Health care fraud and abuse within the Veterans Administration system Essay Example

Health care fraud and abuse within the Veterans Administration system Paper The VA was established in the year 1989. The main aim of its establishment was to provide federal benefits to the US military veterans and their respective families. The agency is perceived to be the second largest of the fifteen cabinet departments. It provides financial assistance, health care and burial benefit programs. It covers around sixty million people who are namely;  Ã‚   veterans, their respective family members and the veterans survivors. VA’s annual budget is higher than 90 billion dollars although it is seeking around $ 125 billion for next year (2011). Sixty billion dollars from its budget is stipulated for health benefits and the remaining is directed towards pensions and disabilities. Other benefits of VA include home loans, educational assistance, vocational rehabilitation for the disabled veterans and life insurance. The predecessor of VA was the veteran’s administration which had been established in 1930. VA is divided into, veteran’s health administration, national cemetery system and veteran’s benefits administration. It facilitates the management of the veterans hospitals or clinics and also disbursement and eligibility of the disability pensions (Answers.com. 2010). We will write a custom essay sample on Health care fraud and abuse within the Veterans Administration system specifically for you for only $16.38 $13.9/page Order now We will write a custom essay sample on Health care fraud and abuse within the Veterans Administration system specifically for you FOR ONLY $16.38 $13.9/page Hire Writer We will write a custom essay sample on Health care fraud and abuse within the Veterans Administration system specifically for you FOR ONLY $16.38 $13.9/page Hire Writer The VA has is plagued with many fraud cases which result from deception, poor system guidelines and many more other causes. This research proposal is going to discuss the top reasons as to why the VA is plagued with these fraud cases. Public recognition Lack of public recognition is perceived to be one of the top reasons as to why the VA is plagued with fraud. This is because no monitoring is done on the kind work of being done by men and women at the VA’s office. Vital work is basically done without much public recognition. This brings about schemes which are aimed at creating fraudulent claims for 100% disability that resulted in retroactive lump-sum payments to the deceased veterans. For example in the year 2001 a former supervisor at VA’s Atlanta regional office was sentenced for a 13- year imprisonment and also ordered to pay more than 11 million dollars as restitution for her taking part in a scheme to pay benefits in the name of deceased veterans. This calls for the undertaking in a number of corrective measures which must include technology-based and procedural controls than can quickly prevent and quickly identify similar frauds and stronger responsibility for the VA managers. Public recognition will require all the work of the veterans to be publicized and exposed in the notice boards and internal WebPages. Dysfunction of the system The second top reason as to why there is increased fraud in Veteran Affairs the dysfunction of the system which openly tends to invite fraud. Congress has also facilitated to the systems dysfunction because it has pressurized the VA into making it easier for the veterans especially when it comes to the settling of the disability claims. The VA has also currently proposed changes which will simplify the acts of deception from the veterans. Fraud emanating from deception is depicted by the higher number of veterans from Afghanistan and Iraq coupled with Post Traumatic Stress Disorder thus making for it easier for the veterans to fake the disease. Medicalnewstoday.com,(2010) describes this deception emanating from the disorder as â€Å"profitably working the levers of sympathy for the wounded and obligation to the troops, and exploiting the sheer difficulty of nailing a surefire diagnosis of a condition that is notoriously hard to define. Each of these cases represents potentially millions of dollars in tax-free benefits over the veterans lifetime benefits that may continue while the veteran works and even into retirement. This deception is facilitated by the lack of availability of the clinicians who perform these disability evaluations. This is because the clinicians assume that it is not their responsibility to assess the patient’s stories. The new rule (making it easy for the veterans to settle their disability claims) should be thoroughly researched on traumatic and PTSD. With reports indicating that the number of Vietnam War veterans who committed suicide to be more than those who died in the battle field, much of the funds should be directed towards the treatment of the veterans. Most of the military women and men in uniform are usually stigmatized when they try to seek help for the demons in their brains or minds that forces them to contemplate suicide as the way out. It will therefore be important for the health specialist to evaluate every veteran once he or she comes from the damage (Medicalnewstoday.com, 2010). Trained staff The other top reason for fraud in VA is lack of a well trained staff. A staff which has no basic concepts of what they are doing may result into poor outcome or negative output when it comes to production. Fraud comes in on the side of auditors who have no explicit knowledge of auditing. Fraud is facilitated by construction works due to the excessive prices paid in major construction. This overpayment for constructions work should be returned to the reserve fund. Audit fraud is also facilitated by some contract award actions, adminstration, contract awards and administration must be enhanced to en sure that no excess prices are paid for construction work. To improve construction contracting the VHA should ensure that contracts always result better or reasonable prices for the work which is already completed. Contracts which are in the interests of the state government are efficiently controlled to prevent waste, fraud, mismanagement and abuse. Contracting fraud was facilitated by the fact that the contractors aren’t enlightened enough to use the available resources to ensure that price determinations are adequately supported and reasonable and fair prices are achieved. Fraud is facilitated by the fact that the staff lacks the appropriate knowledge in the department’s information system. When the staff have the problem of obtaining accurate data from the information system the department basically overestimates the sum total of the reimbursements that it assumes that it will recover. For example in the year 2001 the department ended up retaining a consultant to help in billing of outstanding charges estimating that he could recover around d six million dollars, however the consultant ended up recovering a maximum of 450,000 million dollars. The VA aggravated its problems by collecting the reimbursements because it really missed training opportunities since the department and the homes have used money inefficiently in the past. Lack of training has resulted into an