As part of its response to the massive VA fraud scandal, the Department of Defense (DoD) has instituted several measures to curb the spread of military health insurance fraud.
One such measure, announced in September, is the creation of the Military Health Fraud Investigations Team.
In a statement, the DoD stated, “Our new team is being set up to investigate allegations of military healthcare fraud, including claims for benefits and expenses that are denied by VA, and to protect DoD employees and retirees who may have been exposed to the risk.”
The team will consist of a deputy director, an assistant director, a civilian investigator, and a career official who will serve as liaison to the VA on investigating and prosecuting these cases.
Additionally, a “security officer” will be appointed to assist with oversight of the team and conduct security reviews of potential instances of fraud.
The newly created team is expected to be operational within 180 days.
In the statement, VA Secretary David Shulkin noted, “We will work to keep our team working to detect, investigate, and deter military health fraud.
I am confident that this effort will reduce the likelihood that any further fraudulent claims will be made by DoD.”
According to a December 27, 2018, report by the Government Accountability Office (GAO), the Department was able to identify 6,800 fraud cases during FY2018.
Of these, the report states, “VA found 5,000 cases involving military personnel who reported they had been denied medical benefits and other benefits for illnesses.”
In the case of one fraudulent claim, the government discovered the identity of the claimant was not known.
In an April 24, 2018 report by The Hill, an unnamed senior government official told the committee that there are “hundreds of fraud cases in the Department that are ongoing and we do not know the identity” of the whistleblower who made the allegation.
“There is a very high risk of the military going after whistleblowers, and we have to do a better job,” the official told committee members.
“I am concerned that the military will be more willing to go after whistleblowers than the civilian government.”
The GAO report also said that there were “signs of a potential increase in the use of the government-run DoD health care website and other online health care providers” that were used to create fraudulent claims.
According to the report, the Pentagon “is also in the process of building a new health care information system that will be used by military employees and contractors.”
The Pentagon has stated that it “does not believe the current system is adequate to ensure the security of DoD personnel or contractors.”
In an interview with the committee, a Pentagon official stated, “[VA] is using the DoDE [Department of Defense Information Technology] system, which is not as secure as the current VA system.
The military is using that system, so they can access the data from that system.”
However, the official continued, “the DoDE system does not have the capacity for security.”
According a December 19, 2018 statement from the Department, “In the case where a civilian employee is the primary claimant, VA has determined that they should be paid as a contractor, rather than a DoD employee.”
VA has also said it will no longer investigate any instances of “malicious activity” by a civilian worker or contractor.
However, an official with the VA’s Fraud Prevention and Response Directorate told The Hill that “VA has made no decision on whether it will continue to investigate or prosecute a contractor for any fraudulent claims made on DoD data.”