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HRD-85-49 1 (1985-08-28)

handle is hein.gao/gaobabfgl0001 and id is 1 raw text is: BY THE US GENERAL ACCOUNTING OFFICE Report To The Administrator Of Veterans Affairs VA Needs Better Control Over Its Payment,'To Private Health Care Providers In fiscal year 1984 the Veterans Administration's (VA's) Department of Medicine and Surgery (DM&S) paid about $93 million to private physicians and other health care providers for care provided to eligible veterans. GAO evaluated DM&S' system for determining how much it pays these providers for medical services. DM&S policy provides that clinics are to establish an appropriate fee for each procedure performed by private providers. The maximum allowable fee is to be at or above the middle of the range of fees charged the general public but is not to approach the top of the range (90th percentile). At the five clinics GAO reviewed, 74 percent of the maximum allowable fees examined fell outside the intended range. As a result, these clinics, which accounted for about 15 percent of all claims processed by 79 VA clinics in fiscal year 1983, often paid health care providers either more or less than they should. This problem exists because DM&S' system for developing and applying fee schedules is not adequately main- tained or updated and is difficult to administer. Since all clinics use this system, GAO believes that the problems identified at the five clinics would be found at other clinics. GAO is recommending that, rather than updating its existing fee schedule system, DM&S use fee schedules from other federal programs to pay private health care providers. 127792 GAO/HRD-85-49 1cr-, ,,Y AUGUST 28,1985 b'3 01

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