Senators have called on VA to intervene after Veterans Choice Program vendor Health Net failed to reform its practices to improve performance.

Centene subsidiary Health Net Federal Services is responsible for processing payments to community health care providers but severe delays have harmed the program. Eleven senators sent a letter to Secretary David Shulkin demanding VA take action last week saying they were “fed up” with how the company is managing its program.

“Our home state providers deserve better than the miserable customer service provided to them by Health Net, which appears to be devoting even less attention to the Choice Program as its expiration nears,” the senators wrote.

“Moving forward, we expect VA to take immediate action to address our concerns so that the provider experience is improved,” they added.

The company was recently admonished by the Office of Personnel Management’s Office of Inspector General for not cooperating with investigators. The company refused to comply with requests to audit its IT systems.

Bad History

Six months ago, Health Net was in the news for failing to pay tens of millions to community care providers resulting in many veterans having to pay out of pocket for health services while waiting for the company to do its job.

Health Net Company Profile

Health Net is a managed care organization. The Company provides managed health care services through health plans and government-sponsored managed care plans.

Its segments are Western Region Operations and Government Contracts. It provides and administers health benefits to approximately 6 million individuals across the United States through group, individual, Medicare, Medicaid, dual eligible, the United States Department of Defense (Department of Defense or DoD), including TRICARE, and the United States Department of Veterans Affairs programs.

Source: https://www.fiercehealthcare.com/payer/department-veterans-affairs-health-net-customer-service-senate

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35 COMMENTS

  1. This goes right along with what a few of us vets and civy’s were talking about yesterday, at a small get together!
    The last thing mentioned was;
    *”Everyone wants a piece of the pie!”*
    Kinda like, we’re receiving [Billions of] taxpayers monies, why have an audit to see who’s stealing it?

  2. Evolution of Swamp Choice Program: 1) Swamp Monsters at VA create fake wait lists to put-off care while Veterans continue to die, 2) Swamp Monsters continue to rake-in the Non-Performance Bonuses that again, are based on fake wait lists, 3) Congress Critters shake a free hand of scolding then back to Stairmaster positions,4) Choice Program is created with fucked rules with outside contractors such as HealthNet and TriWest, 5) The comes-up with their ingenious “AS A CROW FLIES RULES”, 6) The Crows are just as fucking confused as the Veterans, 7) More Wait Lists, 8) UNPAID CHOICE BILLS, 9) Vets being sent warning of collections or worse and the outsourced medical entities start refusing CHOICE because the VA REFUSES TO PAY THEIR BILLS, 10) Non-Performance Bonuses PAID, even though Congress Critters shook a mean free hand at them telling them no more bonuses UNTIL the fix is in, 11)The VA heard “FIX” so using an already fucked situation, why not utilize the already fucked IT ‘Fixes” needed for extra $$$$ while never “FIX’ing” CHOICE, 12) Choice Crows and VSO’s all lined-up for repeated hats full of cash…all for the Vets, 13) Bonuses Paid, 14) Toss some more money on a burning fire, 15) Choice is now completely fucked while Veterans either have died waiting or on their way out, 16) Choice Crows still fucking confused as to what happened….

    **cookie jar CLINK**

    As long as the problem remains UNFIXED, the cash will continue to flow. That “fix” is cutting-off life-flow of cash to the AFGE and cause the lamprey and leeches to go elsewhere…hopefully deep in outer space. Have we ever sent Choice Crows into outer space as a test or only dancing monkeys?

    • It seems to be the story every election…last election they created a fake “fix” and this election say how awful the fake fix is …back and forth and america gets more corrupt and people aren’t being served just bilked for billions in taxes going to these politicians and their friends via contracts and jobs..

    • I think that is the key nam…cash flow.

      If these harrumphing Senators want to fix this, they can pass a simple amendment to add some teeth.

      I’m sure Health Net/TriWest/whoever is getting paid a fee for what they are doing. It sure isn’t a fee tied to their claims processing capability.

      This amendment needs to tie their processing claims to whatever they are being paid…to process claims.

      Pay them a percentage of the dollar amount of each claim. If they are 30 days late in paying a claim, their payment drops by 10%. If they are 60 days late, their payment drops by 50%. If they are 90 days late, they only collect 25% of their usual fee for processing a claim. If they are 120 days late, Health Net/TriWest/whoever pays the claim.

