Veterans Choice Overbilled By ‘Tens Of Millions,’ Grand Jury Investigates
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 two Veterans Choice Program contractors responsible for processing payments from VA to non-VA health care providers.
That audit investigated the practices of TriWest Healthcare Alliance and Health Net Federal Service, the two vendors primarily responsible for processing billing resulting in numerous delays in veterans receiving needed non-VA health care. IG reported that the duo collected at least $89 million more than they should have.
RELATED: VA Nurse Implicated In Veteran Death
Some of you may recall Veterans Choice was created because veterans could not get timely access to doctors. How many doctors can you hire with $89 million? Quite a few.
Four Bad Billing Practices Of Veterans Choice Vendors
Four troubling practices resulting in windfalls for the companies were:
- Duplicate errors: The VA got billed more than once for specific medical services.
- Health insurance errors: The VA was billed for services covered by private insurance payments.
- Pass-through errors: The VA was billed more than private medical providers had been paid for their services.
- Rate errors: The companies did not require medical providers to pay according to rates set by Medicare or contracts.
Since the finding, Health Net was instructed to reimburse $50.8 million. TriWest also reportedly owes $38.9 million.
VA Lets Itself Get Ripped Off
“Our audit staff has attributed these errors to the lack of an appropriate payments process for Choice claims and an inefficient internal control system,” wrote Missal. “As a result, we estimate that (the VA) overpaid the (contractors) by tens of millions of dollars.”
Due to payment backlogs, VA stopped reviewing bills and invoicing submitted by Health Net and TriWest to instead allow them to submit compensation as a “bulk payment.”
RELATED: VA Busted On Mental Health Numbers
By August, the two companies collected $2 billion in compensation for charges that were not scrutinized in any manner. VA reportedly took no steps to protect against overpayment or fraud.
TriWest apparently detected a problem and hired a consultant to determine whether the company overbilled VA.
The takeaway here is that VA had no idea it was overbilled by tens of millions of dollars and it took an external consult of a vendor to assess the scope of the overbilling. Imagine what could have happened had TriWest not noticed the extra $40 million?
Now, I am not sure about you, but as a business owner, if an extra $40 million ended up in my account, I am not sure what company would not have noticed a problem. After all, it’s not like TriWest gets a tip for doing a good job, like a waitress or some other service professions.
Source: https://www.va.gov/oig/pubs/admin-reports/VAOIG-17-00000-379.pdf
Health Net made it into the top 5 government contractors in billions of dollars of contracts per year the first year of its contract.
You don’t suppose the Phoenix and Cheyenne Directors that orchestrated the crisis that led to “Choice” were able to get some laundered remuneration in their part?
Just to point out, 100 million, less than 1% charged to marketing when many corporations of that size go over 10%, will make 100 Directors millionaires if they had a way to launder the bribes.
Anyone following the money?
“The takeaway here is that VA had no idea it was overbilled by tens of millions of dollars and it took an external consult of a vendor to assess the scope of the overbilling. ”
Of course no one is getting a kick back with a wink and nod!
“‘Shocking’: US congressmen want answers on claims of secret Cold War radiation tests”
Published time: 3 Oct, 2017 14:44
“https://www.rt.com/usa/405550-congressmen-secret-radiation-testing/”
Three US Congress members have demanded answers from Washington after a new book claims to reveal details of how the government secretly sprayed, injected, and fed radiation and other hazardous materials to “vulnerable” people during the Cold War.
The congressmen’s outrage comes in response to the book ‘Behind the Fog: How the US Cold War Radiological Weapons Program Exposed Innocent Americans,’ which is said to have revealed the practices when it was published in August.
Author Lisa Martino-Taylor, an associate professor of sociology at St. Louis Community College, said the radiological weapons program was a top priority for the government at the time.
According to the author, unsuspecting people across the United States – and even in England and Canada – were subjected to potentially deadly material through open-air spraying, ingestion, and injection.
“Biological weapons simulation test planned in Oklahoma”
Updated: Nov 14, 2017 – 8:20 AM
“https://www.fox23.com/news/biological-weapons-simulation-test-planned-in-oklahoma/646596934”
NEWKIRK, Okla. – Quick Facts:
Department of Homeland Security plans to release chemicals to test the protection offered by buildings in Newkirk, Oklahoma.
