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HRD-79-58 1 (1979-03-16)

handle is hein.gao/gaobaayup0001 and id is 1 raw text is: UNITED STATES GENERAL ACCOUNTING OFFICE WASHINGTON, D.C. 20548 HUMAN RKSOURCMA DIVISION MARCH 16,1979 B- 133142 The Honorable Harold Brown The Secretary of Defense Dear Mr. Secretary: We have surveyed internal control procedures used in the Civilian Health and Medical Program of the Uniformed Services (CHAMPUS) and have noted that they are not adequate to pre- vent ineligible persons from obtaining CHAMPUS benefits. In our survey we analyzed just one type of potentially erroneous benefit payment--payment for care received by de- pendents of former active duty personnel after their sponsor was separated from active duty. When an active duty member (sponsor) is separated from the uniformed services, his/her dependents lose entitlement to CHAMPUS benefits as of 12:01 a.m. on the day after separation, unless the separa- tion is because of retirement or death. Our analysis of benefit payments for dependents who lost their CHAMPUS eli- gibility during fiscal year 1975 showed that an estimated $780,000 was paid over a 26-month period for care received after sponsor separation. Our analysis involved developing computer programs showing all persons separated from active duty in fiscal year 1975, excluding those who died, retired, or reenlisted, and matching these data with CHAMPUS data on paid claims, including dates medical services were received. The improper payments result from lack of an eligibility verification system and weak controls over the issuance and retrieval of military identification (ID) cards. HRD-79-58 (106142) 108833l

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