      You would see Heath Net scrambling to make damn sure the VA submitted the proper paperwork. Approvals were on time and payments made in a timely manner. As it stands now, there is zero incentive to pay a claim on time. In fact, if they are paid according to some administrative measure of how much time they spend on each claim, they have an incentive to play games rather than process the claim.

      • “Pay them a percentage of the dollar amount of each claim. If they are 30 days late in paying a claim, their payment drops by 10%. If they are 60 days late, their payment drops by 50%. If they are 90 days late, they only collect 25% of their usual fee for processing a claim. If they are 120 days late, Health Net/TriWest/whoever pays the claim.” I like this idea. It makes sense…..which means it will never happen.

  3. We had a word in the Marine Corps that is really two words spoken so close together it becomes one as does the meaning. This thing today, as in most all things VA is in USMC parlance known as a “clusterfuck”. I did a tour as an Officer Candidate in OCS too which is sort of like boot camp but with an extremely perverse take on personal responsibility. We had a two word definition (officers learn to be wordy). An Army OSC Tac Officer (The equivelent of a drill instructor but more twisted) would term this a “circle jerk”.

    The civilian translation for both terms is “government”.

  4. I got to share. You can now donate cash online to VA and they promise a letter of thanks. I got my thanks yesterday!!!

    “Dear Rev. (Dennis):
    I wish to extend my personal thanks to you on behalf of the Roseburg VA Medical Center patients and staff for your recent donation of $5.00 for the Disruptive Behavior Committee. A receipt is enclosed.

    As requested, this donation has been deposited in the following General Post Fund account(s):
    GPF 01 (8180S). $5.00

    100% of your donation will be used to supplement the excellent care and services provided to our Veteran patients and their families. We are very grateful for your generosity and support of our Nation’s Veterans.

    Sincerely,
    James Shulfer
    Chief of Voluntary Service”

    LOLZ! What a difference $5 makes!!! For years now the DBC has told me I am nothing but a violent disruption, but slip them $5 and they write you and tell you how grateful they are for your generous nature! VA has now officially thanked me for being a nice guy!

    my God I will be laughing about this all day and frame it alongside the six PRF letters plus the letter from the COS denying care based on the DBC recommendation which took Washington D.C. to override…

    Ain’t I a stinker? God Bless and keep the faith!

    • It’s a DBC trap, Dennis. They are playing passive-aggressive hungry, hungry hippos. Swipe left/right with that letter and return to sender with your thanks but no thanks notice written-out in brown # 2 pencil.

  5. Unless their is a class action law suit, the same-o-same-o will continue and nothing will change…

    • AFGE: “Resistance Is Futile”. (the AFGE and The Borg have more in common than they don’t).

      AFGE: Assimilated Fat Gut Entities.

  6. cj ¯¯̿̿¯̿̿’̿̿̿̿̿̿̿’̿̿’̿̿̿̿̿’̿̿̿)͇̿̿)̿̿̿̿ ‘̿̿̿̿̿̿\̵͇̿̿\=(•̪̀●́)=o/̵͇̿̿/’̿̿ ̿ ̿̿

    B.S., all B.S, that’s all you’ll get from the VA, and your elected “officials”

    I like my VATV
    Money for nothing…
    Checks for free…

    As the VA Cash Cow keep shitting dollars.

    ———————————–╱╱╱╱╱╱╱╱╱╱╱╭╮╱╱
    ———————————–╭┳━┳┳━━━━━╭┫╰╮╱
    ———————————-┃┃╭╯╰╮┈VA┈┃▎▃╰╮
    ……..()$)==–()$)==()$)==-╯┣╯┈╭╯CASH╰╭╯╭▌
    ———————————╱┃┈┈╰╮COW╮┈╰┳┻╯
    ———————————╱┃┏┳┳┻┻━┓┣┳┳╯╱╱
    ——————————– ╱┃┃┃┃╱╱╱┃┃┃┃╱╱╱
    ——————————– ╱┗┛┗┛╱╱╱┗┛┗┛╱╱╱

  7. Ooooh. Senators demand. They better not demand too loud or they might find something they will have to fix, and it might hurt the bottom line of their fellow former politician buddies.

    It might hurt their own bottom line.

    Former House Speaker Dick Gephardt and former Wisconsin governor Tommy Thompson are at Centene, and former Pelosi pool boy George Miller is with Health Net.

    Wanna get serious about investigating what is wrong with Choice? Don’t pitch it back to the same VA fools who, if they are not actively sabotaging it they quietly watched it happen.

    If these Senators were serious about it and serious about insuring veterans get timely care, they would request the Government Accountability Office audit the entire program, both within the VA and any contractor involved in it.

