Medicare could inappropriately pay up to $38 million from 1994 to 1997 for Medicare-eligible military retirees enrolled in a healthcare plan managed by nine private-sector hospitals, according to a congressional report.
The General Accounting Office, a congressional investigative agency, said Medicare inappropriately paid more than $9.5 million in federal fiscal 1994 for healthcare services delivered to enrollees in the military managed-care plan sponsored by the nine facilities, called Uniformed Services Treatment Facilities, or USTFs.
Upon enrollment in the USTF managed-care plans, Medicare-eligible military retirees must agree not to use Medicare.
But in some cases, the beneficiaries receive Medicare-reimbursed care from another provider, or sometimes at a USTF or one of its contractors, when that service should be covered by the Defense Department's capitated payment to the USTF, the GAO said.
The GAO's report said some of those inappropriate payments occur because federal law does not bar USTF enrollees from receiving Medicare-reimbursed care.
The USTFs objected to the report. In comments contained in the document, they said they cannot always detect when Medicare-eligible USTF enrollees receive Medicare-reimbursed care at nonaffiliated providers, nor have they been given the tools to detect such incidents.
Furthermore, the USTFs said they have established guidelines that allow for disenrollment of beneficiaries who receive Medicare-compensated care and refunding of Medicare for inappropriate payments.