Summary

Military Treatment Facilities: Eligibility Follow-up at Wilford Hall Air Force Medical Center

GAO-03-402R  April 4, 2003

Full Report (PDF, 13 pages)   Accessible Text   

In October 2002, we reported the results of our audit of selected internal control activities at three military treatment facilities: Eisenhower Army Medical Center, Augusta, Georgia; Naval Medical Center-Portsmouth, Portsmouth, Virginia; and Wilford Hall Air Force Medical Center, San Antonio, Texas. As part of our work for that report, we requested data files of all patients who had been admitted, treated as outpatients, or received pharmaceutical benefits during fiscal year 2001. Despite considerable effort by the three facilities, only Wilford Hall Air Force Medical Center was able to provide a file of beneficiaries who received pharmaceuticals during the year. We compared this file to data in the Social Security Administration's (SSA) Death Master File as a technique to identify instances of potential fraud or abuse. For Wilford Hall, we identified 41 cases in which a prescription was ordered for an individual after the date of his or her death as recorded in the SSA Death Master File. Congress requested that we determine whether individuals fraudulently obtained pharmaceuticals or other health benefits by assuming the identity of a dead person, and, if so, to identify the specific breakdowns in internal controls that allowed such fraud to occur. We confined our investigation to the 41 cases described above.

We did not find indications of individuals fraudulently obtaining health care benefits in our examination of the 41 cases we identified of people receiving treatment after they were listed in SSA's Death Master File. In 40 of the 41 cases, data entry errors and/or internal control weaknesses at either SSA or at the military treatment facilities created the impression that a deceased person had received prescriptions. Of the 40 cases, 10 were instances in which SSA's Death Master File had incorrectly listed as deceased the individual on whom a prescription was dispensed and 30 resulted from Department of Defense (DOD) data entry errors.

Subject Terms

Fraud
Health care services
Internal controls
Medical records
Military facilities
Defense Enrollment Eligibility Reporting System
SSA Death Master File
DOD Composite Health Care System