Mr. ANDREWS. He has already given us the cost per day per patient for dependents in military hospitals, $34 a day.

Mr. FOGELBERG. That is right.

Mr. ANDREWS. What I am interested in is the total cost of the program to the Government. The only figures you gave were for the civilian hospitals.

Mr. WHITTEN. Off the record.

(Off the record.)

Mr. OSTERTAG. I would like to raise the question why this program, or this part of the program, should not be put together with the other program in the first place so it is all part and parcel of the same thing. I do not see how, from the standpoint of dollars and cents you can deal with it realistically the way it is presented here. Mr. FOGELBERG. The Medicare program is a part of the budget program 2400. It just happens to be a project under that budget program, so from the viewpoint of the budget program, the whole thing is together. It is just a separate project where we analyze the Medi

care program.

In another project, we analyze the cost of operating Army hospitals. That is in 2420.

In another project, 2430, we reflect costs of providing care to Army beneficiaries in the hospital facilities of other services. It is split for ease of analysis. It is under the same budget program.

Mr. OSTERTAG. You are presenting here a special project without our being able to see the whole picture of which this is only a part; is that correct?

Mr. FOGELBERG. 2440 is the total picture insofar as the Medicare program carried out by the executive agent is concerned. It is not the total picture of providing care to the dependents of the uniformed services.

In order to provide the total picture, we would have to break out of project 2420, that portion relating to dependents which is provided in Army hospitals, and also break out of the other project that portion which is provided care in other service hospitals, but still you do not have it, because the Navy and Air Force each provide care for dependents in their own hospitals.

(The information may be found on p. 261.)

Mr. FLOOD. When do we get that?

I came in here at 2 o'clock under the impression I was going to listen to a well-planned budget. We have been troubled with this program for years and now we think it is working, and today we are advised we are finally going to have a presentation on the Medicare program that will satisfy us so we will know what is going on, how much it will cost, how successful it has been, and that we do not have. Mr. MAHON. I think it has been a pretty good presentation.

Mr. FLOOD. What you have heard is. But that still is not the Medicare program. What we heard could not be improved on. The presentation was fine.

Mr. ANDREWS. I think you have heard it all except the cost that is incurred by sending patients to military hospitals. You have that on a daily basis, $34.

All you have to do is to multiply it by the number of patients you have.

Mr. FORD. That is not the responsibility of General Wergeland. Mr. FLOOD. Do not misunderstand me, I find no quarrel with the presentation. It is highly satisfactory. This is not what I thought I was going to get. That might be my fault. I do not know why the committee cannot have this arithmetical detail. It is purely arithmetical.

Mr. FOGELBERG. I just want to say this, Mr. Flood: The treatment of dependents in Army facilities has been going on for many, many years. The care in civilian facilities is a recent supplement to that. Mr. FLOOD. Nobody knows that better than we.

Mr. FOGELBERG. And because of that we have always confined our presentation to the supplemental and not the overall program.

Mr. FLOOD. You have made an excellent presentation for your assignment for today.

Now, will you some place or other add another column, in addition to your other duties, showing the figure we are looking for? We will be happy, even me.

Mr. FOGELBERG. I will try.

(The information to be supplied follows:)

Estimated total cost of hospitalized cases under Dependents' Medical Care Act, Public Law 569, 84th Cong., to Department of Defense

1 The Departments of Army, Navy, and Air Force do not maintain accounts reflecting the cost of providing care to dependents of the uniformed services in their hospitals; consequently, this estimate is based on the reimbursement rate established by the Bureau of the Budget of $34 per patient-day less the $1.75 paid by the dependent.

Based on a formula developed from a special selective study by the Bureau of the Budget to determine the Impact of a pay increase for military personnel on the medical reciprocal rates for reimbursement among the services.

IMPROPER PAYMENTS

Mr. ANDREWs. General, on page 6 you say:

When there has been an indication of improper payment, corrective action has been taken successfully. Fraudulent actions have been extremely rare. Would you elaborate on that a little? What do you mean by that? Did you overpay some hospitals, or some physicians, or surgeons? General WERGELAND. It may pertain to the hospital or physician, and if we were short, we corrected it, and if it was an overcharge, we corrected that as well.

Mr. ANDREWS. What do you mean by "corrective action has been taken"?

General WERGELAND. For example, if a doctor happened in error to overcharge a patient, we would go back through the contractor to that physician and collect this money back from him.

Mr. ANDREWS. Do you take any disciplinary action?

General WERGELAND. Usually it is not intentional. We have really had no trouble in re-collecting those things.

Mr. ANDREWS. Will you put in the record how much you have recollected in 1960 and 1961?

General WERGELAND. I think we have that. (The information to be supplied follows:)

Breakdown of collections for paid and unauthorized care

1

1 Through Dec. 31 1961. Does not include adjustments made by contractors. Source: ODMC Records.

RECEPTION OF PROGRAM BY MEDICAL PROFESSION

Mr. FLOOD. I would like to ask this-do you have any complaints from anybody who says they are 100 percent American and you are not? Do you feel socialized, or the troops feel socialized about this? Do they claim this is un-American?

Do the hospitals object to this?

Does the American Medical Association object to this?

What protests and objections are vehement and violent against this whole thing as being bad for morale, un-American and all that kind of business? Have you heard this attack lately?

