Report | April 28, 2016

Delinquent Medical Service Accounts at Landstuhl Regional Medical Center Need Additional Management Oversight



Our objective was to determine whether Landstuhl Regional Medical Center (LRMC) effectively managed accounts delinquent over 120 days by properly transferring the debt to the appropriate debt collection agency or by actively pursuing collection. This report is the fifth in a series on delinquent medical service accounts (MSAs). We nonstatistically selected and reviewed the 25 highest-dollar delinquent MSAs valued at $1.9 million.


U.S. Army Medical Command (MEDCOM) and Regional Health Command Europe (RHCE) Uniform Business Office (UBO) officials did not effectively manage delinquent MSAs for LRMC. As of May 26, 2015, LRMC had 12,043 outstanding MSAs, valued at $4.6 million. Of the 25 MSAs reviewed, RHCE UBO officials did not transfer 23 MSAs, valued at $1.8 million, to the appropriate debt collection agency after the accounts were delinquent for 120 days. In addition, RHCE UBO officials did not actively pursue collection for 18 delinquent MSAs, valued at $1.3 million.

This occurred because:

  • RHCE UBO officials did not develop adequate procedures to properly process delinquent debt;
  • RHCE UBO and LRMC personnel did not comply with DoD guidance requiring the collection of complete and accurate patient information;
  • MEDCOM UBO officials did not provide clear guidance for implementing adjustments to billing weights, which are used to calculate patient charges using diagnosis, risk factors, staff, and equipment; and
  • MEDCOM UBO officials did not take timely action and provide guidance for MSAs elevated by RHCE UBO officials.

As a result, RHCE UBO officials missed opportunities to collect $1.7 million on the 25 MSAs we reviewed. Unless RHCE UBO officials improve collection efforts and take prompt and aggressive action to collect on these 25 MSAs, and on the $2.7 million in additional delinquent debt, LRMC will continue to incur delinquent balances for future MSAs.


We recommend that the Commander, RHCE, review, research, and pursue collection on the delinquent MSAs that remain open; review and modify procedures for patient followup so MSAs delinquent for 120 days can be transferred; and coordinate with MEDCOM to review, research, and take action as needed on accounts affected by changes in billing weights. We also recommend that the Commander, MEDCOM, request a modification to the Armed Forces Billing and Collection Utilization System to ensure that MSAs delinquent for 120 days are transferred and take action to collect or provide guidance on uncollectible debt and updates to billing weights.

Management Comments and Our Response

Comments from the Chief of Staff, MEDCOM, responding for the Commander, MEDCOM, addressed all specifics of the recommendations and no further comments are required. Comments from the Chief of Staff, MEDCOM, responding for the Commander, RHCE, partially addressed the recommendations; therefore, we request the Commander, RHCE, provide additional comments to this report by May 27, 2016.

This report is a result of Project No. D2015-D000CL-0214.000.