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[separator headline=”h1″ title=”Triwest At It Again”]

Dear Esteemed Veterans & Patients

It’s been awhile since we gave an update on the issue  and so it bears a short but honest telling. We were forced to put a stop to taking Triwest because January 15, 2016 they stopped co-operating with us to get their debts paid off. They lied to Congressman Barr’s office saying they were helping, but in fact, January 15 was the end of cooperation due to the legal counsel there (Todd Pomeroy) stepping in because Triwest owed, by law: principle, interest, and fees (see below). Under KY State Laws they are debtors and owe us, the creditors, money. Once they were provided a detailed list (the summary data of course you saw in our blog post), they clammed up, causing us to begin to use our own legal counsel. Then they cited us having legal counsel as reason to stop talking and moved to defend their position from a lawsuit. You can read our detailed response to their response here.

[accordion open=”1″]
[accordion-item title=”Graph of VAMC growth”]This demonstrates our growing close relationship with VA and high approval rating from veterans:[/accordion-item]
[accordion-item title=”Totals Bars”]This shows Total bars for comparison[/accordion-item]
[accordion-item title=”Total VA income by month”]This shows the amount of VA work we were doing, representing approximately a third of my business which I do not have currently due to Triwest’s non-payment necessitating our stoppage of services. Bear in mind we had spent 2 years building up our VA services (see graph 1)
What that graph cannot show is that the effort to get those dollars was on the order of 2 or 3x (see flowchart elsewhere)[/accordion-item]

[accordion-item title=”Stacked Version”]

This graph clearly indicates the switch-over lag in Triwest AND how after Todd Pomeroy stopped the sharing of data (January) that we had a right to know (how we were being paid by patient name/case) and we were forced to end participation in CHOICE due to the hardships this imposed on our business (due to our close previous relationship with the VAMC and large caseloads) the sudden drop-off in income for my business.
It also shows clearly that prior to PC3 implementation we were on a growth track. Which means more Veterans helped.[/accordion-item]

[accordion-item title=”Summary and link to raw data”]

It is important to note that during that huge gap we were receiving w or 3x the cases without payment coming through. This was the period I was forced to let go our veteran staff office manager, and lost an acupuncturist. After January 15, when it became clear that Triwest was not going to help resolve the situation, we lost another staff member.

Bear in mind the spike was due to our re-filing of clean claims that WPS lost; which under KY law became delinquent. The gap is the important piece. Also, that spike was not representing all that was owed, and much of that came later. But some still not paid, and Todd refuses to provide the tables.

Below are the raw data with remaining principle owed.

total principle owed to us by Triwest $84,853.13
Total paid by Triwest $79,817.99
Principle Balance $5,035.14
Interest Surcharge $18,362.05
Account Maintenance Fees $2,050.00
Total owed by Triwest $25,447.19

From Todd’s response today it’s obvious Triwest isn’t “anxious to resolve” anything in a “timely manner” but to stonewall and harm businesses. We had hoped they would fix things and we wouldn’t have to leave CHOICE. Then we hoped the bad press in May and June would change things and we could re-enter the system.

In total, the estimated yearly cost in damages for my business on top of outstanding principles is ~$10,500/month, take away that which is paid in 2016 is ~$89,900 in lost income this year alone. Enough to pay for multiple personnel and actually I would have expanded the business another $100k in other markets with my freed up time. Lost revenue for 2017 from VA sources estimated to be conservatively $126000. Adjusting for growth curve, our monthly would be anywhere up to $550,000 based on a mean growth based on above. Therefore expected would by somewhere between the two.

2013 $2,035.00 growth
2014 $9,891.05 386.05% mean
2015 $107,820.82 990.08% 436.53%
2016 $36,068.87 -66.55%
2016.2 $126,000.00
2017 $550,025.26

What we would like to see is positive change, the closing of debts, and proven improvements to the CHOICE program that would enable us to resume care of veterans absent of receiving VAMC funds directly.

Our VP (Jenny-Marie) is a Navy veteran, and we want to hire non-acupuncture staff almost exclusively as veterans.
After all, doesn’t Triwest realize without us and other providers they aren’t going to get those revenue dollars from KY nor will veterans deserving pain and PTSD treatment receive those services via acupuncture??

It’s $5-6k in principle. There’s simply no excuse for not sharing the tabular data to close their open accounts!

Raw SS data:


[separator headline=”h2″ title=”The Long and Short of It”]

They have probably spent more money not paying their debts to us in payroll to lawyers than the actual debt. This isn’t surprising from a company with a factual history of Fraud.
For more info about their company (click here).

