The U.S. Department of Veterans Affairs (VA) is dedicated to providing exceptional medical care to veterans. To ensure the financial sustainability of these services and to act as responsible stewards of taxpayer funds, the VA has established the Federal Medical Care Recovery Program. This program is designed to recover the costs of medical care provided to veterans when those costs are legally the responsibility of a third party, not the veteran themselves or the American taxpayer.
What is the VA’s Federal Medical Care Recovery Program?
The VA’s Federal Medical Care Recovery Program operates under the principle of subrogation. Subrogation is a legal right allowing the VA to recover medical expenses from a third party who is legally liable for a veteran’s injuries. This means if a veteran receives medical care at a VA facility for injuries caused by someone else, such as in a car accident, due to medical malpractice, or in a workplace injury covered by workers’ compensation, the responsible party or their insurance should cover the costs of that medical care.
The funds recovered through this program are reinvested directly into VA medical facilities. This supplemental funding helps maintain and improve the high standard of medical care and services that veterans rightfully deserve, ensuring that VA facilities are well-equipped and staffed to meet the healthcare needs of veterans.
How to Request VA Medical Bills for Recovery Purposes
If you are a veteran who has received care at a VA facility or through the Veterans Choice Program (now the Program of Community Care) for injuries that may be the responsibility of a third party, you may need to obtain VA medical bills for your claim. To request these bills, you will need to complete and submit a specific form provided by the VA.
To get your VA medical bills, follow these steps:
- Access the Request Form: The form you need is titled “Request for VA Billing for Care Related to Personal Injury or Workers Compensation.” You can typically find a link to this form on the VA Office of General Counsel’s website or related VA resource pages. Click here to access the form.
- Complete the Form: Fill out all sections of the form accurately and completely. This will include providing details about the veteran, the injury or illness, the circumstances surrounding the injury, and any potential third parties who may be liable.
- Submit the Form: Submit the completed form to the VA office indicated on the form or the relevant VA contact for medical billing requests.
Important Note for Camp Lejeune Justice Act Claimants: If your claim arises under the Camp Lejeune Justice Act (CLJA), please be aware that these claims are specifically against the United States government. Due to legal restrictions, the VA is prohibited from asserting a claim against the U.S. government for recovery. Therefore, the VA will not generate billing for CLJA cases, and you should not submit billing requests for these claims.
Veteran’s Duty to Notify VA: Your Responsibilities
Veterans and their beneficiaries have a crucial role to play in the success of the Federal Medical Care Recovery Program. There is a legal duty for veterans, or those acting on their behalf, to inform the VA about situations where a third party might be responsible for their medical care costs. This duty includes several key obligations:
- Provide Information: You must furnish the VA with all requested information concerning the circumstances that led to the injury or illness for which you are receiving VA care. This includes details about any potential third parties involved and any actions you plan to take or have taken against them.
- Notify of Settlements: It is essential to notify the VA if you reach a settlement or receive a settlement offer from a third party related to your injury or illness.
- Cooperate with VA Claims: You are required to cooperate with the VA in the pursuit of any claims or legal actions the U.S. government may take against a responsible third party to recover medical costs.
How to Fulfill Your Notification Duty:
- Initial Notification: Completing the “Request for VA Billing” form serves as your initial notification to the VA regarding a potential third-party liability situation. Ensure you fill out all sections of the form thoroughly.
- Ongoing Duty: Your duty to inform the VA is ongoing. You must keep the VA updated about any settlements, settlement offers, or any developments in your case. You can notify the VA case manager assigned to your case, whose contact information will be provided in the VA Notice of Claim.
For a more detailed understanding of your notification responsibilities, you can review the Federal Register Notice related to notification, cooperation, and verification in claims arising from torts. Access the Federal Register Notice here.
Timely Notification: When Should You Inform the VA?