A legal notice appeared in the local newspaper, saying the department would release “non-hazardous, non-toxic chemicals and biological materials”
The tests are planned for 2018
The data should help the department assess the impact of biological weapons
A notice in an Oklahoma newspaper set many Newkirk residents on edge.
The Department of Homeland Security announced the small town near the Kansas border will host a biological weapons simulation at the now-abandoned Chilocco Indian School.
In 2018, the department wants to release “non-hazardous, non-toxic” chemicals and biological materials on buildings in the area.
They want to see what might happen if a terrorist were to release similar chemicals as a biological weapon, and if buildings would offer residents any kind of protection.
“US Army fails to provide medical care to experiment subject soldiers”
Kim Hong-Ji / Reuters Published time: 15 Nov, 2017 00:25
“https://www.rt.com/usa/409883-army-medical-care-veterans-experiments/”
Veterans’ rights groups are claiming the US Army is withholding crucial information about chemical and biological agents veterans were exposed to in experimentation.
“The Army still has not provided notice to test subject veterans regarding the specific chemical and biological tests to which they were subjected — and their possible health effects,” attorney Ben Patterson of the law firm Morrison and Foerster told NPR.
At least 70,000 troops were used in the experiments, a 2015 NPR report found.
The Army’s requirements for coverage include filling out Department of Defense Form 214 or War Department discharge form, having served as a “research subject” including a US army chemical or biological substance testing program, and having a diagnosed medical condition believed to be a direct result in the experimentation program.
The army pledged to pay for medical care after thousands of former soldiers won a class action suit against the military over being used in chemical and biological experiments between 1942 and 1975.
The 2009 lawsuit was filed by the Vietnam Veterans of America and other plaintiffs who wanted to know which chemical agents they had been exposed to and what health risks are associated with them.
Still, the Army is not meeting its legal requirements. The Army has not issued broad notifications as per the court ruling, and is still not answering queries about which chemical agents veterans were exposed.
“Army To Provide Medical Care For Thousands Of Veterans Who Were Test Subjects”
Bill Chappell NPR, November 14, 2017·2:51 PM ET
“https://www.npr.org/sections/thetwo-way/2017/11/14/563095946/army-to-provide-medical-care-for-thousands-of-veterans-who-were-test-subjects”
After thousands of U.S. veterans won a class action suit against the military over being used in chemical and biological testing, the Army says it will pay for their medical care. But the group’s attorneys say the service is falling short of meeting its obligations and that it’s withholding details veterans are seeking about what agents they were exposed to.
The Army says veterans can be treated for any injuries or diseases caused after the service used the soldiers as research subjects in the period from 1942 to 1975.
As for how to apply for treatment or coverage through the program, the Army says its Medical Command is conducting “an exhaustive search” for veterans who may have been research subjects “so that no individual who may benefit from medical care is inadvertently omitted.”
The lawsuit dates to 2009. It was filed by the Vietnam Veterans of America and other plaintiffs who wanted to know which chemical agents they had been exposed to — and whether those agents might have caused health problems. A court decided in the plaintiffs’ favor in early 2016.
Copy of the notification at:
“https://apps.npr.org/documents/document.html?id=4211357-Army-Medicine-App-for-Medical-Care”
The US has two single payer medical systems – The VA and Medicare. Both are unquestionably corrupt. It’s absolutely the best way to argue against single payer systems. As if by design.
When’re we going to do something major about the unaccountability of the VA, and their life-altering, and -threatening behaviors? Something that’ll send a strong, and clear message, that we’re not going to put up with being mistreated, wasted monies due to the lack of accountability measures, poor management practices, fragmented vetting of new VA hires, substandard generic pharmaceutical and medical supplies, and that cheap single ply non-perforated toilet paper, that’s in the bathroom stalls.
Plus, the VA needs to install heated toilet bowl seats in the areas of the poo compounds in all of the VA’s facilities. And, to place those plastic targets in the bottom of the urinals, so to keep the amber-colored fluid in those white, but stained, porcelain apparatuses.
C’mon, lets back these people up against the wall, and say, “NO MORE.” There’s gotta be a better way to somehow stop these crimes against us Veterans. Can you hear me now? We need to establish some psychological warfare standards on VA employees, to make them think that we can do even more to them. “THAT’S THE POWER.” Nuttin Butt Trueph- – – Nutter.
