Dear Comptroller General Walker:
The Indian Health Care Improvement Act provides direct authority for the Indian Health Service
(IHS) to collect reimbursement for health care provided to American Indians/Alaska Natives from private insurance companies and other sources. Since the enactment of the reimbursement provision, the IHS has had a very difficult time collecting from private insurance companies despite enhancements in its computerized system, the Resource Patient and Management System (RPMS).
It is my understanding that IHS has engaged in a practice of regularly writing off claims as uncollectible when claims are denied or when collection would involve considerable effort.
Given the of the IHS system and the number of patients served, I am concerned that the IHS may be potentially under-collecting hundreds of millions of dollars from private sources and that taxpayers are picking up the tab for the difference.
I request that GAO perform a study that evaluates and analyzes the following:
• IHS accounting policy for writing off accounts receivable from third-party insurance and health maintenance organizations as uncollectible and a comparison of this policy to actual practice;
• processes and internal controls over billings and collections from third-party insurance and health maintenance organizations;
• IHS claims filed with third party private insurance and health maintenance organizations since 1995, exclusive of Medicare and Medicaid claims, including the amount of denied claims and the amount of claims written off; and
• information about denied claims according to area, facility, year, private organization, and denial reason or code.
Based on the above study, I also request that GAO make any recommendations necessary to improve IHS accounting systems, policies, and collection procedures to help ensure that IHS is collecting amounts that are rightfully due from private health providers and safeguarding the federal government’s interests and financial funding for IHS programs.
Sincerely,
Max Baucus
Source: Ranking Member’s News