absence of the billing experts and also knowledge at the department insufficient training accompanied by poor management and lack of executive management sponsorship has immensely contributed to deficiencies and also errors in the department’s information system thus giving birth to a system that doesn’t work efficiently as it should. The department has tried to correct the cash flow problems but unsuccessfully. It always request loans from the general fund to enable it cover some of the timing differences cause by delays the department’s reception of federal funds or reimbursements. . Health care providers can minimize the fraud audits by training their staff well this is because it is always very easy for the poorly or untrained staff to make billing mistakes. Detailed records should also be very well kept by providers incase of any questions arising from the auditing process. Signature stamps should also be given very special considerations before they are given or used by others. Providers should safely keep the billing profiles cooperate with auditors and also take care with the collection efforts. Economic recession is also perceived to be another major reason as to why there is fraud in the veterans affairs. This is because it has caused many insurance frauds which are also evident t in veterans’ affairs. Recession is making everything so expensive that many people cannot afford. Due to this the veterans have found their salaries too little to accommodate their leisure and family needs and that is why some have been caught committing frauds through the insurance. To solve this VA should work hand in hand with the insurance fraud unit which provides focused and specialized efforts towards combating of specific crimes. Disaffection The other reason for fraud in the veteran affairs if veterans disaffection. This is because many veterans just like all the other employees see themselves threatened therefore turning into latent malefactors. This is because fraud has become an equal employer for all. Most of the veterans engage in this behavior because the can rationalize their acts to self or themselves. To discard this veteran’s disaffection which is causing fraud the VA must have special people who can maintain the organizations tradition of excellence. For this special people to be available the VA has to compete with other employer in order to attract them. VA is aware of the fact that its kind of employees become valuable over time and to keep the around then they should be offered a truly benefits package and superior compensation. The VA has been working hard to control employee disaffection for it offers a competitive salary and superior array of benefits for the veterans and their families (4.va.gov, 2009). Indifference to internal control The other reason of fraud in veteran affairs is indifference to internal control. This is because the department has poorly manage its cash and that of its three homes for it has failed to pursue some reimbursements to which it is entitled. Most of its funding for its department homes comes from the States General Fund and additional funds comes from the US department of veterans affairs from the fees paid by the residents belonging to the homes and reimbursement which is paid by Medicare. The department estimates that it loses more that 15 million dollars in state and federal funds due to some of the homes had become ineligible for reimbursements. The VA doesn’t take advantage of all the cash sources available. It also has inadequate implementation and use of its billing management information system thus causing additional loss of money. This is because billing errors and also inadequate documentation of costs the department some of the additional reimbursements for those services that the home supplies to its veterans. The VA department has also compounded it difficulties in cash flow by failing to promptly submit its claims for various reimbursements. Internal control basically controls to the fraud because it doesn’t address the lack of resources that effectively manage the fiscal operation of the veteran’s home. This makes the veterans department to poorly prepare inaccurate management reports. The other weakness of the department is that it doesn’t utilize many of the tools and also reports available in its information system. For example in the year 20012 it is estimated that homes didn’t use around 35 of   the system   modules purchased by the department including a   cost accounting module that would   have given the department   a valuable tracking and budgeting tool. Fraud is also facilitated by the fact that the veteran’s affairs department doesn’t extremely conduct limited reviews on its internal controls. For instance it is true that the VA doesn’t frequently keep current its policies and procedures manuals. It also doesn’t frequently produce some precise accurate operational reports which it could use as one of its management tools. To solve the problem of indifference in internal control the department should ensure that it has the ability to bill for the services which are provided by its three homes. This can be facilitated through the continuous seeking of recertification of its homes so that they can bill for Med-Cal and Medicare reimbursements it can also follow up some of the claims submitted to the secondary insurance providers to ascertain that it has received the reimbursements and submit or issue claims to the secondary insurers that it had not billed in the past. To ensure that there is prompt billing of charges the department should continue to mainly focus of the clearance of its backlog claims and also ensure that the staff performs all the assigned tasks so that claims can be billed promptly. To ascertain whether the consultants who assist when billing are a cost effective solution to some of its problems related to cash flow, the department should make use of the results of its current contractor as the basis to make analysis on the benefits and costs of continuing to hire the consultants. The department should also assess whether payments from medi-cal and Medicare and additional assortment of federal reimbursements will adequately or efficiently cover the cost of the consultants. The department should also take some steps in ensuring that adequate resources and tools are for controlling the fiscal operations are established. One of the steps is the development of periodic management reports which include aging reports of accounts receivable and regular reconciliation of the report with the department’s accounting records to assist the department in evaluating its cash flow and that of all its three homes. The reports however should not cover reimbursement, unbilled claims and accounts receivable. The other step is to ensure that there is a regular review of the department’s internal controls with the aim of ensuring that the department fulfils its missions and also that it keeps proper control over liabilities, expenditure, assets and reimbursement. The third step is to ensure that there are adequate training opportunities for the department employees and  Ã‚   especially the reimbursement staff to inform them of the current developments in Medicare policies and regulations (Bsa.ca.gov, 2001).