    Let a federal contractor tell the GAO they can’t audit their IT department.

    Why are they wanting to look at their IT? Why is Health Net denying that? What is the VA doing about that denial? Why is the VA not overseeing this contract properly?

    • cj ¯¯̿̿¯̿̿’̿̿̿̿̿̿̿’̿̿’̿̿̿̿̿’̿̿̿)͇̿̿)̿̿̿̿ ‘̿̿̿̿̿̿\̵͇̿̿\=(•̪̀●́)=o/̵͇̿̿/’̿̿ ̿ ̿̿

      Exactly 91!!!!

  8. “Eleven senators sent a letter to Secretary David Shulkin demanding VA take action last week saying they were “fed up” with how the company is managing its program.”

    Must be the only 11 that are not getting into the COOKIE JAR…..

  9. I’m one of those veterans who was placed into veterans choice program last year, after repeated cancellations at my local VA. After waiting 7 months, after being placed into the program, I had my 1st treatment, injections to try and help with constant headaches, due to injury and exposure to bio/chemical weapons, 10 weeks after that 1st treatment, the day of my second treatment, the specialist office called and cancelled my appointment, due to non-payment. I’ve called health net, white house hotline, senators, congressman, written to the president, yet not one single person can tell me when the bill will be repaid,,, that specialist won’t even return calls now. The other specialist I wanted to see, it took 11 months for his paper work to get processed, then he was told it would take another 6 months to be accepted, even though I was approved for 20 visits.
    I get calls from Denver VA and Arlington Va, not about my care, but my number somehow was mixed up with other veterans, providers, you name it.
    This is beyond negligence, its outright sabotage. I’m beginning to wonder if race, political affiliation, age are being factored in.
    Or just a failing system trying to keep every last dollar budgeted within its system, and self preservation.
    Last week I went to my local VA, and talked with a young veteran who asked me how my experience with the VA has been, he was just signing up. This is the same young veteran who told me they were offering 100% ptsd disability guaranteed for 5 years, for all who were signing up for ptsd.
    I really don’t know what else to say, or who to call.
    I keep reading all the articles, reports of how much money is being spent, senators calling for action, and my phone rings yet again, mistakenly, for another veterans care.

  10. My husband is now about into the $100,000 and more of unpaid medical bills due to Tri West. Dating as far back as 2015. I have the stacks of unpaid bills to prove it too. Still won’t pay for emergency room bills when they are the ones who told him to go there. I don’t even answer my phone anymore because of the collection agencies call day and night. My husband’s credit? It’s shot all to hell!! Thanks Tri West

  11. I’ve been notified that today will be my last visit to my therapist for PTSD because of non payment by Health Net. 1 bill was paid for a weekly visit out of 24 with 52 visits authorized.

    Apparently Health Net is billing the VA but not paying the bills. That 12.5 Million dollar CEO is probably in line for a YUGE bonus.

    And I’ll have to pay or see my credit score flounder. Who do I sue for that?

  12. A week ago, I had a conversation with a guy in scheduling and eligibilty at the V.A. hospital here in Sioux Falls, and he actually tried to defend the CHOICE program and the V.A.!! Then, he told me that the Choice Program was ending soon, and started that tired, weak, worn out union BULLSHIT of defending the V.A. as currently constituted and advocating for veterans being forced to stay in the V.A. system, instead of being allowed to go anywhere we want, including places with REAL doctors and nurses who care about minor things like, oh, well: Maybe quality and timely medical care, respect, courtesy, counseling without being mentally labeled and having one’s check forced into conservancy and losing one’s Second Amendment rights, and not causing veteran’s to die waiting for financial help and medical care!? Turns out that the jackass is a big union guy more worried about his seven years of OUR bad luck, retirement, and holding his job than ME surviving my Barrett’s Esophagus!! Sad and pathetic sociopathic and narcissistic CLOWNS! End the monstrous gargoylish V.A. monolith, and let us go ANYWHERE!!

  13. VA employee banking on Veterans deaths.

    _______________

    Sioux Falls Veterans Affairs nurse accused of stealing vet’s credit card

    Jonathan Ellis and Joe Sneve
    Argus Leader
    Published 8:17 a.m. CT March 16, 2018

    “A nurse at the Sioux Falls Veterans Affairs Hospital faces felony charges that she stole a patient’s credit card and made more than a dozen unauthorized purchases to the account.