Protest in front of District court and demand they hold VA accountable. DOJ will not do it because they are responsible for defendinh them.
That is why you do not see prosecutions
And, I’ll deck out my wheelchair and cane, brightly covered in glaring fluorescent rainbow paint, turn on the sky spot lights, flip the switch on my LED jacket with blinking colored lights, either roll down or get pushed down the line and light the 50 sticks of Roman Candles that I staked earlier, and with those lit large phosphorous sparklers in one hand, and a bull-horn in the other, while tooting vulgarities out to the public about the VA, then the Court Police hauls me away as being only ONE disgruntled, PTSDed out, didn’t win the war anyway, Vietnam Era Vet, acting out on Court Property. There isn’t anyone here that will be able to come to my rescue. By golly, my income alone won’t sustain this, and we’ve cut back to the max.
@CorpsmanUp! – – – I forgot to tell you, the Vet Protest is at 8am tomorrow. That’s if anyone shows up. – – – Nutter.
“Imagine what could have happened had TriWest not noticed the extra $40 million?”
hmmmm. Let me toss a different spin on “imagination”.
“Since TriWest admits to an ‘extra’ $40 million in overpayments, imagine how much they really raked in with this scam.”
Sorry Dennis but from the article Ben linked to his article.
In written statements, VA representatives said the July letter from TriWest “did not contain new information” and excess payments already had been identified. The company’s notification letter was delivered three months after the grand-jury subpoena to Glassdoor, and 18 months after inspector general inquiries began.
Really? Say it isn’t so. Same thing whenever government contracts out for services…they go with some contractor who has a politician in his/her pocket who miraculously wins contract bids, despite them double billing and charging $300.00 for a pen.
This is rampant in every government agency.
Back to the VA…
Again, allow veterans to choose his/her provider and with Capitalism the medical industry will compete for that clientle and thus improving care and lowering costs of services. With the “Choice” program you have contractors who don’t give a f- because they got the “hook-up”.
Qui tam attorneys should jump on this one and bankrupt these horrible contractors and force them to pay back.
But, I have VA choice bills that have yet to be paid ?. Soooooo, WTF over. The community providers are looking at me for payment, but I keep referring them to the payment center is Beaumont. I dare VA or the community provider to put those bills on my credit report.
The Government always wants to blame someone else for its sheer stupidity by claiming “fraud”. Guaranteed this is yet another massive VA screw up that will leave someone other than a VA employee holding the bag with jail time to boot. Shits lame.
On December 7, 2008, then-President-elect Barack Obama announced at a press conference in Chicago that he would nominate Shinseki to become the Secretary of Veterans Affairs, this was the worst day for all soldiers that went to the VA, it was like his bad decision on how to raise moral in the military by giving out the rangers beret to everyone who never earned it.
Screwing over veterans is a bipartisan activity. No change under our current administration and look at VA’s history…problems before and after Obama.
All the Seal movies coming out was a tell tale sign. A break in the code for profit of course.
Peta protesting at the goat lab was another pansy bitch ass society outcry.
DAV and the other VSOs are the main culprits, they sit idly by with their fucked up looking pizza hats and watch the carnage.
That entire publication/profit of Seal Team Six and BinLOUDandDeadend take-out and the one guy allowed to say shit and take a LOOK AT ME approach, made me want to puke from get-go and I could only come to conclusion it was allowed for PROPAGANDA reasons because WAR is SO MUCH fucking fun, just like a video game…and PROFITABLE…the war profiteering VA and DoD contracts and those neglected, like Choice, ensures $$$ goes into pockets and Vets left with picked-pockets.
Oh, maybe those funny hats ARE edible AND a floatation device, never thought of that!
#VAStopFuckingOverVets – – – A tell all name. I was going to register, but if you do, you have my blessing to continue in ANY measure to bitch slap the VA. Thank you very much (Mahalo Nui Loa [many thanks], indigenous language of Sandwich Islands) – – – Nutter.
This is a great blog folks,
I think we should have a daily hashtag for the VA or any of its components.
I will start with Namnibor’s #FuckTheVA line .For some reason, that cheers me up when I see itl! LOL!
