WASHINGTON — Hundreds of thousands of veterans could be eligible for sizeable reimbursements of unpaid medical bills if a new class-action lawsuit against the Department of Veterans Affairs is successful.
The move comes amid an eight-year fight between VA and veterans advocates over who should foot the bill for emergency medical care. It also follows a federal court ruling in August which for the first time allowed veterans to file suit against the department as a class rather than individuals.
The size of the class in the latest lawsuit has yet to be established. But officials from the National Veterans Legal Services Program, who filed the legal action, say in the last eight years more than 700,000 individuals may have incurred medical expenses that should have been covered by VA administrators.
“It is a travesty to see the VA continuing to deny these benefits to needy veterans,” said attorney Bart Stichman, executive director of NVLSP.
This is the second lawsuit the group has filed over violations of the Emergency Care Fairness Act of 2010. The first was on behalf of Air Force veteran Richard Staab, who was saddled with $48,000 in unpaid medical bills from emergency heart surgery after VA refused payment because his secondary insurance covered part of the procedure.
Department officials argued in court that the additional insurance coverage eliminated their obligation to pay for the veterans’ health care costs, even if that left individuals with hefty medical expenses.
The U.S. Court of Appeals for Veterans Claims in 2016 ruled against VA, requiring them to step in and cover those emergency costs. VA officials issued a new rule in January to comply with that decision, but said it would only cover limited emergency room costs that happened since the appeals court ruling.
But NVLSP officials say even within that limited window, the department is still refusing to cover reasonable costs of veterans who are forced to seek emergency care.
The lead plaintiff for the new lawsuit is Coast Guard veteran Amanda Wolfe, who underwent an emergency appendectomy in September 2016. The procedure was done at a hospital near her home, rather than the VA medical center three hours away.
Her private-sector health insurance covered about $20,000 in medical costs but still left her with about $2,500 in expenses. VA officials refused payment, saying those costs were her responsibility for copayments, deductibles and other private-sector fees.
Her lawyers argue that if she had risked traveling to the VA facility for surgery, or if she had opted not to get any private-sector coverage, VA would be responsible for the whole cost of the procedure. But by using private insurance for some of the costs — and saving the federal government money — she is being punished.
"This is a violation of the law,” Stichman said, adding the new VA rule amounts to “paying veterans pennies on the dollar” for their legitimate costs.
Court officials will have to determine in coming months whether the NVLSP arguments for recognition of a class of veterans eligible for damages is warranted. If so, it could be the first ever sanctioned by the U.S. Court of Appeals for Veterans Claims.
In the past, VA officials have estimated they could be saddled with up to $10 billion in emergency room costs if they are forced to cover all gaps in veterans’ private-sector insurance policies, an expense that could adversely harm medical care throughout the department.