Series: Duplicate Medicaid Fee-for-Service and Veterans Health Administration Payments

OBJECTIVE

Subject to a few exceptions, Medicaid is the payer of last resort, meaning that Medicaid will pay for a service only if there are no other sources of payment available. Federal law requires that if a Medicaid enrollee has any other source of coverage of funding for a service (i.e., third-party liability), that source must pay before Medicaid pays. Under the Veterans Community Care Program, the Department of Veterans Affairs (VA) enters into arrangements with non-VA providers to furnish hospital care and medical services to eligible veterans. When the VA authorizes community care services for a veteran who is eligible for both VA and Medicaid benefits, VA is solely responsible for paying for those medical services. Duplicative claims may be improperly paid by both Medicaid and VA if claims for services are billed to both programs. We will conduct a series of audits to identify duplicate Medicaid fee-for-service (FFS) and VA payments across various States. Specifically, phase 1 will include audits of States with a large population of veterans receiving community care services. In phase 2, we will perform an audit across all States to calculate a nationwide error rate for duplicate VA/Medicaid FFS payments.

There is 1 project in this series.

ACTIVE PROJECTS IN THIS SERIES (1)

Duplicate Medicaid Fee-for-Service and Veterans Health Administration Payments

Project OAS-26-09-014 • Announced on Jun 10, 2026

TIMELINE