Hashtag #ShulkinHasTits
Are you surprised? Pennies to the VA are like $MILLIONS$, and $MILLIONS$ are like $BILLIONS$. VA needs to be Audited. And, I still believe that if one is performed, the Audit would reveal $Billions$ in recoverable funds. That’s it. Simple, yes? No? What then?
Overpayments, murder, drug theft, vacations, bonuses, ice cream, and kiddie days. VA employees are adversarial (I like that word now), even against making sure that the Agency isn’t over paying for services. Wow!
No Accountability + No Audit = Wasted Days and Wasted Nights inside VA
Nuttin Butt Trueph – – – Nutter.
Should be instead, “$10.00’s are like $BILLIONS$.” Miscalculation on my part. Seems to be going around these days. – – – Nutter.
Now that’s explains why I have thousands upon thousands of unpaid medical bills that have been piling up for the last 3 1/2 years. I cannot begin to tell you how many times I have jumped down the throat of Glenn Gray- Customer Care for Tri West because the bills weren’t being paid.
I remember all so well about what Glenn had told me that Tri West and the VA do not get along, they can’t stand each other let alone can’t stand working with each other. That’s explains it!
Because of this “overpayment” I now see the Choice Program closing it doors because of no money to fund the program. I say we turned these idiots upside down and shake the money out of their pockets that they stole from the veterans!
if companies like these guys, over charged millions, say for a span of 2 years how much interest would they accrue, 1 ,million 2 million. interest. get caught and that is free money.
who at the va has been held accountable ? ask any va official they will say I don’t know that happened before we were in charge.
It just keeps getting better and better!
“UNCLE SAM WANTS YOU!”
From; “End Times Prophesy”
Titled;
“Army lifts ban on cutters, mentally ill and drug abusers to meet recruiting goals!”
Published on 14 November 2017
The first 6 minutes are about this issue.
P.S.
Could it be our government is moving closer to a “draft”?
With them getting ready to come out with the new military id chip implant most likely they will go to a requirement of military service like some other nations.
That will also include all males, women and She-he-its.
Not any mortal on earth is going to be able to successfully force me via a requirement to have a damn implant of anything. Way too ‘1984’ for me and am sure the chip comes with the Bluetooth option activation of a fatal aneurism, when and if required. ZAPP. No thanks.
I’ll simply claim by religious convictions alone, no fucking implant for me.
Oh my, we can’t get together as a force to stop VA from murder, its inside corruptions, and crimes, but do you think Vets will stand up against id chipping in order to use VA Claims and Health Care Services? – – – Nutter.
The key is to find out “who” these contractors are and find out the nexus to VA and their business. Stirring contracts toward family and friends is enough to warrant indictments. But of course the fake Oig and the Department of Jackasses will do absolutely nothing. The scheme with DOJ could easily parrot the scheme VA has been doing regarding bonuses.. Investigations cost money, so if they don’t investigate, no money is lost.
That is a systemic government problems, that the VA bonus for metrics exposed.
Remember, every Government Agency Head is in line of succession to the President.
These birdheads need better vetting.
There is obstruction with the executive head, that head aka is just a” Patsy”
On that note, Fuck the VA! (British accent)
What is the Choice count up to now? Originally I heard $15 billion, then it changed to $17 billion, then another $2-3 billion was added. Am I missing anything?
$90 million seems like a rounding error when you are talking $20 billion. It makes me wonder how many more millions in fraud are waiting to be found.
Found by someone other than the VA.
Shaking my head AGAIN at the VAs’ MONUMENTAL incompetence…But what should we expect from an entity that can’t even do that most basic of business practices, ANSWEER THE PHONE ? ? ?
Exactly. I jump thru hoops every time trying to get through to a specialty clinic.
Another point would be why were they even given the contract in the first place since they were already busted before? Why do they STILL have the contract? The “We Don’t have anyone else to do the job…” argument doesn’t fly. If they were able to rebuild after the problem before, SOMEONE ELSE, possibly someone competent and honest, could have been found…Problem is, that makes too much sense…
You are right Don, that excuse does not fly.
Since they are paying at Medicare rates anyway, why not cut out the skimming middle man and give the budget to Medicare, then issue all vets Medicare cards with a VA designation?
There is zero need for TriWest or Health Net to be involved other than to skim the budget.
If only the VA were as adversarial with their contractor billing as they are with veterans claims.
The VA just does not give a shit about certain budgets they are given, particularly Choice. Shovel money out the door to politically connected cronies, then go ask the cronies buddy in congress for more.
