Overlapping Inpatient Treatment Expenditures for DOD Beneficiaries Enrolled in Medicare Health Maintenance Organization Plans

EXECUTIVE SUMMARY:

This Department of Defense (DOD) OIG review, with assistance from the HHS OIG, was made as part of the HHS OIG's partnership initiatives to expand audit coverage of the Medicare and Medicaid programs. The DOD OIG's report points out that military treatment facilities provided inpatient treatment to dual eligible beneficiaries who were also enrolled in Medicare's risk-based health maintenance organizations (HMO). As a result, the DOD expended about $45.2 million in Fiscal Year 1997 for inpatient care for DOD dual eligible beneficiaries on whose behalf the Health Care Financing Administration (HCFA) made per capita payments to HMOs. The DOD OIG recommended that DOD consult with HHS and the Office of Management and Budget to develop a strategy, including potential legislative action, to reduce or eliminate overlapping expenditures for DOD beneficiaries, age 65 and older, who are enrolled in HMO plans and provided access to military treatment facilities. We fully support the DOD OIG recommendation and encourage HCFA to work with DOD to eliminate these duplicate expenditures of Federal funds.

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