Audit of the Medical Care Collections Fund for VA-Provided Care

The VA Office of Inspector General (OIG) assessed whether VHA effectively identified opportunities to recover medical costs for veterans who received VA-provided treatment for non-service-connected conditions and who had third-party health insurance. VA’s Medical Care Collections Fund holds the amounts VA recovers from veterans’ third-party health insurers, and VA medical centers can access this fund to provide care and services to veterans. The audit team evaluated veterans’ encounters with their VA medical providers from January 2024 through August 2025 that were coded as “reasons not billable” (RNB) for all medical facilities that used the Veterans Health Information Systems and Technology Architecture (VistA) electronic health records system.

The OIG identified a discrepancy between RNB encounters in VistA and another VA system, the Corporate Data Warehouse (CDW). Although VistA is the main source for CDW, about 985,000 RNB encounters with mandatory review requirements, valued at about $1.9 billion, were in CDW but were missing from VistA RNB reports. By reviewing encounters found in CDW that were not captured by the VistA RNB reports, VHA could collect up to $480 million in additional revenue for the fund that ultimately could be used for veterans’ care. For calendar year 2024, about 53.8 percent of encounters identified in CDW with an RNB code were not on the VistA RNB reports, and about 57 percent of encounters from January through August 2025 were not on these reports.

Relying on incomplete RNB data created a risk that leaders and revenue operations staff did not have all the information necessary to make informed decisions. The acting under secretary for health concurred with the OIG’s three recommendations to improve VA’s guidance and oversight to ensure all eligible costs are recovered from veterans’ third-party insurance, which ultimately supports veterans’ healthcare services.