"For example, we found that 10% of dual enrollees exclusively received care in the VA and that approximately half of outpatient encounters for the dually enrolled population took place in the VA. Medicare might reconsider the current practice of fully funding managed care plans on behalf of beneficiaries who primarily receive care in the VA," the JAMA report says.
Kizer says that during his years heading the VA, he and others tried to change the system to allow the VA to recoup some costs of actually providing the care when other providers and health plans were collecting the payment. It never went through, he says, in part because back then the amounts were only about $200 million a year.
Kizer emphasizes that the veteran has earned the right to use either the VA system or the Medicare Advantage system, "and it would be wrong to penalize them or in any way hurt them. But that doesn't mean the government shouldn't find a way to reduce payments so they're not wasting so much money."