Defense Health Care: Reimbursement of Hospitals Not Meeting CHAMPUS Copayment Requirements
Abstract
For nearly 2 years, the Civilian Health and Medical Program of the Uniformed Services (CHAMPUS) denied payments totaling about $615,000 to a heart and lung hospital because it did not bill patients for their shares of the hospitals charges. Although the hospital bills patients' insurance companies and federal health programs, it has a long-standing policy of not billing patients for medical services, regardless of their ability to Pay. The Congress became concerned that CHAMPUS'S denial of this hospitals medical claims would unjustly deplete the hospital's endowment and deprive patients of needed medical services. Accordingly, it enacted legislation requiring that in fiscal year 1987, CHAMPUS reimburse the claims of heart and lung hospitals that (I) impose no obligation on patients to pay and (2) receive a specified portion of their operating funds from charitable contributions. Later legislation extended the requirement through fiscal year 1988. Public Law 100-180, enacted on December 4, 1987, required GAO to review the practices under various insurance plans and federal programs with respect to payments for charges for medical services to hospitals that do not impose a legal obligation on patients to pay for such services. GAO was also required to evaluate CHAMPUS practices regarding such payments and to make recommendations it considered appropriate for changing these practices.
Document Details
- Document Type
- Technical Report
- Publication Date
- Jun 01, 1988
- Accession Number
- AD1150515
Entities
People
- Lawrence H. Thompson
Organizations
- United States Government Accountability Office