Thursday, October 15, 2009. Chaos and violence continue, the VA appears before Congress about their billing problems, the governments of Turkey and Iraq enter into a series of agreements, charges against Syria continue to be floated by Iraqi government officials, Blackwater does a pre-trial in private, and more.
Today's hearing will focus on the inappropriate billing practices of the VA where veterans receive a bill for the wrong amount or get a bill that they should not have received in the first place," explained US House Rep Glen Nye bringing the House Veterans Affairs Committee's Subcommittee On Health hearing to order. "Unfortunately inappropriate billing effects both service-connected veterans and non-service connected veterans. For example, a veteran with a service-related spinal cord injury may be billed for the treatment of a urinary tract infection. Now the urinary tract infection may clearly be linked to and the 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 burdensome re-adjudication of their claim indicating the original service-connected ratings. It is my understanding that one of the reasons for inappropriate billing of secondary conditions is that the VA cannot store more than six service-connected conditions in their IT system. It is also my understanding that the VA 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."
Nye was bringing the hearing to order in place of Subcommittee Chair Michael Michaud. The hearing was divided into three panels. The first panel was composed of Adrian Atizado (Disabled American Veterans), Fred Cowell (Paralyzed Veterans of America) and Denise A. Williams (American Legion). The second panel was the GAO's Kay L. Daly. Panel three was composed of the VA's Dr. Gary M. Baker with the VA's Stephanie Mardon and Kristin Cunningham.
US House Rep Henry E. Brown is the Ranking Member on the Subcommittee. We'll note this from his opening remarks:
It is the solemn mission -- mission of the Department of Veterans Affairs and the federal government to care for the men and women in uniform who sustain injuries and illnesses as a result of their service to our nation; therefore, I find it deeply troubling to hear about veterans being inappropriately billed for co-payments for medical care and the medication to treat service-connected conditions. A similar issue arose earlier this year when the Obama administration was considering a plan to bill veterans private insurance for service-connected care. Fortunately, this ill-conceived proposal never saw the light of day given the fierce opposition of members from both sides of the aisle and the veterans' service organizations. As I said then, "This flies in the face of our moral obligation as a grateful nation to care for those wounded heroes."
On the first panel, Cowell noted the maze veterans go through when attempting to use the phone to address a billing issue. He noted the differing problems facing service-connected veterans and non-service connected veterans with billing errors, "Service-connected veterans are faced with a scenario where they, or their insurance company, may be billed for treatment of a service-connected condition. Meanwhile non-service connected disabled veterans are usually billed multiple times for the same treatment episode or have difficulty getting their insurance companies to pay for treatment provided by the VA." Paralyzed Veterans of America surveyed 4,000 of their members and 449 responded. Of that 449, 30% told of being "either billed directly by the VA for care that they receive or have tehir insurance companies billed for their care." From there, 22% reported their insurance companies were wrongly billed for the care or "treatment of a service-connected condtion," 17% stated they themselves were "billed directly for treatment of a service-connected condition" and 9% stated they were billed multiple times "for the same treatment episode."
Along with citing PVA's survey, Cowell shared that he himself faces these problems, "But almost every billing statement I receive has several charges that are incorrect. For several years, I simply paid these charges because I did not realize they were eroneus. For at least the past three years, I now work with my visiting nurse to review my bills for incorrect charges. She then corrects the social worker on my team and they work with the DC business office to remove incorrect charges. This is a monthly process because somehow the problem cannot be fixed on a local level and these errors continue to happen. This means that important, front-line health care workers are spending their valuable time on correcting billing issues rather than caring for veterans."
Like PVA, DVA conducted their own survey. Atizado explained that 402 members responded. 62% of respondents stated their insurance companies were "billed for their care at the VA," 43% stated they "receive bills for their care from the VA, 55% stated "that their insurance companies are being billed for treatment from VA of a service-connected condtion," and 43% stated that they were "billed for treatment at the VA for a service-connected condtion." He observed, "What is most troubling is the perception these veterans carry about the VA being indiscriminating in their billing and collections and VA being unresponsive when veterans bring their concerns to the local facility for corrective action."
