Federal authorities could also be paying twice for care of veterans enrolled in Medicare Benefit plans

From 2011 to 2020, the Veterans Well being Administration spent $78 billion to take care of U.S. navy veterans enrolled in Medicare Benefit plans, elevating questions on federal overpayments to these non-public plans.

That is based on an evaluation by researchers from Brown College and the Windfall Veterans Affairs Medical Heart. Revealed in JAMA, the examine notes that as a result of Medicare Benefit plans obtain fastened per-patient funds for well being care companies with out having funds diminished when veterans obtain care via the Veterans Well being Administration, the twin enrollment of some veterans could lead to extra federal spending than is important.

“When the federal authorities pays for care via the Veterans Well being Administration and pays Medicare Benefit plans the total quantity, it could imply the federal government is paying twice for the care of the identical beneficiaries,” mentioned examine writer David Meyers, an assistant professor of well being companies, coverage and apply at Brown College’s Faculty of Public Well being. “These potential overpayments might correspond to substantial further spending by the federal authorities.”

The Medicare Benefit program is the privately run arm of the Medicare program, during which non-public insurance policy are paid by the federal authorities to ship Medicare advantages, Meyers mentioned. The Medicare Benefit program is rising quickly, and the variety of navy veterans who used Veterans Well being Administration companies elevated by 63% from 634,470 in 2011 to 1,033,643 in 2020.

The researchers used Veterans Well being Administration (VHA) enrollment knowledge to establish all veterans who had been dually lined by Medicare Benefit and the VHA and used VHA companies from 2011 to 2020. They discovered that the VHA paid greater than $78 billion for well being companies. Additionally they discovered that whereas the VHA paid for the veterans’ well being care, the federal Medicare program concurrently made full funds for every dually enrolled veteran to their Medicare Benefit plan.

“The Medicare Benefit plan will get paid even when it is not essentially delivering well being care to the beneficiaries,” Meyers mentioned.

Meyers urged two methods to deal with the overpayment drawback: Scale back the funds the Medicare Benefit plans obtain for beneficiaries who’ve VHA protection, or enable the VHA to hunt reimbursement from the Medicare plan. Reimbursement makes probably the most sense, he mentioned, as a result of veterans will nonetheless be lined no matter the place they obtain their well being care.

Underneath Part 1862 of the Social Safety Act, care offered by VA and different governmental entities (with sure exceptions) isn’t lined beneath Medicare, and VA doesn’t search reimbursement from Medicare or Medicare Benefit plans. VA does invoice non-public medical insurance for sure non-service-connected medical care offered to Veterans, funds that immediately help the care and companies offered to Veterans.

“There ought to be a possibility for the Veterans Well being Administration to hunt reimbursement from Medicare so as to have the ability to afford to ship the care that veterans want and deserve,” Meyers mentioned.

The authors hope to conduct further analysis to disclose the exact quantity of duplicate spending.

This evaluation is an element of a bigger examine led by Dr. Amal Trivedi, a Brown College professor of well being companies, coverage and apply and of medication who can also be a doctor on the Windfall V.A. Medical Heart.

“We’re specializing in the expansion of enrollment in Medicare Benefit amongst veterans and what which means for Veterans Administration’s well being care,” Trivedi mentioned. “This examine highlights the necessity to additional perceive the implications of veterans enrollment in Medicare Benefit on doubtlessly duplicative federal spending.”