Allegations of Skimming Impacts VA’s Private Healthcare Providers

By Debbie Gregory.

TriWest Healthcare Alliance and Health Net Federal Services, the companies charged with administering private health care options for veterans, are both under investigation for over-billing the government by tens of millions of dollars.

The Veterans Access, Choice and Accountability Act, expected to cost taxpayers $10 billion has come in closer to $12 billion to date, and that between the two companies, they have collected at least $89 million more than what they were supposed to.

The VA Choice program was launched during a very rough time for the VA Health System, when allegations of misuse, misconduct, claim backlogs and long wait times for veterans seeking treatment at its facilities were every day occurrences. It was created as an emergency stopgap to serve patients who were waiting weeks or months to see doctors in a backlogged VA healthcare system.

To alleviate part of the problem,  if the VA is unable to schedule an appointment for a veteran within a month, or if a veteran lives more than 40 miles from one of its clinics, they can access a network of private clinicians and hospitals managed by TriWest and Health Net.

An audit revealed that both companies billed the VA for more than what they paid medical providers, charged different rates other than what was contractually set up, submitted duplicate bills for the same services, and billed for medical services already covered by private health insurance.

TriWest maintains they have done no wrong, blaming the VA’s billing system for the overpayments. But this isn’t the first time TriWest has been investigated for mismanaging government funds. In 2011, the company paid the Justice Department $10 million to settle a lawsuit that the company systematically defrauded the government.

Inspector General Michael Missal estimated that, in duplicate payments alone, Health Net and TriWest overbilled taxpayers by $89.7 million.

Health Net was instructed to reimburse $50.8 million; TriWest allegedly owed $38.9 million.

Both TriWest and Health Net’s current contracts will run for the next 10 months.

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