TriWest Healthcare Alliance -- the health care company that oversees the Department of Veterans Affairs' community care program in 13 states -- has agreed to pay $179.7 million to resolve claims that it kept overpayments under the VA's Choice program.
The Justice Department announced Monday that TriWest, based in Phoenix, Arizona, reached a settlement regarding allegations that it improperly retained payments from the VA while managing the department’s various private care programs, including Choice.
According to a Justice Department release, TriWest was under investigation for keeping overpayments from the VA in cases where the department had already paid for the services and in instances where it already had received full or partial reimbursement from health care providers.
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"The VA provides invaluable assistance to those who have sacrificed on our behalf," said Michael Bailey, the U.S. Attorney for the District of Arizona. "It is vital that those who administer programs for the VA be held accountable to do so with the utmost care and integrity."
A VA Office of Inspector General report in 2018 found that two health care contractors -- TriWest and Health Net Federal Services -- received more than $140 million in overpayments from 2014 to 2017 while managing the VA's private health care programs, including VA Choice, created in 2015 in response to the department's wait times crisis.
Following release of the VA OIG report in 2018, TriWest President and CEO David McIntyre told the Arizona Republic newspaper that the overpayments were a product of past "mechanical errors on both sides."
On Monday, McIntire said the company identified the overpayments to VA "for return several years ago" and is pleased that "the overpayments it set aside ... have finally been accepted after a lengthy period of government review."
"TriWest brought VA overpayments -- for reimbursement of veterans' health claims that TriWest had already paid to providers -- to VA's attention more than three years ago based on the results of TriWest's own internal audits, and TriWest also requested an avenue to promptly reconcile and repay those funds," McIntire said in a statement to Military.com.
The settlement marks the second time in eight years that TriWest has settled with the Justice Department over its federal health care contract management. In 2012, TriWest agreed to pay $10 million amid allegations that the company defrauded Tricare -- the Defense Department's purchased care health program -- by billing the government higher rates than the company had negotiated with health care providers.
The company also allegedly paid claims to ineligible beneficiaries and sent 3,000 claims to one location in a day to avoid late payment fees.
TriWest managed the DoD's Tricare West Region from 1996 to 2012, when it lost the contract to UnitedHealth following a bitter competition and the subsequent DoJ investigation.
It managed VA community care programs alongside Health Net Federal Services until 2018, when it was named the sole contractor to run the VA's Choice Program. Later, with passage of the Mission Act, the contracts for providing community care were reissued, with Optum awarded the contract for managing three of the five regional networks and TriWest managing two, including the Western states and Alaska.
With the settlement, the claims against TriWest remain allegations and there has been "no determination of liability," according to Justice officials.
But, added VA Inspector General Michael Missal, the "settlement is integral to ensuring that the VA's funds are spent for the benefit of our nation's veterans."
"I appreciate the teamwork and dedication that led to this significant recovery," Missal said.
According to McIntyre, TriWest has provided nearly 34 million appointments for veterans with 720,000 network providers since partnering with the VA on its private care programs and will continue to work with the department to support veterans.
"The resolution of these issues will now permit TriWest to return funds it has long desired to return and continue to improve services to veterans," he said.
-- Patricia Kime can be reached at Patricia.Kime@Monster.com. Follow her on Twitter @patriciakime.
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