Denise Williams noted the American Legion's long committment to veterans:
Denise Williams: A very notable instance where this was evident was in March 2009 when past national commander David Rehbein met with President Obama and learned that the administration planned to move forward on a proposal to charge veterans with private insurance for the treatment of service-connected injuries and illnesses at VA facilities. Under the proposed change, VA would bill the veterans' private insurance company for treatment of their service-connected disabilities. After fierce opposition from the American Legion and other veterans' service organizations, the administration dropped their plan to bill private insurance companies for treatment of service-connected medical conditions.
US House Rep Glen Nye observed, "First of all I'd just like to I want to say I appreciate Mr. Brown, the Rankig Member's comments, when he mentioned something that a number of our panelists also mentioned about the notion that the administration was kicking around earlier in the year about potentially charging veterans' private-insurance for service-connected injuries. And I want to say I was also proud to be part of that bi-partisan effort to raise the issue quickly -- along with our VSOs -- to the White House and fortunately we were able to resolve that and get that taken off the table early."
In her written opening remarks (but not in the opening remarks she delivered), Williams also noted the American Legion haa recently documented ten cases "where VA erroneaously billed service-connected veterans' private insurances for their service-connected medical care. In one case, a veteran passed away in the Tampa VA Medical Center, November 27, 2009. He was 100% service-conected for several conditions, and was also a military retiree enrolled in TRICARE for Life."
Nye asked the panel the typical amount of time their members state it takes to resolve the billing issues.
Fred Cowell: In my personal experience, I generally receive a VA billing statement three or four months from the actual date of treatment. At that point, I have to go through the bill match it -- I have learned over time to match it to a home calendar that I keep so I can track actual visit dates from my home calendars. If I notice more than one billing in that particular month, generally I get a single visit in a month from my home care nurse. Sometimes I'm bill as often as three or four times in that month for that single service. I then have to wait for the following visit which is the following month to talk with her about the issue. She checks her calendar, verifies that there is erroneous billing going on and then she goes back to the DC hospital and contacts the social worker on that team who then reviews the chart and they go up to the business office. So sometimes it can take six to eight months to get a correction for a billing error. And most months, there's more than one billing error on my -- on my statement. And we're hearing the same thing from veterans across the country, PVA members, that it takes six to eight months if they even know that there's a billing error to get it corrected.
US House Rep Glen Nye: Did you say that most months there's a billing error on your statements?
Fred Cowell: That's correct.
US House Rep Glen Nye: Alright, thank you. Mr. Atizado?
Adrian Atizado: Thank you for that question. The veterans that I ended up calling from our survey who said -- who said it was -- that it was okay for us to contact them, the reasons -- or the time runs the gamut from having it corrected within a few weeks to not being corrected at all -- to being corrected for one bill and having a recurring bill, I should say recurring inappropriate bill happen the following treatment episode or the following month. So I can certainly tell you that there's no consistency in the corrective actions. There just isn't. Some veterans have given up, some veterans will pay and some veterans will hold themselves in debt and end up having an offset put on either their compensation or their pension despite the fact that that's an inappropriate bill.
US House Rep Glen Nye: Okay, thank you. Ms. Williams?
Denise Williams: Mr. Chairman, I believe it varies based on the case. But those ten cases that we compiled in April, one of our assistant directors did follow up with the veterans and I believe there were some cases that were not resolved. And this was last week. I must say that our executive director did meet with our VA liason last week and I believe that they are working on resolving those cases so it does vary. We don't have an exact time for when they're resolved but there's still some cases out there that has not been rectified.
Kay L. Daly read her lengthy prepared remarks about . . . a 2008 GAO study. I have no idea why the members were polite and sat through that. That study's been gone over before and, check the calendar, it's 2009 -- almost 2010 (and it is fiscal year 2010). When asked questions, she repeatedly stated something was beyond her scope or she did not know but would get back to the committee. Apparently dusting off a year-old GAO report already discussed at length with Congress was all the time she had for homework and preparation. Not surprisingly, the committee didn't keep her around for long and moved on to the third panel.
