The VA has a bounty hunt on cancer care

The VA has a bounty hunt on cancer care
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There is no better way to say it — the U.S. Department of Veterans Affairs (VA) is a mess.

Just last week, a scathing report from the VA Office of the Inspector General documented a host of problems at the Washington D.C. VA Medical Center — including unsterile conditions, long wait times, and failure to track patient safety events — that have put patients at risk for years.

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Unfortunately, problems at VA facilities are an all too familiar news story. It’s bad enough that the VA can’t fix its own centers, but now their incompetence is threatening veterans access to quality cancer care in their own communities outside of the VA system.    

 

Unable to get timely diagnosis and treatment for their cancers, veterans began to go outside the VA health network for care.

With the VA’s approval, community oncology practices started treating these veterans. Despite facing not getting paid, extraordinary payment delays — oftentimes 120 days or more — and bureaucratic hurdles, these practices continued to do the right thing and treat veterans with cancer.

However, a recent move by the VA threatens that and possibly veteran’s access to any health-care provider outside the VA system. If policymakers don’t act soon, few, if any, private providers will be able to provide cancer care to veterans.

Because of either sheer incompetence or ignorance, the VA never formally contracted with oncology practices, nor did it bother to upload rates into the claims system that tells providers what they will be paid.

As a result, over the years, practices billed the VA for treatment at the standard out-of-network rates of patients with other insurance. Even when the practices were concerned there would be a problem with billing, the VA confirmed on numerous occasions that the payments were correct.

Now, following an audit, the VA has decided these payments were too high and wants its money back. It’s contracted a “bounty hunter” that is reviewing all payments and making demands for the return of over five years of payments. Like a bounty hunter, this contractor is undoubtedly rewarded a portion of what it recoups.

For independent community oncology practices, the millions of dollars being demanded by the VA’s hired gun is a death sentence. It is not right and will put them out of business.

If these practices go out of business, veterans — and the more than 50 percent of cancer patients in America that rely on these practices — will be forced to get cancer care in the much more expensive hospital setting, where bills for the same exact treatment can cost as much as 71 percent more.

The VA’s actions are destroying the likelihood that any non-VA providers will ever provide care to veterans again. Why would they if, years down the road, the VA can simply rewrite history and sic a bounty hunter with the full weight of the federal government on them?

In tremendous irony, the VA’s actions are coming as Congress, and the Trump Administration are moving to overhaul the broken VA system. They want to give veteran more choice to go to outside, community providers for care. Unfortunately, it looks like the agency is making things worse, not better.

Our veterans battling life-threatening diseases, like cancer, deserve timely and local access to nothing less than the highest quality medical care. For too many years, the VA has proved itself incapable of delivering that care, and in their absence community oncologists proudly stepped in to treat veterans with cancer.

But now, through nothing but the gross incompetence of the VA bureaucracy, these practices and, most importantly, the veterans they care for, are stuck in a very real, and very scary nightmare. It must be stopped.

Ted Okon is executive director of the Community Oncology Alliance (COA), a national non-profit organization dedicated solely to preserving and protecting access to community cancer care, where the majority of Americans with cancer are treated.