Providence, Rhode Island [Brown University] — From 2011 to 2020, the Veterans Health Administration spent $78 billion caring for U.S. military veterans enrolled in Medicare Advantage plans, raising questions about federal overpayments to those private plans. .
According to it analysis By researchers at Brown University and Providence Veterans Affairs Medical Center. The study, published in JAMA, found that some veterans’ It points out that dual enrollment for military personnel could result in higher federal spending than is currently the case. need.
“If the federal government pays for health care through the Veterans Health Administration and pays the full amount for Medicare Advantage plans, the government may be paying twice for the same beneficiary’s health care.” said study author David Myers, assistant professor of health sciences. Brown University School of Public Health Services, Policy, and Practice. “These potential overpayments could represent significant additional spending by the federal government.”
Myers said the Medicare Advantage program is the privately operated arm of the Medicare program, and private insurance plans are paid by the federal government to provide Medicare benefits. The Medicare Advantage program is growing rapidly, with the number of people using Veterans Affairs health care services increasing 63% from 634,470 in 2011 to 1,033,643 in 2020.
Researchers used Veterans Health Administration (VHA) registry data to identify all veterans with dual coverage of Medicare Advantage and VHA who used VHA services from 2011 to 2020. did. It turns out that the VHA paid more than $78 billion for medical services. It was also found that while the VHA paid for the veterans’ medical expenses, the federal Medicare program simultaneously paid the full amount for each dual-enrolled veteran’s Medicare Advantage plan.
“Medicare Advantage plans pay even if they don’t necessarily provide care to the beneficiary,” Myers said.
Myers suggested two ways to deal with the overpayment problem. One option is to reduce the payments that Medicare Advantage plans receive for VHA-insured beneficiaries or allow VHA to seek reimbursement from Medicare plans. He said reimbursement makes the most sense because veterans are covered no matter where they receive medical care.
Under Section 1862 of the Social Security Act, health care provided by VA and other government agencies is not covered by Medicare (with certain exceptions) and VA does not seek reimbursement from Medicare or Medicare Advantage plans. The Veterans Administration bills private health insurance for certain medical care unrelated to services provided to veterans, and for funds that directly support care and services provided to veterans.
“There should be an opportunity for the Veterans Health Administration to seek reimbursement from Medicare so that it can afford to provide the care that veterans need and deserve,” Myers said.
The authors hope to conduct additional research to determine the exact amount of duplicate spending.
This analysis is part of a larger study led by Dr. Amal Trivedi, a professor of health services, policy, practice, and medicine at Brown University and a physician at the Providence VA Medical Center.
“We are focused on increasing veteran enrollment in Medicare Advantage and what that means for VA health care,” Trivedi said. “This study highlights the need to better understand the impact of veterans’ enrollment in Medicare Advantage on the potential for duplication of federal spending.”
Funding for this study was provided by the Center for Innovation at Providence Veterans Affairs Medical Center.
