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Tricare charging more for Medicare-covered services

Aug. 27, 2013 - 12:26PM   |  
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More than 12,000 Medicare-eligible retirees have been notified that if they receive care at a VA health facility for illnesses other than service-related conditions, they’ll pay more starting Oct. 1.

According to Tricare, the Defense Department has mistakenly overpaid VA at least $1 million a year in reimbursements for services provided for non-service-connected conditions to Tricare For Life patients.

Tricare For Life consists of Medicare as first payer and Tricare Standard as second payer. VA facilities are not allowed to bill Medicare, so Tricare has been acting as primary payer, reimbursing VA up to 80 percent of the allowable charge for care. It should have been paying no more than 20 percent.

“Although this isn’t a new law, it’s one both agencies recently realized wasn’t being appropriately followed,” Tricare spokesman Austin Camacho said.

Beneficiaries were notified Aug. 2. They can pay more out of pocket at VA (the 80 percent that Medicare pays elsewhere); go to a non-VA doctor who takes Medicare; or speak to VA about first billing other health insurance, if available.

The letter puzzled a Virginia retiree who has seen the same VA doctor for nearly seven years.

“At VA, the primary care provider and your specialists are a team. Now they want us to go to someone else? They can’t even transfer medical records between DoD and VA,” he said.

Tricare officials did not say how long the overpayments occurred but added that DoD will not try to recover the funds.

According to 65 Incorporated, a company that provides web-based Medicare information, 63 percent of veterans surveyed did not know they could not use Medicare to pay for VA-provided services.

If Tricare knew it, no one told Pentagon accountants.

“Medicare, by statute can’t pay for care provided by a government facility. VA can’t bill Medicare, therefore, Medicare can’t pay VA for care provided to TFL beneficiaries,” Camacho said.

The letter urges beneficiaries to discuss the issue with officials at their VA facility.

VA did not respond by press time to a request for more information.

The retired Army officer said he’s not sure what he’ll do, but he questions the government’s logic.

“It seems to me that either way, the government is going to pay for it, whether it’s Medicare, VA or Tricare. We’d rather the government pay a private provider with Medicare than pay itself? Makes no sense,” he said.

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