However, we didn’t give up. We demanded updated data on the names we provided January, also though:

  • February 1st
  • February 12th
  • March 18th (Congressional Inquiry)
  • May 10th (Legal Shield representative)
  • July 28th (Counsel provided)
  • September 14th (in response to the below email)

Amazingly, we received this message last Thursday

“I’m just following up with you in regards to your client’s matter.  Would you be able to provide me with an update as to your client’s status regarding his claims issue?  We are anxious to address Mr. Careaga’s concerns in a timely manner.


Todd A. Pomeroy, Esq.

General Counsel

TriWest Healthcare Alliance

O: (602) 564-2013

But in response to our demands, as of this moment of writing – nothing has been provided, as is our right to have, and issues remain unaddressed. Rather, Mr. Pomeroy opined about “not answer direct inquiries”.

Now does this appear like a “timely manner?” Or “co-operative”? Only in sophistry would lies be considered the truth.
Aside from us, Triwest (and HealthNet) has been caught not paying providers in all sorts of industries and states. We’ve even been contacted from as far away as Hawaii.

[accordion open=”1″]
[accordion-item title=”Problem 1 – Data”]To this day, we still have not received enough verifications to account for services rendered.. We’ve tallied up all the paper remittances sent and the total is less than what we’ve taken in. If a company doesn’t even know what they’ve paid, how can they know if they have paid you enough? Clearly, the above email shows: they don’t.  More frustratingly, they’ve even sent collection bills to us on a name or two, which will not be paid until they take steps to correct their balances.
All of which are still found on the previous blog (click here) or for live stats (click here).[/accordion-item]
[accordion-item title=”Problem 2 – Transparency”]

Our main demands provided February 12th: of improved transparency, response time, processes, and decreased data latency have gone largely ignored. The FOIA request we made: came back very late and largely blacked out (open here, here, and here).

[accordion-item title=”Problem 3 – Jurisdiction”]We still don’t know how they determined the pay for services and under what authority they could do this without oversight. How they were able to get the contract at all is a mystery. They did finally provide a Provider’s Manual, after Congress asked, but they never provided a long form contract. The entire CHOICE program was implemented with a heavy-hand and with little oversight and no actual written agreements between providers and TriWest or HealthNet. They honestly feel they are not held under Kentucky Law. But in the absence of Federal clean claims oversight, isn’t any interstate commerce regulated within the state of commerce performed?[/accordion-item]

[accordion-item title=”Problem 4 – WPS “]Finally, we have not seen any improvements to the WPS/subcontractor system – that’s the company you talk to that pretends to be Triwest, but they aren’t.  Basically, they have done nothing to improve the situation, and yet they rake in billions. Profits are clearly worth more to them than helping the veterans and the VA, whose workers are completely fed up with them.  The Congressman’s office has told me that over 20 different providers in Lexington area alone have engaged their office regarding Triwest’s non-payments.[/accordion-item]

So what has been done to benefit you? Blue Lotus – your provider – has gone back to direct contract with VAMC Lexington (til Congress and VA sort out Triwest, Healthnet, and WPS.

Here’s what you need to do to utilize your rights:

  1. Get VA doctor approval for acupuncture

  2. It goes to Triwest…

  3. Refuse to see anyone else for 3 days. Tell them it is unacceptable to go anywhere else.

  4. After that, tell them to return your contract to VAMC. After a two week period they should be required, having not found you a provider, to return the contract to Lexington VA.

  5. Contact the VA again to verify your rights

  6. Schedule with us with approval from Lexington VA – it must be brought in.

If you fall under VAMC Louisville I regret to report that hospital has made the local decision that they will no longer provide acupuncture to veterans even if it is not in line with broader VA policy. While they acknowledge that acupuncture works because Medicare does not broadly cover it they will not. Dr. Vuocolo the Chief of Staff for Pain Management told us “We don’t consider actual patient outcomes in these decisions, we go strictly by the guidelines of Medicare”.  The absurdity of such logic violates all ideas of a Hippocratic Oath but that is the official position of that VAMC.

I know it is very different, much more difficult. But we still do offer $60 acupuncture for veterans, if you should desire to avoid such troubles.

What we do ask from all of you is to contact the VA Lexington, Louisville and Congress and even the VA in Washington DC and let them know you find the lack of progress and changes unacceptable. Let them know you have a right to real, viable pain care. That far off multi-billion dollar companies don’t have a right over you, that you deserve to be treated humanely and providers deserve to be paid on time.

Thank you, we will provide you with another update when they are forthcoming!
~Sf. Ramon Careaga


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