable backlog, and commit to improving their claims processing performance. Our veterans deserve nothing less than the highest quality of care and customer service possible, and I thank the Subcommittee for its efforts to resolve these issues.