H.R. 9466: Foreign Medical Program Integrity and Improvement Act

This bill would change how the Department of Veterans Affairs (VA) administers the Foreign Medical Program, which helps certain veterans get medical care outside the United States. Its main purpose is to tighten oversight, reduce improper payments, and improve claims handling.

Payment rules

The bill would require the VA to generally pay the lower of:

• the amount billed by the provider, or
• the Medicare rate the U.S. government pays for the same type of care or service.

The VA Secretary could still approve a higher payment if needed to make sure a veteran can get care, including emergency care.

Payments involving deceased individuals

The bill would prohibit use of federal funds to pay for care or services if the claim involves someone listed in the federal Death Master File, and it would also bar payment for services provided by someone listed there after that person's date of death. In practice, this is meant to stop payments connected to deceased patients or deceased providers.

Fraud, waste, and abuse controls

If the VA suspects a claim involves fraud, waste, or abuse, the bill would require the VA to:

• refer the claim to the VA Inspector General,
• be allowed to hold payment while the claim is investigated,
• pay the claim promptly if the Inspector General finds it is proper, and
• deny the claim and try to recover money already paid if the claim is found to be improper.

The bill would also require the VA to keep a list of providers who have submitted fraudulent claims. The VA could not use federal funds to pay those providers for care under this program. Each time a provider is added to the list, the VA would have to send the list electronically to veterans enrolled in the program.

New oversight role

The bill would require the VA to designate a Fraud Detection and Prevention Coordinator to carry out the fraud-related and deceased-claim rules.

Claims administration and contracting

The bill would allow the VA to contract with a third party to serve as a claims administrator for this program. It would also allow the VA, on a temporary basis, to contract for access to an information technology system to help administer claims. If the VA uses that authority, the system would have to be fully implemented within one year of enactment.

Relevant Companies

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