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Delinquent Medical Service Accounts at David Grant Air Force Medical Center Need Additional Management Oversight

DODIG-2015-179

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Objective

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.

Finding

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.

Recommendations

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.