Subcommittee Chair Michael Michaud: I appreciate what VA is trying to do to solve this problem; however, as you heard from the first panel, there seems to be a disconnect when you're looking at billing for service-connected disability. That's a big concern I have because, at the beginning of the year, we heard through the grapevine that this adminstration was going to go after third party collections for service-connected disability. So I'm wondering whether or not there is someone in the VA who believes that is still a good policy? And, even though they're not supposed to, that they're doing it? Unfortunately what I think happens sometimes is the veterans who -- there will be veterans who fight it, then there will be veterans who will not fight it and will actually pay and that's the big concern that I have. And I know that the GAO made seven recommendations on how the VA could correct this. Has the VA adopted all seven of those seven recommendations?
Gary Baker: Yes, Mr. Chairman, VA has provided information to GAO. As we mentioned, a meeting was held earlier last week. But we had provided written response some time ago indicating our actions on all seven activities. And we have incorporated their recommendations into our policies and practices, issued new handbooks, new policy guidelines and training and follow-up. If I might address the service-connected issue, it has never been VA's authority to bill for service-connected conditions. While I understand that there was earlier this year some discussion of changing that practice, that was never communicated to our field facilities and providers as a change in policy. And our information systems, as I indicated earlier, automatically exempt service-connected veterans who are [. . .] service-connected from co-pay billing for inpatient and outpatient care and other exemptions as they relate to eligibility. And our providers received no change of instructions in exempting veterans for treatment of their service-connected conditions. In terms of the concerns that were addressed by the first panel, in terms of billing for service-connected conditions, I wouldn't sit here and say that VA is perfect in its billing practices. Certainly there are times when we make errors. And we stand ready and willing to correct those errors. And if there are instances where we're not being timely in terms of follow-up on that, we certainly want to hear about that so that we can improve not only on individual situations but if we have a systemic problem we're more than happy to address that.
Subcommittee Chair Michael Michaud: Do you view improper billing as a problem or do you feel it's just an isolated case from what you heard from the first panel?
Gary Baker: In terms of improper billing? I think VA billed almost 16 million -- or 13 million co-pay bills last year total. I think there's a possibility that VA makes errors in making co-pay bills or in the millions of third-party bills that we make. I don't believe that we have a large-scale, systemic problem in terms of identification of service-connected conditions. But it is related to the frontline provider who delivers service identifying that the care is related or not related to the veterans service-connected condition. We recognize that there can occassionally be errors made in that situation and that there are interpretation issues that can arise [. . .]
"A plan was written, very quickly put together, uh, very short timelines," declared VA Secretary Eric Shinseki to the US House Veterans Affairs Committee yesterday as to why the VA had screwed up the payments for veterans attempting to pursue higher education. "I'm looking at the certificates of eligibility uh being processed on 1 May and enrollments 6 July, checks having to flow through August. A very compressed timeframe. And in order to do that, we essentially began as I arrived in January, uh, putting together the plan -- reviewing the plan that was there and trying to validate it. I'll be frank, when I arrived, uh, there were a number of people telling me this was simply not executable. It wasn't going to happen. Three August was going to be here before we could have everything in place. Uh, to the credit of the folks in uh VA, I, uh, I consulted an outside consultant, brought in an independent view, same kind of assessment. 'Unless you do some big things here, this is not possible.' To the credit of the folks, the good folks in VBA, they took it on and they went at it hard. We hired 530 people to do this and had to train them. We had a manual system that was computer assisted. Not very helpful but that's what they inherited. And we realized in about May that the 530 were probably a little short so we went and hired 230 more people. So in excess of 700 people were trained to use the tools that were coming together even as certificates were being executed. Uhm, we were short on the assumption of how many people it would take."
