good morning i'd like to go ahead and bring the subcommittee on how to order and apologize for the late start jeremy show will be with us a little bit later asked me to hear from in the meantime so thank you all for being here before we get started i'd like to ask for unanimous consent that all members may have five legislative days in which to revise and extend their remarks no objection so ordered again like to thank everyone for attending this important hearing today's hearing will focus on the inappropriate billing practices of the v a where veterans receive a bill for the wrong amount or get a bill that they should not have received in the first place unfortunately inappropriate billing affects both service connected veterans and non service connected veterans for example a veteran with a service related cord injury may be billed for the treatment of a urinary tract infection now the urinary tract infection may clearly be linked to and as a result of the service connected injury however veterans are still receiving bills for the treatment of such secondary conditions as a result these veterans may be forced to seek a time consuming and burden of their claim indicating the original service connected rating is my understanding that one of the reasons for an appropriate billing of secondary conditions is that the v a cannot store more than six service connected conditions in their  system is also my understanding that the is taking steps to correct the deficiency but the problem has not been fully resolved and our veterans continue to receive inaccurate bills non service connected veterans also encounter over billing and inappropriate charges for co payments one issue that i've been made aware of repeatedly is that some non service connected veterans receive multiple bills for a single medical treatment or health care visit it's evident that inefficiencies in the billing system exist where something is in appropriately triggering the multiple billing episodes it may be simple human error or but this has the potential of imposing an unnecessary burden on our veterans just imagine all the time that our veterans and the stress that they experience in trying to result in proper bills now one thing is clear inappropriate billing is not acceptable and we must do better by our veterans today i hope to get to the bottom of this issue will examine why veterans and their insurers are receiving inaccurate bills learn what the v a is doing to address this problem and explore how we can go to remedy the inappropriate billing but we do bring to points of concern the effects of inappropriate billing on v a s financial resources as well as the better inpatient both of which affect patient care and patient satisfaction if fis and collection of reimbursable cost is a tremendous driver local filippi that adds to their resources towards meeting the growing healthcare demands of we can save a better hour when we compare fiscal year two thousand and nine and the two thousand and ten budget estimate to those or prior years we see a dramatic increase in the medical actions for third party as well as another co payment this is concerning in light of the overall actual tax package collections that have been historically the devious concern that ever increasing budget estimates in the need of local v a facilities to meet them to ensure they have adequate resources may encourage or contribute to inappropriate billing and although it is mitigated to some extent by designating these collections as no your funds the exceedingly dramatic shifting gains and losses in these sub count can have a detrimental effect without facility by facility performance and trend data on collection inspector general to enhance revenue collections and protect against iranian billing if you continue to receive reports from our members that inappropriate billing continue to supplement the anecdotal evidence we have collected over the years davey recently conducted a survey respondents from across the nation show about forty three percent received bills for their care from v a and approximately sixty two percent had other insurance coverage being billed for v a care and we also asked if they had received more than one bill for the same treatment and about eighteen percent affirmed we then asked if they are built for treatment at the v a for service connected condition forty two percent or one hundred sixty seven better instead they are and about fifty five percent confirm that their insurance company is being billed for a service connected related treatment we understand under the law v a must bill veterans and their insurers for providing treatment for non serious connected conditions however inappropriate billing causes unto financial and emotional stress on veterans and their families the four vignettes included in my written testimony from veterans who are being inappropriately bill goes to the heart of being a veteran centric health care system what is most troubling is the perception these veterans carry about being indiscriminating in their billing and collection and v a being unresponsive when veterans bring their concerns to the local facility for corrective action now v a is not supposed to be a for profit health for health care provider but is perceived as such by our veterans and this is because in a private sector it's up to the patient to when they or their insurance are being inappropriately built we believe be held to a higher standard future inappropriate going occur again we appreciate the subcommittee's interest in this issue and we thank you for the opportunity to present our views we will appreciate your consideration of our testimony in pressing important matter to america comments when he mentioned something that i'll remember a number of our panelists also mentioned about the notion that the administration was kicking around earlier in the year potentially charging veterans private corrected at all to being corrected for one bill and having a recurring bill i should say recurring inappropriate happened the following treatment of the following so i can certainly tell you that  there is no consistency in the corrective action there just isn't some veterans have given up some veterans will pay and some veterans will call themselves in debt and end up having an offset put to avoid that billing to their third party insurance company that they be required to submit a claim for service and if that doesn't provide a particular veteran other than avoiding third party billing it certainly does create additional work for the