Foreign Medical Program Integrity and Improvement Act
Sponsored By: Representative Harrigan, Pat [R-NC-10]
In Committee
Summary
Strengthens payment rules and anti-fraud controls for the VA's Foreign Medical Program. It limits what the program will pay, creates new fraud tools, and expands authority to hire outside claims administrators.
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- Veterans: Payments for hospital care or medical services will generally be the lesser of the amount billed or the Medicare rate for the same service. The Secretary can pay more when needed to ensure access, including in emergencies.
- Providers and deceased claims: Federal funds cannot pay for care if the patient appears in the Death Master File. Providers found to have submitted fraudulent claims can be denied payment, put on an official fraud list, and have payments recovered.
- VA administration and oversight: The VA may withhold payments during Inspector General fraud probes and must refer suspected fraud to the Inspector General. The VA can contract with third party administrators and must implement an IT claims system within one year.
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Bill Overview
Analyzed Economic Effects
3 provisions identified: 1 benefits, 0 costs, 2 mixed.
Lower VA payments for foreign care
If enacted, the bill would make the VA pay the smaller of the provider's billed amount or the Medicare rate for the same hospital or medical service under the Foreign Medical Program. The VA Secretary would still be able to pay more than that when needed to ensure a veteran can get care, including in an emergency. This would apply each time a veteran or provider files a claim under the program.
VA could hire claims administrators
If enacted, the bill would let the VA enter into agreements with companies to serve as third-party administrators for Foreign Medical Program claims. The VA could also enter an agreement to get access to a claims information technology system. If the VA uses that IT authority, implementation must be finished within one year after the date of enactment.
New VA fraud controls for foreign care
If enacted, the bill would require the VA to name a Fraud Detection and Prevention Coordinator for the Foreign Medical Program. The VA would not be allowed to use Federal funds to pay for care billed for someone who appears in the Death Master File after their date of death. The VA would refer suspected fraud to the Department Inspector General, could withhold payment while claims are investigated, must pay cleared claims promptly, and must deny and recover payments when fraud is found. The VA would also keep a list of providers who submitted fraudulent claims, bar payments to those providers, and send the list electronically to veterans registered in the program each time a provider is added.
Sponsors & CoSponsors
Sponsor
Harrigan, Pat [R-NC-10]
NC • R
Cosponsors
There are no cosponsors for this bill.
Roll Call Votes
No roll call votes available for this bill.
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