Medicare Advantage: Action Needed to Ensure Appropriate Payments for Veterans and Nonveterans
Abstract
Veterans enrolled in Medicare can also enroll in the VA health care system and may receive Medicare-covered services from either their Medicare source of coverage or VA. Payments to MA plans are based in part on Medicare FFS spending and may be lower than they otherwise would be if veterans enrolled in Medicare FFS receive some of their services from VA. Because this could result in payments that are too low for some MA plans, CMS is required to adjust payments to MA plans to account for VA spending, as appropriate. CMS determined an adjustment was needed for 2017, but not for 2010 through 2016. GAO was asked to examine how VA's provision of Medicare-covered services to Medicare beneficiaries affects payments to MA plans. GAO (1) estimated VA spending on Medicare-covered services and how VA spending affects payments to MA plans and (2) evaluated whether CMS has the data it needs to adjust payments to MA plans, as appropriate. GAO used CMS and VA data to develop an estimate of VA spending on Medicare-covered services. GAO reviewed CMS documentation and interviewed CMS and VA officials.
Document Details
- Document Type
- Technical Report
- Publication Date
- Apr 01, 2016
- Accession Number
- AD1152473
Entities
People
- Christina C. Serna
- Christine Brudevold
- Christine Davis
- Dan Lee
- Elizabeth T. Morrison
- Gregory Giusto
- Jacquelyn N. Hamilton
- James Cosgrove
- Luis Serna
Organizations
- United States Government Accountability Office