06/18/2025

Are You a VA Community Care Provider? Here's an Audit You Should Know About!

VA Looking at Duplicative Payments with Medicare

In the June 2025 edition of their Provider Advisor newsletter, the Veterans Health Administration (VA) informed practitioners about an audit designed to recoup duplicative payments from Medicare. While some Veterans have health care coverage through both VA and Medicare, claims for that care can only be submitted to one or the other, never both. Claims submitted for the same services on the same date of service could lead to duplicative payments and, according to VA, “create the appearance of abusive billing practices.”

According to the Centers for Medicare and Medicaid Services (CMS), this has been a longstanding issue going as far back as 1979, when the General Accounting Office (now known as the Government Accountability Office) issued a report that found Medicare made double payments of more than $72,000 for services provided to Veterans eligible for both Medicare and VA benefits. An April 2023 report from the U.S. Department of Health and Human Services Office of the Inspector General (OIG) found that Medicare paid providers for medical services that were also authorized and paid for by VA’s Community Care program during the audit period, resulting in duplicate payments of approximately $128 million.

VA and CMS to Recover Double Payments

In the case of a double payment, VA or CMS – whichever has the predetermined right to recover – will take action to recoup the doubly paid funds. Recovery efforts began in June and may include payments made for dates of service reaching as far back as June 2019.

If VA determines that you have received a duplicative payment, you will receive a bill of collection with instructions on how to pay the bill, any appeal rights, specific timeframes, etc. 

While VA states that the purpose of these audits is to recoup the duplicative payment, “additional actions could occur in accordance with existing laws and policies, to include administrative fees, penalties and fines, and potential suspension of a community provider from providing care to Veterans through VA or Medicare.”

VA stresses that this effort will “be ongoing, not a one-time data match.” The MAC Insurance Relations team recommends that every office that provides care for VA Community Care Veteran patients regularly perform a self-audit to proactively identify, prevent, and, if found, return, duplicative payments.

Sources:

U.S. Department of Veterans Affairs Provider Advisor, June 2025

Department of Health and Human Services Office Of Inspector General, “Medicare Could Have Saved Up To $128 Million Over 5 Years If CMS Had Implemented Controls to Address Duplicate Payments for Services Provided to Individuals With Medicare and Veterans Health Administration Benefits,” April 2023

By Stephanie Davidson, Michigan Association of Chiropractors, Insurance Relations Manager