    Julie Ann Bergstrom has been charged with four counts of felony identity theft. Police issued a warrant on March 2, and she was arrested on March 9, said Sam Clemens, the spokesman for the Sioux Falls Police Department.

    According to an arrest affidavit, the unauthorized charges were made after the veteran died and during the time he was hospitalized, including the week before his death on July 19, 2017 when he was unconscious. The charges were made between May 28 and July 23 at various retailers, mostly in Sioux Falls.

    An investigator with the Sioux Falls Police Department recovered video images of the person making purchases four times at a Sioux Falls Walmart. The images were distributed for identification and another officer recognized the women in them as a person who worked at the VA.

    Shirley Redmond, a spokeswoman with the VA in Sioux Falls, said Friday that Bergstrom is now a “former employee.”

    “Our VA police are aware of the charges and have been cooperating with the Sioux Falls Police Department,” she said.

    Bergstrom, 48, is licensed with the state of South Dakota as a registered nurse, said Gloria Damgaard, the executive director of the South Dakota Board of Nursing. Damgaard could not say if a complaint had been filed, but if one is filed, the board would investigate.”

    Full Article at: “https://www.argusleader.com/story/news/2018/03/16/va-nurse-accused-stealing-vets-credit-card/430374002/”

    __________

    Nothing like VA employees making money off of dead Veterans.

  14. 03/19/2018

    Dear Benjamin Krause,

    Centene Corporation is functioning under several names at the same location according to John Ashcroft [MO State Secretary].

    “Senators have called on VA to intervene after Veterans Choice Program vendor Health Net failed to reform its practices to improve performance.” The Senators should be contacting the U.S. Attorney General not the incompetent VA Secretary who may be leaving at any moment of time due to his personal embezzlement of Taxpayers funds [Wimbilton Tickets +].

    The Michael F. Neidorff, Chairman, President and CEO, plans to leave in 2020—and it is obviously to 11 U.S. Senators he is taking it [the money] with him.

    This CEO has made $20.8 million in 2015.

    What do you think U.S. AG Jeff Session should do?

    Sincerely,

    Don Karg

    • I would personally call it war profiteering, and since we happen to be in year 17+ now of WAR…I think our Army Corp of Civil Engineers need some practice building some nice wooden gallows…err, swing-sets for these tripe.

  15. The VA used up it’s entire “believability capital” to every single private provider doctor group and hospital in the U.S. that once accepted ‘Choice’, but now DO NOT. What non-VA providers once figured was another payment system like ‘fee-base’ that worked (paid out of local VA hospital $, albeit Medicaid-like in dollar amounts) now is rejected by every-fucking-one as a SHIT program to keep the fuck away from. Only the most shittiest and broke doctors might accept it yet. The providers roll their eyes when a veteran is on the choice program, and think “here is a poor slob with this shit insurance – we will politely tell him/her your fuckin’ POS insurance is not welcomed here”. And they end it with: “It’s not you – it’s the VA — how poorly our government (to whom I pay taxes to by gunpoint) treats the veterans. Good bye –go somewhere else ….like hell.”

    Meanwhile all the scumbags are wrestling and pointing fingers on how the ‘new choice program” will be designed. They fail to realize the non-VA providers aren’t going to trust them no matter what they come up with. The VA lost it’s credibility completely now.

    To boot….Healthnet and Triwest are the only shits that the VA has to choose from (no choice) that will ‘administer the choice program when it is overhauled. They will ruin that in a minute. Yes, an overhauled choice program straight out of the congressmen’s assholes and the Shulkin asshole (boy it’s smelly up there) run and administered by HealthNet and TriWest. Now ain’t that different and on track?

  16. Off topic – but another stick up Shulkin’s ass by Brookings again:
    Q+A: Why this Brookings expert took the VA to task over medical marijuana
    Las Vegas Sun, Monday, March 19, 2018
    John Hudak , a senior fellow at the Brookings Institution, January report examining the U.S. Department of Veterans Affairs’ response to a congressional inquiry on medical marijuana pulls no punches.
    “When the VA lies to Congress about medical marijuana, it lies to our wounded warriors,” the report was headlined.
    Hudak, a member of the Brookings Institution and one of the nation’s foremost experts on marijuana policy, examined VA Secretary David Shulkin’s response to a letter from Democratic members of the House Veterans Affairs Committee in October asking him why the VA wasn’t conducting research into medical marijuana.
    Read More: “https://lasvegassun.com/news/2018/mar/19/qa-why-this-brookings-expert-took-the-va-to-task-o/”

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