Audit of the DoD’s Management of the Third Party Collection Program for Medical Claims

Submitting OIG:

Department of Defense OIG

Date Issued:

Monday, September 16, 2019

Agency Reviewed / Investigated:

Department of Defense

Submitting OIG-Specific Report Number:

DODIG-2019-108

Component, if applicable:

Defense Finance and Accounting Service (DFAS)

Defense Health Agency (DHA)

United States Air Force (USAF)

United States Army (USA)

United States Navy (USN)

Location(s):

Agency-Wide

Type of Report:

Audit

Funds for Better Use:

$70,714,306

Number of Recommendations:

View Document:

Attachment	Size
DODIG-2019-108.pdf	4.98 MB

Recommendation Number	Recommendation Status	Significant Recommendation
D-2019-0108-D000AX-0001-0001.a1	Open	No
Rec. 1.a.1: The DoD OIG recommended that the Director of the Defense Health Agency review all medical facilities in the Military Health System to determine which medical facilities are not collecting other health insurance information at all clinics in accordance with Defense Health Agency Procedures Manual 6015.01, and coordinate with commanders of those medical facilities to enforce existing other health insurance collection regulations, and as appropriate, take administrative action for noncompliance.
D-2019-0108-D000AX-0001-0001.a2	Open	No
Rec. 1.a.2: The DoD OIG recommended that the Director of the Defense Health Agency review all medical facilities in the Military Health System to determine which medical facilities are not submitting claims to insurance providers in compliance with the time requirements in Defense Health Agency Procedures Manual 6015.01, and coordinate with commanders of those medical facilities to implement additional controls that enforce the requirements.
D-2019-0108-D000AX-0001-0001.a4	Open	No
Rec. 1.a.4: The DoD OIG recommended that the Director of the Defense Health Agency review all medical facilities in the Military Health System to determine which medical facilities are not conducting followup in compliance with the requirements in Defense Health Agency Procedures Manual 6015.01, and coordinate with commanders of those medical facilities to immediately revise procedures to ensure claims are followed up on in accordance with Defense Health Agency Procedures Manual 6015.01 and DoD Financial Management Regulation Volume 16, Chapter 2, requirements.
D-2019-0108-D000AX-0001-0001.a5	Open	No
Rec. 1.a.5: The DoD OIG recommended that the Director of the Defense Health Agency review all medical facilities in the Military Health System to determine which medical facilities are not managing claims requiring refunds, and as appropriate, coordinate with commanders of those medical facilities to initiate refunds to insurance providers, identify funds spent that the medical facility was not entitled to spend, and take action to mitigate any risk to the medical facilities' mission.
D-2019-0108-D000AX-0001-0001.a6	Open	No
Rec. 1.a.6: The DoD OIG recommended that the Director of the Defense Health Agency review all medical facilities in the Military Health System to determine which medical facilities are not transferring eligible third party claims that are delinquent for more than 120 days to the Treasury Cross-Servicing Program, coordinate with commanders of those medical facilities to enforce Public Laws 104-134 and 113-101, which require medical facilities to transfer eligible delinquent claims to the Treasury Cross‑Servicing Program, and take administrative action for noncompliance.
D-2019-0108-D000AX-0001-0001.a7	Open	No
Rec. 1.a.7: The DoD OIG recommended that the Director of the Defense Health Agency review all medical facilities in the Military Health System to determine which medical facilities are not providing legal support to the Uniform Business Office and coordinate with commanders of those medical facilities to provide legal support to collect on Third Party Collection Program claims, and report on the benefits of the Defense Health Agency providing centralized legal resources for all DoD medical facilities to support cost recovery programs, and take action as appropriate.
D-2019-0108-D000AX-0001-0001.d	Open	No
Rec. 1.d: The DoD OIG recommended that the Director of the Defense Health Agency determine whether changing the field name in Military Health System GENESIS to assist front desk personnel resolved credentialed provider errors at medical facilities using Military Health System GENESIS and if not, identify an alternative course of action to assign credentialed providers to patient encounters.
D-2019-0108-D000AX-0001-0001.e	Open	No
Rec. 1.e: The DoD OIG recommended that the Director of the Defense Health Agency coordinate with commanders at all medical facilities operating Military Health System GENESIS to identify all patient encounters that are not assigned a credentialed provider or are missing medical coding or doctor's notes, and develop a course of action to process and bill the claims through the appropriate cost recovery program.
D-2019-0108-D000AX-0001-0001.g	Open	No
Rec. 1.g: The DoD OIG recommended that the Director of the Defense Health Agency coordinate with medical facility commanders to develop a course of action and enforce existing Defense Health Agency requirements that Uniform Business Office personnel review previous patient encounters for potentially billable events when new other health insurance is identified for a beneficiary.
D-2019-0108-D000AX-0001-0001.h	Open	No
Rec. 1.h: The DoD OIG recommended that the Director of the Defense Health Agency report the dollar impact of not collecting on prescriptions written for more than a 30-day supply and as appropriate, implement procedures to require Uniform Business Office personnel to collect at least the reasonable charges on pharmaceutical claims equal to the allowable portion covered by insurance policies.

Recommendation Number

Recommendation Status

Significant Recommendation

Additional Details

D-2019-0108-D000AX-0001-0001.a1

Open

Rec. 1.a.1: The DoD OIG recommended that the Director of the Defense Health Agency review all medical facilities in the Military Health System to determine which medical facilities are not collecting other health insurance information at all clinics in accordance with Defense Health Agency Procedures Manual 6015.01, and coordinate with commanders of those medical facilities to enforce existing other health insurance collection regulations, and as appropriate, take administrative action for noncompliance.

D-2019-0108-D000AX-0001-0001.a2

Open

Rec. 1.a.2: The DoD OIG recommended that the Director of the Defense Health Agency review all medical facilities in the Military Health System to determine which medical facilities are not submitting claims to insurance providers in compliance with the time requirements in Defense Health Agency Procedures Manual 6015.01, and coordinate with commanders of those medical facilities to implement additional controls that enforce the requirements.

D-2019-0108-D000AX-0001-0001.a4

Open