38 U.S. Code § 1703 - Contracts for hospital care and medical services in non-Department facilities
(a)
When Department facilities are not capable
of furnishing economical hospital care or medical services because of
geographical inaccessibility or are not capable of furnishing the care
or services required, the Secretary, as authorized in section
1710 of this title, may contract with non-Department facilities in order to furnish any of the following:
(1)
Hospital care or medical services to a veteran for the treatment of—
(2)
Medical services for the treatment of any disability of—
(C)
a veteran described in section
1710
(a)(2)(E)
of this title, or a veteran who is in receipt of increased pension, or
additional compensation or allowances based on the need of regular aid
and attendance or by reason of being permanently housebound (or who, but
for the receipt of retired pay, would be in receipt of such pension,
compensation, or allowance), if the Secretary has determined, based on
an examination by a physician employed by the Department (or, in areas
where no such physician is available, by a physician carrying out such
function under a contract or fee arrangement), that the medical
condition of such veteran precludes appropriate treatment in Department
facilities.
(3)
Hospital care or medical services for
the treatment of medical emergencies which pose a serious threat to the
life or health of a veteran receiving medical services in a Department
facility or nursing home care under section
1720
of this title until such time following the furnishing of care in the
non-Department facility as the veteran can be safely transferred to a
Department facility.
(5)
Hospital care, or medical services that
will obviate the need for hospital admission, for veterans in a State
(other than the Commonwealth of Puerto Rico) not contiguous to the
contiguous States, except that the annually determined hospital patient
load and incidence of the furnishing of medical services to veterans
hospitalized or treated at the expense of the Department in Government
and non-Department facilities in each such noncontiguous State shall be
consistent with the patient load or incidence of the furnishing of
medical services for veterans hospitalized or treated by the Department
within the 48 contiguous States and the Commonwealth of Puerto Rico.
(6)
Diagnostic services necessary for
determination of eligibility for, or of the appropriate course of
treatment in connection with, furnishing medical services at independent
Department out-patient clinics to obviate the need for hospital
admission.
(b)
In the case of any veteran for whom the
Secretary contracts to furnish care or services in a non-Department
facility pursuant to a provision of subsection (a) of this section, the
Secretary shall periodically review the necessity for continuing such
contractual arrangement pursuant to such provision.
(c)
The Secretary shall include in the budget
documents which the Secretary submits to Congress for any fiscal year a
detailed report on the furnishing of contract care and services during
the most recently completed fiscal year under this section, sections
1712A,
1720,
1720A,
1724, and
1732 of this title, and section 115 of the Veterans’ Benefits and Services Act of 1988 (Public Law 100–322; 102 Stat. 501).
(d)
(1)
The Secretary shall conduct a program
of recovery audits for fee basis contracts and other medical services
contracts for the care of veterans under this section, and for
beneficiaries under sections
1781,
1782, and
1783
of this title, with respect to overpayments resulting from processing
or billing errors or fraudulent charges in payments for non-Department
care and services. The program shall be conducted by contract.
(2)
Amounts collected, by setoff or
otherwise, as the result of an audit under the program conducted under
this subsection shall be available, without fiscal year limitation, for
the purposes for which funds are currently available to the Secretary
for medical care and for payment to a contractor of a percentage of the
amount collected as a result of an audit carried out by the contractor.
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