Duplicate Payments by Federal Government Increasing

Dually enrolled patients in the VA and Medicare account for substantial, duplicate costs

WEDNESDAY, June 27 (HealthDay News) -- The federal government spends a substantial and increasing amount on individuals who are dually enrolled in separate managed care programs (the Veterans Affairs health care system [VA] and Medicare Advantage plan [MA]), according to a study published online June 26 in the Journal of the American Medical Association to coincide with presentation at the Annual Research Meeting of AcademyHealth, held from June 24 to 26 in Orlando, Fla.

Amal N. Trivedi, M.D., M.P.H., from Brown University in Providence, R.I., and colleagues retrospectively analyzed use of health services and estimated costs for 1,245,657 veterans simultaneously enrolled in the VA and an MA plan between 2004 and 2009.

The researchers found that there was an increase in the number of persons dually enrolled, from 485,651 in 2004 to 924,792 in 2009. In 2009, 5.0 percent of MA beneficiaries were VA users and 8.3 percent of the MA population was enrolled in the VA. In 2009, 10 percent of dual enrollees exclusively used the VA for outpatient and acute inpatient services, 35 percent exclusively used the MA plan, 50 percent used both, and 4 percent received no services. The VA financed 44, 15, and 18 percent of all outpatient visits, acute medical and surgical admissions, and acute medical and surgical inpatient days, respectively. Private insurers were billed $52.3 million by the VA to reimburse for care provided to MA enrollees; 18 percent of the billed amount was collected, representing 0.3 percent of the total cost of care.

"In light of the severe financial pressure facing the Medicare program, policymakers should consider measures to identify and eliminate these potentially redundant expenditures," the authors write.

Several authors disclosed financial ties to pharmaceutical and health care companies, including VA and/or the Centers for Medicare & Medicaid Services.

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