Healthcare Inspection Review of Inappropriate Copayment Billing for Treatment Related to Military Sexual Trauma

OHI reviewed allegations that veterans at VA Austin Outpatient Clinic (OPC) in Texas (part of Central Texas Veterans Health Care System) have been charged for treatment that was related to Military Sexual Trauma (MST) treatment. Erroneous copayments for MST-related care occurred because staff inappropriately changed patients’ copayment status from “not required to make a copayment” to “copayment required”, without reviewing for an MST designation. In addition to educating staff on the process for reviewing MSTs prior to adding charges, the standard operation procedure should require staff to establish a process to check for the practice in an established on-going quality assurance activity. CTVHCS managers cancelled all erroneous charges and refunded the patients any payments received. We recommended that the Acting Under Secretary for Health ensure: an appropriate control process or procedure is in place at all facilities to prevent erroneous copayment charges, that facility Directors educate staff on the process for reviewing for MST prior to adding copayment charges, that facility Directors include in their Standard Operation Procedure the requirement that staff review for an MST designation prior to adding charges and establish an on-going quality assurance activity to monitor the practice, and that facility Directors educate providers to not designate care or medication as related to MST unless the care or medication is provided for MST related conditions. The Acting Under Secretary for Health, VISN 17 Director, and CTVHCS Director concurred with the findings and recommendations and provided implementation plans.