VA Billing Reports Left Out 985,000 Patient Visits Worth $1.9 Billion; Up to $480 Million Could Have Been Collected From Insurers, Inspector General Says

The Department of Veterans Affairs' billing-review reports left out about 985,000 patient encounters, valued at about $1.9 billion, that VA policy required staff to recheck before treating them as not billable to private insurers, the VA Office of Inspector General said in an audit released Oct. 26.

By law, VA can bill a veteran's private health insurance for treatment of conditions that are not connected to military service. That money goes into VA's Medical Care Collections Fund, which medical centers can use to pay for veterans' care. The fund collected $3.8 billion in fiscal 2024 and $4.6 billion in fiscal 2025, according to the report.

VA Billing Reports Missed Most Coded Visits

Auditors reviewed visits from January 2024 through August 2025 that staff had coded as "reasons not billable." Revenue staff use reports from VistA, VA's older electronic health record system, to recheck those codes and catch visits that should have been billed.

The inspector general compared those reports with VA's Corporate Data Warehouse, which draws mainly on VistA data. About 12.6 million of the 23.5 million visits with a not-billable code in calendar 2024, or 53.8 percent, were not on the VistA reports. From January through August 2025, about 8.6 million of 15.3 million, or 57 percent, were missing.

Because those visits were not on the reports, "revenue operations staff could not perform the second-level review required by VHA policy," the report says.

For visits that did appear, the audit found the coding largely accurate: staff correctly marked an estimated 99 percent of 2024's not-billable encounters, about 23 million of 23.2 million, the report says.

Up to $480 Million, With Conditions

Using figures from the Veterans Health Administration, the inspector general calculated that VA "could have collected up to $480 million in revenue" for the missing visits during the audit period. That estimate assumes the care was for conditions unrelated to military service, was eligible for insurance billing and involved veterans with billable insurance.

The inspector general said it "could not claim a reasonable monetary benefit for these encounters," because revenue staff told auditors they do not track how many wrongly coded visits could be corrected and billed. The report lists no questioned costs.

The audit notes this is not the first time the office has found missed billing. A 2012 inspector general report found VA did not effectively identify care that could have raised its revenue by at least $152 million a year from 2010 through 2014.

VA Agrees to Fix the Reports

The inspector general said it briefed VA health and technology officials in December 2025 and again in July 2026. Officials acknowledged the data were missing, and in July 2026 said they were still working to find the root cause.

The acting under secretary for health agreed with all three recommendations in a Sept. 2 memo. VA said revenue staff will work with its technology office to find out why the reports miss visits, build a new report using Corporate Data Warehouse data, and use that data to review visits with mandatory and high-risk codes. The inspector general said it will close the recommendations once VA shows the fixes are in place.

VA is moving from VistA to a new federal electronic health record, with full rollout expected in 2031, according to the report.

Sources: VA Office of Inspector General, "Audit of the Medical Care Collections Fund for VA-Provided Care," Report 25-00148-252, Oct. 26, 2026 (PDF): https://www.vaoig.gov/sites/default/files/reports/2026-10/vaoig-25-00148-252-final.pdf ; report page: https://www.vaoig.gov/reports/audit/audit-medical-care-collections-fund-va-provided-care ; Cover photo: Veterans Administration Building, Washington, D.C. (G. Edward Johnson, CC BY 4.0, via Wikimedia Commons)