Rep. Julia Brownley (D-CA), House VA Health Oversight Subcommittee
WASHINGTON, DC — Lawmakers on both sides of the aisle agree that VA is failing to adequately serve the needs of high-risk veterans seeking urgent mental health and substance abuse treatment. The department itself has admitted that it does not have the resources, at least when it comes to available beds in residential rehabilitation treatment programs (RRTP).
Legislation currently being debated in the House—the ACCESS Act—would expand community-care access for such programs, including requiring VA to set up a pilot program that would allow veterans to begin treatment at a community RRTP without a referral from VA.
This particular provision has sparked a number of op-eds, labeling it a Trojan horse designed to further turn VA into an insurer rather than a healthcare provider. This fear has escalated in recent months as the Trump administration continues its massive overhaul of federal agencies.
Democrats also are concerned that expansion of access to community RRTPs creates the potential for fraud, with disreputable facilities recruiting veterans for the purpose of exploiting their VA benefits, something that has happened to private insurers, Medicaid and other federal benefit programs.
In 2021, the owners of a South Florida rehabilitation program were convicted of bilking insurers out of $112 million for addiction treatment services that were never provided. The owners gave patients narcotics to keep them complacent and to keep them coming back to the treatment center.
Last year, an investigation by state officials into hundreds of sober living homes in Arizona found evidence that operators had submitted as much as $2.5 billion in fraudulent charges to Arizona’s Medicaid system in a scheme targeting the state’s Native population.
And in December 2024, VA’s Office of the Inspector General released a fraud alert notifying veterans that similar schemes might be targeting them.
“[We are] investigating allegations that certain drug and alcohol rehabilitation facilities or treatment centers are attempting to exploit veterans with substance use disorders for profit through various unethical and illegal practices,” the alert stated. “Recruiters are targeting veterans to use these facilities, often offering incentives and misrepresenting the services available. The facilities then excessively bill VA for unnecessary or unrendered treatment, despite providing little or no care to these vulnerable individuals.”
Veterans might make a particularly appealing target, lawmakers said, because of the department’s inconsistent fee schedule when it comes to community-based RRTPs.
“VA is reimbursing at much higher rates than the industry norm,” said Rep. Julia Brownley (D-CA), at a House VA Health Oversight Subcommittee hearing focusing on the ACCESS Act. “The average is $3,000 a day, with some getting $6,000 a day. That’s more than the average cost of care per day in the ICU.”
Veterans a Soft Target
VA has also struggled with gaps in oversight when it comes to community providers of all sorts. Combined with the financial incentive, this makes veterans a soft target for dishonest providers, Brownley noted.
VA is currently working on creating a fee schedule, which requires modifying its contracts with its community care network administrators, TriWest and Optum. According to Acting Undersecretary for Health Dr. Maria Llorente, in December VA came to an agreement with TriWest to pay RRTPs per diem instead of through multiple line items, reducing the risk of such extreme overpayments.
For some supporters of the ACCESS Act, the benefits outweigh the risks. At the hearing, Subcommittee Chair Rep. Marianette Miller-Meeks (R-IA) asked witnesses “Do you believe no care is better than care in the community?” and “How cost-effective is it if people die waiting for care in the VA?”
“VA’s current processes are not designed to provide veterans care when and where they need it. Instead, veterans are left waiting—navigating delays, bureaucratic red tape, and systemic inefficiencies that create barriers rather than breaking them down,” Miller-Meeks said. “While I believe Congress and VA have taken some necessary steps to increase access, it is not enough. We continue to hear from veterans who are turned away from the lifesaving care they need.”
