Members of Congress from Virginia say chronic late payments from the Department of Veterans Affairs to doctors are jeopardizing care for the state's aging veteran population.
The state's two senators and 11 House members urged VA administrators to fix a system that can leave health-care providers waiting more than four months for payments they should have received within 30 days. The delays can damage credit, they said.
Congress created the Veterans Choice program in 2014 in response to a scandal exposing excessively long wait times at a Phoenix VA hospital that also had been a problem nationwide.
The program is intended to relieve pressure on VA hospitals by allowing veterans to receive care from private providers if they cannot book an appointment at their local VA facility within 30 days or access a facility within 40 miles of their home.
Since its inception, Veterans Choice has been hobbled by administrative errors, including tens of millions of dollars in overpayments, according to findings of the VA Office of the Inspector General.
"With many health care providers reporting accounts receivable in the millions of dollars, the level of late payments is unacceptable," the Virginia delegation wrote in an Oct. 3 letter to Secretary of Veterans Affairs David Shulkin.
Rep. Rob Wittman (R-Va.) said Congress requires VA to pay bills in a timely manner.
"Everyone else in society has to do that," he said in an interview. "If this program is going to work properly, then these bills need to be paid on time."
Wittman, chairman of the House Armed Services subcommittee on sea power and projection forces, said he has talked to the committee chairman, Rep. Phil Roe (R-Tenn.), about calling Shulkin to testify if VA doesn't reconcile outstanding bills soon. Virginia is home to 733,000 veterans.
"This is the law," he said. "This is what you're supposed to be doing. Why isn't it getting done?"
VA spokeswoman Paula Paige said in a statement, "VA appreciates the lawmakers' concerns and will respond to them directly."
She referred specific questions to a May speech by Shulkin in which he said it takes more than 30 days to process 20 percent of VA claims from 25,000 providers nationwide. An additional $50 million in charges are older than six months. He blamed the backlog in part on paperwork delays.
Community care is handled through several federal programs, making it "too complex, and it's confusing veterans and our employees alike," he said.
Riverside Health System in eastern Virginia reported that 45 percent of claims totaling $2 million went unpaid for more than 120 days. Private insurance companies as well as Medicare and Medicaid take about 60 days, said Mark Duncan, Riverside's lobbyist.
Riverside considers it an honor to care for veterans, but "we need to have the tools the resources to provide that type of service to these folks over the long term," Duncan said in an interview. "They've more than earned that service."
The letter details a case relayed by the office of Rep. Barbara Comstock (R), who represents Northern Virginia, in which a veteran was denied dentures because VA failed to pay a private provider $203,000. Comstock's spokesman said the case has been resolved.
Veterans Choice allows veterans to avoid inconvenient travel to VA facilities in Martinsburg, W.Va., or the District, but VA "must get its house in order," Comstock said in a statement.
In August, Congress approved $2.1 billion in emergency funding intended to shore up the program until February.
Last month, Sen. John McCain (R-Ariz.), chairman of the Senate Armed Services Committee, wrote a letter to Shulkin demanding a full accounting of Veterans Choice spending after the Associated Press reported that the program could face another shortfall before the end of the year.
"We said at the time that it was essential, given the growing demand for care under the Choice program, that the VA immediately correct the failures that created such a serious shortfall," McCain wrote. "It appears as if you have not done so."