VA reduces improper private care payments by 98%

The Department of Veterans Affairs has dramatically reduced improper payments in its Community Care Program, cutting the error rate from 78 percent in 2020 to just 2.4 percent in 2025, according to a Government Accountability Office report released Tuesday. This improvement comes even as the program's total spending has nearly tripled during the same period, growing from $9.5 billion to $25 billion as more veterans access private healthcare through VA-authorized providers.

The Community Care Program allows eligible veterans to receive healthcare from private providers in their communities when VA facilities cannot provide timely care or when veterans live too far from VA medical centers. Established nationwide through the 2018 Mission Act, the program represents one of the largest expansions of veteran healthcare options in decades, enabling millions of veterans to see civilian doctors, specialists, and hospitals while the VA covers the cost through contracted third-party administrators. The program has become essential infrastructure for veterans who face long wait times at VA facilities or who live in rural areas with limited access to VA medical centers.

The GAO report explains that improper payments occur when the VA reimburses contractors managing community care for outdated claims, incorrect reimbursement rates, payment amounts that don't match authorized services, or bills that exceed what was actually approved for a veteran's care. While these errors don't always indicate fraud, the financial waste they represent diverts resources that could otherwise support veteran healthcare. VA officials told auditors they achieved the reduction by addressing broader system and policy issues, including payment processing errors and eligibility problems that emerged during the program's rapid nationwide rollout following the Mission Act.

Despite the progress, the GAO identified ongoing vulnerabilities to fraud within the system. As recently as February 2026, a home health care company submitted fraudulent claims totaling $100,000 for services never provided to veterans, and in another case, a provider agreed to pay $3.7 million to resolve charges of fraudulent billing for medically unnecessary services. The GAO recommended that the VA develop and implement a comprehensive fraud-risk framework that identifies inherent risks, assesses the likelihood of fraud, and establishes clear risk tolerance levels. VA officials concurred with this recommendation and committed to establishing proper oversight during the ongoing Veterans Health Administration reorganization, with completion targeted for March 2028.

For disabled veterans who rely on community care for specialized treatment, mental health services, or routine medical appointments outside the VA system, these improvements matter significantly. Better financial oversight means more resources remain available for actual healthcare delivery rather than being lost to payment errors or fraud. The reduction in improper payments also suggests that the administrative systems supporting community care authorizations and claims processing have matured, which should translate to fewer payment delays and billing disputes that veterans sometimes experience when using private providers.

Veterans currently using community care or considering it should ensure their authorizations are current and that their private providers understand VA billing procedures. If you encounter unexpected bills from community care providers or notice delays in VA payment processing, contact your VA medical center's community care office or work with a veterans service organization to resolve the issue. As the VA prepares to award new community care contracts later this year, officials have committed to addressing remaining payment issues, which should further improve the reliability of this critical healthcare option for disabled veterans who depend on timely access to private medical services.