​The Veterans Health Administration (VA) has announced the agency is starting recovery audits for community care claims submitted for Veteran and beneficiary care. 

Since Community Care Network (CCN) contracts include their own requirements for recovery/recapture audits, CCN claims are excluded from the scope of this contract. 

The audits, which cover claims submitted from 2024 – 2029, are required by and support the Payment Integrity Information Act of 2019. As part of the audit process, impacted providers may hear from Cotiviti or Machinify, who are performing the reviews on behalf of the VA. 

What to expect if selected:

Audits will focus on claims for inpatient, outpatient, and skilled nursing facility. 
Claims paid to beneficiaries, secondary payer pharmacy claims, and bowel and bladder claims are excluded. 
The VA Financial Services Center will oversee any validated overpayment collections. 
Providers may request reconsideration of findings or explore repayment options. 

The contract is at no cost to the VA; Cotiviti will be paid a percentage of the recovered funds. A portion of the recovered funds will be returned to the authorizing VA Medical Centers (VAMCs) but must be used for the original purpose and fiscal year in which it was originally obligated. The VA will conduct quarterly reviews to validate the accuracy of the audit findings. 

Before the start of each new audit, Cotiviti will post a preliminary audit plan to their public-facing website for 30 calendar days for public review and comment. VA and Cotiviti will review comments and make appropriate adjustments before the plan is finalized. The final audit plans will be posted to Cotiviti’s public website before each audit begins. 

Providers can reach Cotiviti at 855 287 1667 (Monday-Friday, 9 a.m. – 8 p.m. ET). Machinify contact details will be shared once they are available. 

More information about the VA recovery audits may be found here.

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