A new report out Tuesday from the Department of Veterans Affairs (VA) Office of Inspector General reveals that the VA has been unable to collect about $665 million in revenue after it paused operations of its Program Integrity Tool.
The Veterans Health Administration’s (VHA) Program Integrity Tool serves as a data repository for veterans’ community care billing claims. The VHA, in collaboration with the VA’s Office of Information and Technology (OIT), paused the use of the tool in February 2023 after it discovered issues with its “database code logic and of compromised stored data.”
“Although the tool is offline, community care claims continue to be received and paid through their respective claims processing payment systems,” the report says. “However, VHA has not been able to bill veterans or private insurance companies for community care claims dated after the pause began, meaning that until Program Integrity Tool operations resume, VHA is missing opportunities to increase available funding for veterans’ health care.”
“Further, the pause impedes oversight efforts by VHA program offices and others who use the tool to help identify fraud and waste or for research and other oversight activities,” it adds.
While the tool is offline, the OIG said a backlog of claims is accumulating that will pose “a significant challenge to revenue collection activities.”
Specifically, the OIG estimated that there will be a backlog of about 40 million paid community care claims that must be processed when the VA resumes the tool.
Additionally, the OIG “estimates that the Program Integrity Tool’s pause has resulted in approximately $665.5 million in Revenue Operations collections that have not been recovered as of February 2024.”
In a memo accompanying the report, the VA said that it is working to get the Program Integrity Tool back online. The agency completed a review of the tool in November 2023 and identified 18 defects. As of June 2024, the VA has addressed over one-third of the identified defects, prioritizing critical and high-impact issues.
“Of the remaining 12 defects, seven are currently in progress. OIT remains committed to a full Program Integrity Tool recovery and will continue to provide updates on our progress,” VA Chief Information Officer Kurt DelBene said in the memo.
The OIG concluded that OIT’s “continued involvement will be necessary to resolve the remaining issues and make sure Revenue Operations receives all data necessary to bill veterans and private insurers.”
