VA reviews paid claims to ensure payments are accurate and comply with federal requirements. One way VA does this is through recovery audits, conducted in accordance with the Payment Integrity Information Act of 2019.

Recovery audits may identify improper payments, including:

• Payments made at an incorrect reimbursement rate
• Payments for non-covered or unauthorized services
• Duplicate payments for the same service
• Payments affected by coding errors
• Recovery audit scope

Recovery audit scope 

Audits may cover VA claims paid to community providers for inpatient, skilled nursing and outpatient services as well as claims for the Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA) and the Spina Bifida Health Care Benefits Program.

Audits exclude claims paid to beneficiaries, claims where VA was a secondary payer, and pharmacy and bowel and bladder claims.

Reconsiderations and payment plans

The recovery audit contract allows providers to request reconsideration of findings through two levels of dispute, as well as alternative repayment options (e.g., compromise or payment plans). VA has retained final authority on all provider appeals.

Audit transparency and public notice

Before initiating new recovery audit efforts, VA provides public notice of audit plans to support transparency and consistency. Final audit plans are published before audits begin and include an opportunity for public comment.

Recovery audit support

VA uses a contracted vendor to support recovery audit activities. Providers may be contacted by Cotiviti GOV Services as part of this process.