General WERGELAND. No, sir. We have no such complaints at the present time. As a matter of fact, I spoke to a recent official of the American Medical Association at one of the State society meetings, and he said, "I have been everywhere, and I find no complaint against the medicare program.'

Mr. FLOOD. So the hospital administrators take the Government checks, the doctors and everybody concerned take the Government checks, there is no rejection of the checks, there is pretty generally no refusal to serve. Apparently this is a very happy program and a very worthwhile relationship insofar as the civilian components are concerned, and the patients are being treated and the Government

General WERGELAND. Right. Except in very few isolated cases. Mr. FLOOD. I would be worried about any country if I did not have that.

CASES OF FRAUD

There has been no trouble here with any conspiracy between hospitals and doctors and patients to commit fraud against the Treasury! There has been no long-range prosecution and investigations of doctors or dentists or hospital attendants or facilities that this was an invita

tion for them to engage in false claims and criminal action and raiding the Treasury, except in rare cases?

General WERGELAND. Up until March 1, 1961, I am pleased to say that we have had, out of the million cases, only 49 reported cases of fraud. We have closed and taken collection action in all those cases except two. One of those cases remaining in a sense is not fraud so we actually have $7,200 outstanding at the present time.

Mr. FLOOD. The answer to my question is no, there is no problem? General WERGELAND. No problem.

Mr. FLOOD. And you have no suggestion made by the American Medical Association, or hospital associations, or any of the patients, they consider this an outrageous invitation for all participating parties who could be beneficiaries thereof to raid the Treasury and abuse the whole purpose of the program?

General WERGELAND. No, sir.

Mr. FLOOD. And these are all American citizens in most of the States?

General WERGELAND. Yes, sir; and Puerto Rico.

CERTAIN TYPES OF CARE PROVIDED

Mr. FLOOD. What you mean by "available" facilities, the word "available" is the key word?

General WERGELAND. We would not, in any instance, admit a dependent patient to a service facility in lieu of a military patient. Military patients have preference in our hospitals, so if the military are using these hospitals, naturally the service would issue one of those nonavailability statements and the dependent patient would go to a civilian hospital.

Mr. FLOOD. With reference to the provisions of admissibility, do you treat if unfortunately an Army man would have an alcoholic dependent, or one addicted to drugs? Do we take care of what amounts to SIW's in a case of this?

General WERGELAND. We would only take care of those cases in the acute stages where they would be in danger.

Mr. FLOOD. In an emergency condition of psychoneuroses, those you would treat for 21 days?

General WERGELAND. Twenty-one days.

Mr. FLOOD. I am thinking of conditions that you would classify as an SIW. Are we responsible for venereal infections, and things like that?

General WERGELAND. If it requires hospitalization, we would be responsible if the condition was sufficiently acute to warrant that treatment. We do not have much trouble with that.

Mr. FLOOD. That does not seem to contribute much to the morale of the Armed Forces.

General WERGELAND. It is negligible as far as our dependents are concerned.

Mr. FLOOD. I want the record to show that.

Outpatient treatment means what?

General WERGELAND. Like treatment in a doctor's office.

Mr. FLOOD. You have the phrase here on page 4 "outpatient treatment for bodily injury." What does that mean?

You have an automobile accident?

General WERGELAND. Yes; an automobile accident. A youngster breaks his arm, or his collarbone. A youngster gets a cut. The youngster gets a bruise. He falls off the roof. He has a contusion. Mr. FLOOD. You come home from a party and everybody cracks up and we pay 90 percent of it?

General WERGELAND. That is right.

Mr. FLOOD. This is an interesting program.

Knowing the Army like I do, that is not going to appear. An automobile accident is an automobile accident. You do not have to go into all the details, I suppose.

General WERGELAND. In our annual report to Congress we include a table in which we show the various items by diagnosis as to what we treated and the average cost for each.

DEPENDENT DENTAL CARE

Mr. FLOOD. Do you go into dental problems? Do you have any special eye business and dental business?

General WERGELAND. We do not have dental care.

I might add at this time that 50 percent of the answers we get back from our surveys to the users of the program show they would like very much to have dental care.

Mr. FLOOD. I am sure of that.

General WERGELAND. That is not included in our program, except as an adjunct to the treatment of a medical or surgical condition. Mr. FLOOD. That does not surprise me.

Mr. FORD. There has been some talk about this dental care program. Has the Army, or any other Federal agency, ever figured out what the estimated annual cost would be for this particular program!

General WERGELAND. Yes; about 2 or 3 years ago we went into that in considerable detail and we estimated the cost to the Government of civilian dental care for the dependents of active duty personnel would have been $29 million under the program that was advocated by the dental people.

Mr. FORD. $29 million per year?
General WERGELAND. Per

year; yes, sir.

Mr. FORD. It is pointed out there would be no hospital costs involved. General WERGELAND. Dental care is almost entirely outpatient work. Mr. FORD. General, this program, after getting off at the outset in some ways a little beyond what I think the Congress intendedGeneral WERGELAND. Yes, sir.

Mr. FORD. Has now come around to a point where I think it is extremely well run and your presentation at last convinces me it is in the right proportion and handled well. I believe if it continues along this trend it will be well received by this committee and the Congress. It has had a few ups and downs. It got a black eye initially, but I think it is on the right track at present, and I want to congratulate you.

General WERGELAND. I want to add the commendation to the Surgeon Generals who have been most cooperative in connection with the program. Everybody has been, the contractors, the doctors, the hospitals everywhere.