GAO Report Highlights Challenges in VA’s Foreign Medical Program

A new report from the Government Accountability Office (GAO) has identified significant challenges in the Department of Veterans Affairs’ (VA) Foreign Medical Program, which provides health care reimbursements to veterans with service-connected disabilities living or traveling abroad. Issues include delayed or lost payments due to the continued use of paper checks, staffing shortages that slow claims processing, and insufficient fraud risk management despite evidence of potential fraudulent activity. The GAO has issued nine recommendations to improve the program, which the VA has agreed to implement.

The report highlights that in fiscal year 2024, the VA’s Veterans Health Administration (VHA) reimbursed approximately $128.3 million to 8,024 veterans and health care providers—a significant increase from previous years. However, only 37% of claims were processed within the agency’s 45-day target, falling well short of its goal of 90%. One major issue is the continued reliance on paper checks for reimbursements, despite federal law calling for electronic payments. Delays and losses associated with paper checks have caused significant disruptions for veterans and providers awaiting payment. While the VA has initiated a transition to electronic payments, there is no clear timeline for completion.

The report also points to staffing shortages as a key contributor to processing delays. In August 2023, the VHA increased the number of authorized positions for the Foreign Medical Program from 25 to 38 to improve processing times. However, by 2024, 14 of these positions remained unfilled, partly due to a hiring freeze within the VHA. While some steps have been taken, such as allowing remote work for certain positions, the GAO found that the VA has not fully explored or implemented additional strategies to address these staffing challenges.

Additionally, the GAO raised concerns about the VA’s ability to detect and prevent fraud within the Foreign Medical Program. In 2024, the VA suspended multiple health care providers for alleged involvement in a long-term fraud scheme. However, the agency has not conducted a comprehensive fraud risk assessment in accordance with best practices. The GAO recommends that the VA establish a dedicated entity to oversee fraud risk management, regularly assess inherent fraud risks, and coordinate with external stakeholders such as the Department of the Treasury. Implementing these measures could help the VA strengthen oversight and prevent improper payments.

The VA concurred with all nine of the GAO’s recommendations, including finalizing the transition to electronic payments, addressing staffing shortages, and improving fraud risk management. The agency has outlined steps it plans to take but has not provided a clear timeline for implementation. As the Foreign Medical Program continues to grow, the GAO emphasized the need for immediate action to improve efficiency and ensure veterans receive timely and secure reimbursements for their medical care abroad.

Article by multiple RFHC contributors.

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