Triwest has not been forthcoming about paying their bills. This isn’t a surprise, it’s a statistical fact in our case, as is well documented. What you may not know is that there is not only a battle for the new CCN contract (click to read RFP) (they lost PC3 in 2016) but Triwest is also under investigation by a Grand Jury which is convened to decide whether there is enough evidence for fraud to indict. Remember, this company has a definite history of fraud.
What follows is our investigation and summary of current known facts. We encourage you to conduct your own research and reach out to your Congressman and Senators and let them know how you feel. Even if you don’t agree with us that Triwest has not treated veterans and providers correctly; you can still make your voice known, as is your right.
The following is a summary as per my assistant,
- An audit of two Veterans Choice billing contractors found the duo overbilled VA by “tens of millions” triggering a federal grand jury investigation.
- VA OIG audited the billing practices of TriWest Healthcare Alliance and Health Net Federal Service,
- OIG reported that the duo collected at least $89 million more than they should have.
- This is a WSJ article providing the back and forth narrative between Glassdoor and issues/arguments about the 1rst Amendment.
- The article implies the need for witnesses against TW. There were 125 postings on Glassdoor, with some TW employees stating “all they care about is numbers.”
- The government and prosecutors contended that they want and need to speak to employees about TW practices that “maximize profit and numbers”
- Federal prosecutors have subpoenaed reviews on the Glassdoor.com website written by 125 employees or former employees of TriWest. The company appealed the subpoena to the Ninth Circuit Court of Appeals.
- The court ruled that Glassdoor must turn over the records.
- The inspector general recently reported to Congress that the two companies have collected at least $89 million more than what they were supposed to. TriWest is also being investigated by a federal grand jury for possible wire fraud and misuse of government funds.
- How much all of this cost taxpayers is not yet known. Missal stated in his memo
- Duplicate payments alone racked up $89.7 million in over-payments.
- These deal with the so called whistle blower Shea Wilkes from Overton Brooks in Shreveport, LA. who sent a letter to President Trump
- These articles say what we know, veteran wait times are inexcusable
- There are life and death situations.
- Reimbursements are slow or never to happen, etc.
In September, VA Inspector General Michael Missal issued a memorandum that listed four major “errors” that had resulted in excess payments to TriWest and Health Net. These were:
- Duplicate errors: billing the VA more than once for medical services.
- Health insurance errors: billing the VA for medical services already covered by private health insurance.
- Pass-through errors: billing the VA for more money than what the companies paid medical providers for their services.
- Rate errors: charging medical providers different rates than what were set by Medicare or contracts.“
We have been awaiting Triwest to settle their debts with us, but instead they tried to buy my silence with our own due billings – to the cent – which we then informed Congress of.
I’ll tell you what I told them. If they want to settle in confidentiality, then they need to pay restitution for damages, but I don’t beg for money I am owed; and neither should any provider. If you agree with that, please let Triwest know directly, as well as your Congressmen and women.
PS – Remember how we provided them a flowchart of why and how their system was broken? It’s a bit strange that they think they deserve the CCN contract when they clearly made no real attempt in 2016 to fix their system. What type of setup do you think they want to have for CCN? It sounds to me like PC3-repeated all over again. We at Blue Lotus will not be a part of such a fiasco again.
Sf. Ramon Careaga, BSEE, MSTOM, L.Ac.
This came from Congressman Barr’s office yesterday
I have not had any official response on this matter and I will be checking with our Legislative staff in Washington, DC. I thought you would also be interested in this new legislation. Essentially Congress is funding CHOICE for the next six months as Congress formulates a new plan of legislation and reform. I will keep you informed of this process sir. Below is short summary of the proposed legislation.
“Update on the VA Choice Program Funding
Congressman Barr voted in favor of and the House and Senate passed S. 114, a bill to authorize appropriations for the Veterans Choice Program. This legislation was signed into law by the President and became law on August 12, 2017. I believe that Congress intends to reauthorize this program before funding fully runs out at the end of December.
Three years ago when committee oversight and subsequent media reports uncovered that veterans around the country were waiting for care, Congress passed the Veterans Access, Choice and Accountability Act (P.L. 113-146), which established the Choice Program. The Choice Program allows veterans who meet certain qualifications to seek care from health care providers outside VA.
The Choice Act included language to state that the Department of Veterans Affairs (VA) is authorized to continue services until August 7, 2017, or until the funds provided in the Choice Act ran out. After VA reported to Congress that funds would be available after the sunset date, Congress passed legislation that was signed into law in April 2017 to eliminate the sunset date for the Choice Program. On June 17, 2017, Secretary Shulkin notified Congress that, due to an increased demand for care through Choice, VA expects the funding for the Choice Program to be depleted by mid-August.
At a June 2017 hearing on the Veterans Health Administration (VHA) budget, Poonam Alaigh, M.D., Acting Under Secretary for Health at VHA, responded to Chairman Roe’s question about what would happen if Congress fails to replenish the Choice fund. Dr. Alaigh noted that, if Congress fails to act, veterans will not be able to access care outside VA through Choice; wait times will go up to the level they were before the Phoenix waitlist scandal; and Third Party Administrators (TPAs) around the country will be laid off. Secretary Shulkin told the committee during a March 2017 hearing on community care that allowing the Choice Program to sunset would be a “disaster for American veterans” and warned we would see the “same situation we saw in April 2014 in Phoenix.”
- 114 provides $2.1 billion to continue the Choice Program for six months while Congress works on other reforms to the Choice Program. It would also authorize 28 major medical facility leases and enhance the recruitment, retention and training of the VA workforce. To offset that, the bill would extend the current $90 per month limit on pensions paid to veterans residing in Medicaid-funded nursing homes, extend the requirement to collect fees for housing loans guaranteed by VA and extend the authority to utilize other agency income information.
In August 2017, the President signed the VA Choice and Quality Employment Act of 2017 which authorized $2.1 billion in additional funds for the Veterans Choice Program (VCP). The law reflects the ongoing commitment of VA and Congress to make sure Veterans get the right care, at the right time, from the right provider.
Constituent Services Representative
Representative Andy Barr (KY-06)