Veterans
Aim to improve care, health outcomes and continuity while reducing avoidable delays and payment burden.
Government programs · Concept for discussion
Foreign Medical Payment Integrity & Veteran Protection Program
CRUM-FCI™ · Foreign Care Integrity & Value Program
A proposed intelligence and control layer for Veterans and VA, with modular engines that support care quality, Veteran outcomes and payment integrity within existing VA workflows.
A Veteran’s perspective
Better care. Better outcomes. A better life for Veterans.
Our mission begins with the Veteran whose health depends on what happens between an appointment, a claim and reimbursement. We want to improve that entire journey—helping fellow Veterans access appropriate care and giving providers useful feedback about the care they deliver.
Alongside clinical evidence and patient-reported outcomes, billing information can help build a report card of care: Was the treatment appropriate? Is there a better option? Where are there gaps in quality, follow-up or local access? The goal is to help qualified teams improve care, address poor performance and explore how effective treatments could become available closer to Veterans abroad.
Success means meaningful, repeatable improvements in Veterans’ health and lives, with less waste and stronger accountability. We want to help raise the standard of care around the world and honor the sacrifices Veterans have made.
Patient-first decision support: CRUM-FCI is proposed as support for care quality and payment integrity. It would not automatically deny Veteran claims. Billing codes or risk scores alone cannot establish care quality; clinical judgment, explainable findings and accountable human review remain essential.
A clear purpose
Verify the Veteran. Verify the care. Verify the provider. Verify the code. Verify the price. Then pay.
CRUM-FCI would provide an intelligence and control layer alongside VA’s existing adjudication and payment systems. Its engine modules would organize evidence, identify gaps and explain findings for authorized reviewers. VA would retain its existing payment infrastructure and final decision authority; CRUM-FCI would neither replace payment processing nor automatically approve or deny claims.
Veteran & Foreign Provider → CRUM-FCI intelligence & control layer → Existing VA adjudication & payment
Proposed engine modules cover coding integrity, clinical validation, provider integrity, IFMA pricing analysis, payment-integrity checks, fraud/waste/abuse analytics, Veteran outcomes and care continuity. Together, they would provide explainable review findings and a clearer view of the Veteran’s care. Implementation would require agreed rules, validation and agency authorization.
Fair payment. Measurable care. A record that follows the Veteran.
Proposed IFMA approach
Allowable payment = appropriate local-market benchmark + justified quality/complexity adjustment, subject to applicable VA/FMP rules.
This is a proposed analytical reference for agency evaluation, not an established VA payment formula or a replacement for VA’s payment rules. Benchmarks and adjustments would need documented evidence and approval under the applicable rules; the responsible agency retains payment authority.
Measure the care and the Veteran’s experience
The proposed approach would connect pricing review with measurable care outcomes: the Veteran’s starting condition, treatment goals, progress, follow-up and reported experience. Under an agreed governance arrangement, VA could define and monitor these measures to identify opportunities for better care and more consistent outcomes across countries.
A health record built around the Veteran
A proposed longitudinal electronic medical record would bring together diagnoses, treatments, medicines, test results, care goals and follow-up plans. With appropriate consent and authorized access, decision support could highlight care gaps and questions for the Veteran and treating clinician to review as the Veteran’s needs change. Recommendations would require clinical review.
Continuity when care returns to the United States
The goal is for the Veteran’s care history to follow them. A coordinated handoff could give the receiving VA or U.S. care team the records and treatment plan needed to assess and continue appropriate care. Direct VA record integration, information sharing and oversight would require VA agreement, technical validation and applicable privacy and security safeguards; these connections are not represented as live today.
Risk indicators would support accountable human review. A score would not establish fraud, determine eligibility or authorize payment on its own.
Government agencies
Aim to give agencies a clearer view of care quality and outcomes, strengthen documentation and identify potentially improper payments.
Taxpayers and providers
Aim to align payments with appropriate care and reasonable pricing while helping complete, correctly coded claims move efficiently.
A tailored proposal can define a 90-day pilot, care-quality and patient-outcome measures, review time, validated savings, false positives, appeals and Veteran payment burden. It can also address the executive case, fraud/waste/abuse controls, CPT/HCPCS/NCCI/MUE review framework, proposed IFMA methodology, explainable scoring, human-review safeguards, technical architecture, data requirements, implementation roadmap and presentation materials grounded in official VA/CMS references. Applicability would require review with the responsible agency; this scope does not imply an existing VA agreement. Performance targets and results would need validation.
Green Healthcare International is an independent healthcare coordination organization and is not affiliated with or endorsed by the U.S. Department of Veterans Affairs. Official VA Foreign Medical Program information.
Government and public-sector inquiries
Request information or a tailored proposal
Tell us about your agency, objectives and intended scope. This request goes to Green Healthcare International, not to the VA, and does not file an FMP claim.
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