Shinseki admits, for the first damn time, that he knew the Post-9/11 GI Bill would not be ready and had even hired an outside consultant to weigh in. But he never got around to telling Congress until after -- AFTER -- veterans were suffering. And Congress never got around to be offended on behalf of veterans or on behalf of themselves.
US House Rep Corinne Brown was called out in yesterday's snapshot and deserved to be called out a lot worse. Last night, a veteran and veterans' advocate at yesterday hearing shared how disgusted he was with her remarks and asked that I add that Brown spoke as if the GI Bill was "for ex-cons. She spoke about us like we were uneducated felons who'd committed capital murder and should be saying, 'Thank you, VA, for taking pity on our criminal asses'." And he's exactly right. Brown's statements were appalling clueless and shamefully offensive. If you looked around while she was speaking, you could see the veterans and veterans families present just recoil as Brown spoke. She was also of the opinion that Shinseki was doing something wonderful and good and noble.
What world does she live in? Is she not a member of Congress? Senator Jim Webb championed the Post-9/11 GI Bill, as did others but he was a leader. Congress passed it, it became a law. The Secretary of any department following the law is not a gift and it's a damn shame Corrine Brown thought it was. A congressional aide pointed that out today, to give credit where it's due.
After Shinseki volunteered that the VA always, ALWAYS, knew this would happen, the Committee should have exploded with righteous indignation over the fact that (a) this was done to veterans and (b) the VA failed to inform Congress of what they knew. That never happened. The entire hearing was treated like a joke with jokes at the start of it. (See Kat's "House Committee on Veterans Affairs" from last night.)
Today Stephanie Herseth Sandlin chaired a Subcommitte hearing on the GI Bill. She and others did a strong job and we'll go over that hearing tomorrow but listening to her and and US House Rep John Adler have to remind the VA that they are supposed to keep Congress informed of any problems -- real or potential -- that may arise or do arise and watching VA's witnesses nod along as if they'd done that was just unbelievable. We'll cover the hearing tomorrow. In part because I'm not in the mood to go into it right now and in part because a friend who was at the hearing wants to share a few thoughts before I write it up.
Today Recep Tayyip Erdogan, Turkey's Prime Minister, arrived in Baghdad. The Pakistan Times notes that he met with Nouri al-Maliki whose spokesperson, Ali al-Dabbagh, declared that "about 50 agreements" between Turkey and Iraq "will be signed" during the visit. Pinar Aydinli, Thomas Grove, Ibon Villelabeitia and William Hardy (Reuters) note that chief among the expected agreements is one that would allow for the transporation of "Iraqi natural gas to Europe via Turkey". Hurriyet Daily News adds, "The two nations will also discuss cooperation against the outlawed Kurdistan Workers' Party of PKK, Prime Minister Erdogan said. He urged European countries to do more to combat drug smuggling by the PKK." Today's Zaman hails the meeting as "a giant step forward to boost ties" and notes agreements also cover "sharing water" before adding, "Erdogan's visit to Iraq came just days after Turkey and another southern neighbor, Syria, signed deals to create a similar mechanism of cooperation and formally abolish visa requirements on Tuesday. Foreign Minister Ahmet Davutoglu, who was one of the nine ministers accompanying Erdogan on his Baghdad visit, walked across the border with his Syrian counterpart, Walid al-Moallem, in a symbolic move underling the growing cooperation between their countries after signing the agreement to end the visa requirements and create a Turkey-Syria High-Level Strategic Cooperation Council." This comes as Alsumaira reports that Hosheyar Zebari, Foreign Minister of Iraq, announced today that talks between Iraq and Syria "to solve the security crisis have been halted" and found Zebari again declaring that the United Nations is launching an envoy mission/investigation into the bombings of Black Wednesday/ Bloody Wednesday/ Gory Wednesday. AFP quotes Zebari claiming, "What we agreed in New York, with the UN Secretary General, is the nomination of a UN employee who will make an assessment on foreign intervention in Iraq, and will also investigate the causes and consequences of the crimes of August 19." AFP notes the UN has thus far refused to confirm or deny Zebari's assertion. Jane Arraf (Christian Science Monitor) quotes Zebari declaring the meetings between Syria and Iraq ended: "After four meetings the government realized that these meetings are pointless and they have not produced any . . . tangible results or any movement." She adds any "investigation into foreign interference in Iraq would also include Iran and other neighbors but the Iraqi government has focused on the suicide truck bombs which Iraq has blamed on Baath Party extremists living in Syria." Strangely for someone claiming that an investigation would take place, Zebari also declared that if there is no special envoy, then his country would take the matter to the UN Security Council. Gina Chon (Wall St. Journal) notes that Zebari was originally advocating for an international court and the United Nations did not sign off that.