It is crucial to notify the VA as soon as you become aware of circumstances where a third party may be responsible for your injury-related medical care costs. Prompt notification is essential because veterans receiving VA care have a legal obligation to cooperate with the VA in recovering taxpayer money from liable third parties. This duty to notify and cooperate is continuous from the moment you become aware of a potential claim.
VA Participation in Multidistrict Litigation (MDL)
The VA actively participates in multidistrict litigation (MDL) cases. MDLs often arise when numerous plaintiffs are injured in a similar manner by a defective product, hazardous substance, or widespread disaster. These mass tort litigations involve large groups of individuals claiming injuries from commercial products or events. The VA’s involvement in MDL ensures that its rights to recover medical costs are protected in these large-scale legal proceedings.
Obtaining Bills for CHAMPVA Beneficiaries
The Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA) provides healthcare benefits to family members of certain veterans. If you need to request medical bills for care provided under the CHAMPVA program, you must use a separate request form and process.
Click here to access the CHAMPVA Request for VA Billing form.
When requesting CHAMPVA billing, it is vital to submit all information related to the CHAMPVA beneficiary, not the veteran, to ensure your request is processed efficiently. Submitting complete and accurate information to the correct VA office will help prevent delays in processing your request. It is important to note that this specific office handles CHAMPVA billing requests and is not the correct point of contact for bills related to care directly provided or paid for by a VA Medical Center. For those bills, follow the standard request process mentioned earlier.
Accessing VA Medical Records
To obtain your VA medical records, you need to submit a separate request directly to the VA Medical Center where you received care.
Click here to access the Request for VA Medical Records form (VA Form 10-5345).
You can find contact information for specific VA Medical Centers through the VA facility directory. Access the VA Medical Center Directory here.
Following Up on Your Billing Request
After submitting your request for VA medical bills, please allow adequate processing time. Unless you have an urgent legal deadline, such as a mediation, trial date, or court order, it is recommended to wait at least 60 days from the date of your complete submission before following up on your request.
If you have not received your billing after 60 days, you should contact the Facility Revenue staff at the VA Medical Center that provided or paid for your care. Click here for a list of 60-day follow-up phone numbers.
Once you receive your billing, your primary contact for any further questions or issues will be the Case Manager from the Revenue Law Group, whose details will be provided in the Notice of Claim and ledger of billed charges.
Frequently Asked Questions about VA Medical Care Recovery
Q: Why is the VA seeking reimbursement for my medical care? Aren’t veterans entitled to free medical care?
While veterans are entitled to medical care, this does not mean it is without cost in all situations, especially when a third party is legally responsible for the injuries requiring that care. The VA is obligated to recover costs when certain third-party payers are responsible. These payers include:
- Tortfeasors and Their Insurers: This commonly includes auto insurance, medical malpractice insurance, and homeowner’s insurance in cases of accidents or negligence.
- Veteran’s Own Insurance: This can include your own auto insurance (including no-fault or personal injury protection coverage), and underinsured or uninsured motorist coverage.
- Workers’ Compensation Insurance: For work-related injuries or illnesses.
- Maintenance and Cure in Admiralty: In maritime law cases for seamen injured in the course of their duties.
It’s important to understand that VA reimbursement from these sources does not change a veteran’s responsibility to pay any applicable VA co-payments for their care. The legal basis for the VA’s recovery program is found in 38 U.S.C. § 1729 and 42 U.S.C. § 2651, as well as 38 C.F.R. § 17.47.
Q: What if my service-connected condition was worsened by an accident? How does this affect VA reimbursement?
If you have a service-connected condition that is aggravated or exacerbated due to an accident or incident, the VA may still seek reimbursement for the additional care costs directly related to the accident. Care for the underlying service-connected disability itself is generally not reimbursable unless the accident caused a need for further treatment beyond the baseline care for the service-connected condition. In these cases, the third-party payer responsible for the accident would be responsible for reimbursing the VA for the extra costs incurred due to the accident-related aggravation. This is also governed by 38 U.S.C. § 1729 and 42 U.S.C. § 2651.
