Our objective was to determine whether
David Grant United States Air Force Medical
Center (DGMC) properly managed delinquent
accounts over 180 days by effectively
transferring the debt to the appropriate debt
collection agency or by actively pursuing
collection. This is the fourth in a series of
reports concerning delinquent medical service
accounts (MSAs). We nonstatistically selected
and reviewed the 25 highest-dollar delinquent
MSAs valued at $394,139.
DGMC Uniform Business Office (UBO)
management did not effectively manage
delinquent MSAs. As of November 30, 2014,
DGMC had 3,489 outstanding MSAs, valued
at $769,385. DGMC UBO management did
not transfer 20 of the 25 accounts, valued at
$344,934, to the U.S. Treasury for collection
after the account was delinquent for 180 days.
Furthermore, DGMC UBO management
did not actively pursue collection for all
25 nonstatistically selected delinquent MSAs,
valued at $394,139. This occurred because
DGMC management did not have a billing
system in place to monitor the delinquent
MSAs; prioritize aging accounts; notify staff of
the MSAs that require followup; and comply
with DoD guidance that requires the collection
of complete and accurate patient information.
In addition, various DGMC departments did not
have written policies or procedures established
and DGMC management did not provide
sufficient oversight by elevating difficulties
in collection from Medicare and Non-North
Atlantic Treaty Organization Coalition Forces
patients to the Air Force Surgeon General UBO.
As a result, DGMC UBO management missed opportunities to
collect $707,591 in delinquent payments. Unless DGMC UBO
management improves collection efforts and takes prompt and
aggressive actions to collect the delinquent debt, DGMC UBO will
continue to incur rising delinquent balances for future MSAs.
During the audit, DGMC management took action to transfer
10 accounts to FedDebt, collect on 1 account from the
Department of Veterans Affairs, and wrote off 7 accounts.
We recommend that Commander, DGMC, validate if the planned
medical billing system will prioritize delinquent medical service
accounts and alert the clerks as to which accounts require follow
up, review, research, and pursue collection on the delinquent
accounts that remain open. In addition, the DGMC Commander
should establish procedures to document the process of patient
follow up. We recommend that Deputy Director for Business
and Finance, Air Force Surgeon General, coordinate with the
Assistant Secretary of Defense (Health Affairs) develop a
plan to address the reimbursement problems that arise from
Medicare and Non-North Atlantic Treaty Organization Coalition
Forces and assess whether further action can be taken against
delinquent MSAs. We also recommend that Assistant Secretary
of Defense (Health Affairs) coordinate with Department of
Health and Human Services to develop a strategy to address the
difficulties DGMC has encountered with receiving reimbursement
for services provided to Medicare beneficiaries.
Management Comments and Our Response
Comments from the Assistant Secretary of
Defense (Health Affairs) addressed the recommendation.
Comments from the Deputy Director for Budget and Finance,
Air Force Surgeon General, and the Commander, David Grant
Medical Center, partially addressed the recommendations;
therefore, we request that the Deputy Director and Commander
provide comments in response to this report by October 26, 2015.
This report is a result of Project No. D2015-D000CL-0110.000.