Meanwhile AFP reports that Iraq's Parliament announced yesterday the draft election law was being "delayed until next week" with claims that it will be addressed on Monday. UPI and Official Wire report the law will be addressed Saturday. However, Alsumaria reports it will be Monday and reports on the draft law amdendments:
According to the amendments, the number of lawmakers would become 311. Elections would be carried out following the province considered as one electoral district. Seats would be proportionate to the number of inhabitants according to ratio cards' statistics.
The pending issue of the open list brought up several views.
The first view: Candidacy would follow the open list system. Voters may vote to the whole entity slate, to one of the candidates on the list or to an individual candidate.
The second view: Candidacy would follow the open list system with a maximum of three candidates who should not exceed the double number of seats allocated for the electoral district. Voters may vote to the whole entity slate, to one of the candidates on the list or to an individual candidate.
The third view: Candidacy would follow the open list system with a maximum of three candidates who should not exceed the double number of seats allocated for the electoral district. Voters may vote to the whole entity slate, to at least three candidates on the list or to an individual candidate.
NPR's Quil Lawrence (Morning Edition -- link has text and audio) reports, "Parliament is now expecting to vote on the election law this Sunday, but that may again be delayed. If Iraq does not carry out elections by January, it will raise serious questions about the government's legitimacy."
Laith Hammoudi (McClatchy Newspapers) report a Baghdad roadside bombing which claimed the life of 1 person and left three more wounded, a Kirkuk roadside bombing which injured four police officers, a Mosul bicycle bombing injured three people and, dropping back to last night, a Toz Khurmatu sticky bombing which claimed the life of 1 "Kurdish security member" and left his wife and their two children wounded. Reuters notes 2 Mosul roadside bombing which resulted in the death of 1 police officer (four people left injured) and the other injured one person. Lin Zhi (Xinhua) notes a Saadiyah roadside bombing which left an Iraqi officer and an Iraqi soldier injured, a Baladruz roadside bombing that left three Iraqi soldiers injured "when a roadside bomb hit their vehicle" and a Baquba bombing near a home which injured two people.
Reuters notes 1 journalist was injured in a Ramadi attack yesterday.
Turning to the US, September 16, 2007, Blackwater shot up Baghdad. The death toll was at least 14. The press reaction was to undercount and to make jokes. No, Gwen Ifill, it is not and never will be forgotten. Pretrial hearings are taking place in DC; however, the press has been blocked from attending. Del Quentin Wilber (Washington Post) reports US District Judge Ricardo M. Urbina has shut the press and the public out of the pre-trial hearings and the judge asserts he is doing so to guarantee a fair trial:
In a letter Tuesday, The Post asked Urbina to reconsider. Post attorney James McLaughlin said the court should have put the proceedings on the open docket and given the public an earlier chance to challenge the basis for the closure of the hearing. He said concerns about the impact of pretrial publicity were "highly speculative" unless supported by factual findings in open court.
Urbina denied The Post's request. He said the rights of the five guards to a fair trial outweighed the public's interest in attending the proceedings. He said he was concerned about how news accounts of the statements might affect witnesses, some as far away as Baghdad.
