Chairman Takano, Ranking Member Tester Urge VA to Quickly Implement Court Decision & Reimburse Veterans for Emergency Care Claim Errors

U.S. Court of Appeals demands VA reimburse billions of dollars to veterans whose emergency care was only partially covered by other insurance

WASHINGTON, D.C. – House Committee on Veterans’ Affairs Chairman Mark Takano (D-CA) and Senate Committee on Veterans’ Affairs Ranking Member Jon Tester (D-MT) applauded this week’s federal court ruling in Wolfe v. Wilkie, which found the Department of Veterans Affairs (VA) unlawfully denied payment for hundreds of thousands of veterans whose other health insurance did not fully cover emergency care they received at non-VA facilities.

Chairman Takano and Ranking Member Tester today urged VA to expeditiously reimburse veterans for all past and future claims, notify previously affected veterans of their appeal rights, and correct future notices it sends to veterans about these claims.  

“We applaud the federal court’s decision this week— by siding with our veterans, we are finally getting justice for those who were saddled with unfair financial burden after receiving emergency healthcare,” said Chairman Takano and Ranking Member Tester. “We demand answers from VA as soon as possible to explain how many veterans are affected, how VA intends to comply with the Court’s order, and what additional resources—if any—Congress will need to provide for the Department to carry this out. VA must drop its fight and implement the Emergency Care Fairness Act of 2010 as Congress has always intended.” 

This decision marks the second time since 2016 that the court has struck down VA’s regulation, reaffirming VA must step in as a “secondary payer” to prevent emergency medical expenses from being unfairly passed on to veterans when their non-VA health insurance doesn’t cover the full cost.

In its scathing decision, the U.S. Court of Appeals for Veterans Claims wrote, “Even after [our previous decision], VA was affirmatively informing veterans that they were not entitled to reimbursement for non-VA emergency medical care if they had any insurance covering the service at issue. In other words, the Agency was telling veterans that the law was exactly opposite to what a Federal court had held the law to be.”

Last month, Takano, Tester, and 33 other members of Congress sent a bipartisan, bicameral letter to the Secretary of Veterans Affairs after a damning VA Office of Inspector General (OIG) report found that VA had inappropriately rejected or denied emergency care payments for about 60,800 veterans during a 6-month period in 2017. The OIG found that VA likely should have paid claims for about 17,400 these veterans. In light of this week’s federal court ruling, the number of veterans who have incurred unnecessary financial burden could be in the hundreds of thousands, and based on past VA estimates, the Department will be required to pay between $1.8 billion and $6.5 billion in reimbursements for claims filed between 2016 and 2025.  

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