Q: Will the VA file its own lawsuit to recover costs?
Generally, no. While the government has the legal right to file its own lawsuit, intervene in an existing case, or remove a case to federal court, the VA typically asserts a subrogation claim within the veteran’s existing personal injury or workers’ compensation case. This approach allows the VA to work collaboratively with the veteran, who retains control over their primary case. The VA’s preference for subrogation is in line with 38 U.S.C. § 1729 and 42 U.S.C. § 2651.
Q: How are VA medical charges calculated?
VA medical charges are determined according to federal law and regulations, specifically 38 C.F.R. § 17.101(a)(2). The regulations provide formulas that take into account the type of care provided, the geographic location of the VA facility, and other relevant factors. These rates are published in the Federal Register and are judicially noticed, meaning courts recognize them as established legal facts (44 U.S.C. § 1507). State courts are also bound by judicial notice of federal laws and regulations. VA billing rates are not subject to challenges based on arguments of unreasonableness or arbitrariness (U.S. v. Jones, 264 F.Supp. 11 (E.D. Va. 1967) and Phillips v. Trame, 252 F.Supp. 948 (E.D.Ill.1966)).
Q: How do I understand the charges listed on my VA billing ledger?
The VA billing ledger contains detailed information about each charge. Key columns include:
- Account ID: A unique identifier for each charge, indicating the VA Medical Center and a specific charge sequence. The VA facility’s zip code is important for charge calculation based on geographic rates.
- Service Date: The date the medical service was provided.
- LOS (Length of Stay): Relevant for inpatient charges, indicating the number of days for per diem calculations.
- Bill Classification: A shorthand code for the type of bill (e.g., RX for pharmacy, OUTP for outpatient, INP for inpatient).
- Bill Type: Describes the category of charges (e.g., Pharmacy, Outpatient Facility, Professional charges, Inpatient Facility charges). Note that facility and professional charges are often billed separately.
- Provider Name & Provider Taxonomy: Information about the VA medical provider who rendered or referred the service.
- Primary Diagnosis: The primary diagnosis code determined using standard medical coding practices.
- Billed CPT/HCPCS Code(s): Procedure codes used for charge calculation.
- Billed DRG: Diagnosis Related Group code, used for inpatient facility charge calculation.
- Billed Charges: The calculated charge amount as per federal regulations (38 C.F.R. § 17.101).
Q: What if I want to dispute a charge on my VA notice of claim?
If you believe any charge on your VA notice of claim is incorrect, you must submit timely written documentation explaining your dispute to the Revenue Law Group team member identified in your notice of claim. The Revenue Law Group will review your dispute and notify all relevant parties of the resolution.
Q: Is it possible to request a compromise or waiver of a VA subrogation claim?
Yes, if there are insufficient settlement funds to cover all claims, you can request a compromise or waiver of the VA’s subrogation claim. To do so, you need to provide specific information to the Revenue Law Group team member assigned to your case, including:
- Settlement amount.
- Details of all insurance coverage.
- Attorney’s fees and costs.
- Amounts of other medical claims and any reductions negotiated.
- Any other factors you want the VA to consider, such as veteran co-payments.
Requests for compromise or waiver are subject to approval by the Department of Justice for claims between $300,000 and $1 million, and by the Office of the Attorney General for claims exceeding $1 million. The Revenue Law Group will inform you of the decision after the review process.
Important Advice Regarding VA Claims: A payment to you or a release from you does not extinguish the VA’s claim. The VA’s claim must be settled at the time of settlement distribution. Always contact your VA case manager before settlement to confirm the final VA claim amount. Any payment less than the full VA claim amount requires approval from the VA Office of General Counsel Revenue Law Group. Depositing a partial payment by the VA does not constitute approval of a reduction or compromise of the full claim, and any outstanding balance remains due.