Meanwhile Eric Watkins (Oil & Gas Journal) reports that the Parliament did manage to push through the legislation necessary to get 100 British soldiers back in Iraq to "protect its vital southern oil export terminals." They did that yesterday and Watkins doesn't find the offense in it. Foreign troops in Iraq are supposedly there for 'safety' but Watkins has just revealed British troops are being brought back in to protect the oil. Nouri sure is lucky he doesn't have to foot that bill too, isn't he? British soldiers? Less lucky. Mehdi Hasan (New Statesman) covers the Iraq inquiry in England. So British troops can be used to protect Iraqi oil -- their lives are judged that unimportant by the UK and corporations. In the US? Adam Lichtenheld and Ron Moore's "No Contractor Left Behind Part IV: Congress's Powerless Probe" (DC Bureau):
After a flurry of Pentagon contracting scandals involving KBR went unaddressed by Republican lawmakers under the Bush administration, Democrats ran on promises of "real and serious" oversight in their successful 2006 campaign to win back Congress.
But American soldiers poisoned by KBR in Iraq six years ago have found weak refuge on Capitol Hill. Democratic leaders have left the Qarmat Ali probe to a lone senator, Byron Dorgan (D-ND), and a largely powerless Congressional panel, the Democratic Policy Committee (DPC). Having traditionally operated as a partisan support forum, the DPC lacks the capabilities to ensure accountability for the sick veterans of Qarmat Ali -- who have struggled to afford costly medical treatments while the company that endangered them continues to reap millions of dollars in windfall profits.
It was Sen. Dorgan, the DPC's chairman, who first uncovered the Qarmat Ali incident and brought it to Congress last year. Since then, the Senate committee charged with direct oversight of the U.S. military -- the powerful and highly influential Armed Services Committee -- has largely stayed silent. When DCBureau called Armed Services chairman Sen. Carl Levin (D-Mich.), spokesman Bryan Thomas declined comment.
"I've tried to do as much as I can with the limited capacity I have," Dorgan said. "It just begs for investigation."
The Democratic Policy Committee issued the following:
(WASHINGTON , D.C. ) --- The U.S. Army is ramping up its response to the exposure of U.S. troops in Iraq to the deadly chemical sodium dichromate, U.S. Senator Byron Dorgan (D-ND) said Friday. He said it has also doubled the Army estimate of the number of U.S. troops who may have been exposed to the cancer-causing chemical from 347 to more than 1,164.
Department of Veterans Affairs is also stepping up its effort to respond to the exposures to better monitor and treat exposed soldiers.
"These are significant breakthroughs," Dorgan said Friday. "Lives will be saved because of these actions."
As Chairman of the Senate Democratic Policy Committee (DPC), Dorgan chaired hearings on the exposure, and the Army's response in June 2008 and August 2009. Multiple failures by the contractor, KBR, were revealed at the 2008 hearing. The hearing in August focused on the Army's response to the exposure and its failure to adequately monitor, test, and notify soldiers who may have been exposed of the health risks they may now face. Dorgan has been pushing the Army, and the Department of Veterans Affairs to launch a more vigorous effort to reach, warn, monitor and treat soldiers who may have been exposed to the chemical at the Qarmat Ali water treatment facility in 2003.
Dorgan released a letter Friday from Army Secretary Pete Geren who said the Army is now working to track down and notify all 1,164 exposed soldiers to alert them to the health risk they now face. Geren told Dorgan the Army is now working more closely with the Department of Veterans Affairs to ensure that VA health professionals know to be looking for sodium dichromate exposure symptoms and how to treat them.
Dorgan also released a letter from Secretary of Veterans Affairs (VA) Eric Shinseki informing him that the VA is stepping up its response to the exposure. Shinseki wrote that the VA is now offering veterans who were at the site free medical monitoring and treatment. Previously, soldiers exhibiting symptoms consistent with sodium dichromate had to prove their conditions were service connected. That burden of proof, which the VA has lifted,often delayed or prevented treatment for illnesses for which prompt and urgent treatment often means the difference between life and death.
National Guard troops from West Virginia , Oregon , South Carolina , Indiana and members of the Army's 3rd Infantry Division were among those at the Qarmat Ali site who were exposed to the deadly chemical.