What does it say about Health Net that TriWest caught this overbilling and Health Net didn’t say a word, although they collected millions more?
What does it say about the entire Choice program and oversight of it that the contractors can over bill $90 million, but providers wait over a year to be paid by those contractors? And some times never get paid?
THANK YOU!!!
The VA fights tooth and nail in issuing benefits to veterans….but this overbilling “somehow” passed over their heads?!?
nothing will come of this. “THEY ARE TO BIG TO FAIL”
in the interim vets with medical needs are hanging around until they get tired of it all and check out
AAAAAHAAAAAHAAAAAHAAAAA!!! Boy that’s a knee slapper. The kings of scamming, deceit, and remorseful theft catch someone else with their hand in THEIR cookie jar. I think this just the tip of the iceberg. It usually is. Close, lock and seal your doors, the shit’s gonna get deeper!
Sorry, (Remorseless)
But no morsel or crumb left in cookie jar for payment for services, a bit like ‘The Grinch That Stole Christmas”.
Namnibor you said “But no morsel or crumb left in cookie jar for payment for services”.
That may be because the engineers saw installing a bottom on the Veterans Choice cookie jar as an obstacle to success in self enrichment.
What IS at bottom is as Ross Perot famously dubbed it, ‘That giant sucking sound’…If VA Sec. Shulkin were serious about saving $ and fixing the damn VA, he needn’t look any further than EVERY CONTRACT the VA has outsourced…then ASK WHY we are even paying the lazy engorged purple team assholes to do as LITTLE as they actually do? Hmmmm. This care bear is pissed.
Seymore and namnibor,
I wonder how much of those taxpayers monies, from the two contractors of Choice, went into that “Newly Formed Foundation of “Songbird” McCain?”
Anyone want to wager that their bank account[s] got fatter?
I’ll bet you counted all the A’s to make sure all groups had 5 of them. Didn’t you? lol – – – Nutter.
“…VA had no idea it was overbilled by tens of millions of dollars…” and not one person noticed it? Give me a freaking break!
Does anyone actually believe this crap? It kinda reminds me of where $9 million was spent by some people, to receive a “FAKE DOSSIER” on another person, and no one knows anything about it!
This government must really think the American People have been so “dumbed down”, they can commit crimes out in the open!
Well, guess what. The government HAS been committing crimes, in the open, for some time. And, “We the People” have been allowing them to get away with it for decades!
So, WHEN are “We the People” going to say something? WHEN are “We the People” going to tell our elected and appointed officials to “Honor the Oath of office!”
The “Founding Fathers” actually did NOT want lawyers serving in Congress! I can understand why. Because ALL of the “bills” introduced to Congress, the “Legislative Branch”, would be “slanted” to gain access to the taxpayers monies. And, of course, “slanted” to give them more power over the citizenry! Thereby, making them a form of “Monarchy”! Something “We the People” threw off in 1776 in our “Civil War” against Great Britain – “our mother country!”
How many want to bet the Grand Jury does NOT indict anyone over this? IF they do, it’ll probably be some poor schmuck way down on the ladder! You know, someone down in accounting.
And, let’s not forget about the Veterans who were forced to pay for the procedures Choice was supposed to pay for!
Or, how the Veterans lost their credit score!
Or, I wonder IF any veterans lost their homes, cars or properties, because the Choice Program screwed up?!?!
Oh, and before I forget!
“FUCK THE VA!”
IBM Watson and the VA are only partnered to detect Veteran Travel Pay Fraud….down to the penny, it does not work the other way up food chain.
There’s “Overbilling” then there’s “Intentional Fraud”, and I am going with the intentional option to defraud and flock and fleece the taxpayers with the VETERAN being the golden magic ticket…then we Vets have our credit ruined, then not too many Dr.’s even accepting Medicare for payment want to even deal with Choice…why?….because of fucking nonpayment….but someone’s pockets are getting thicker…anyone owning mutual funds with Choice Billing Partners on the coffers…a LOT of congress critters…
I do like that title “Veterans Choice Overbilled By ‘Tens Of Millions,’ Grand Jury Investigates”. But lets face it the title is not telling the full story about McCain’s Tri-West or Health Net.
No doubt there are hundreds of millions of dollars that have been paid to Tri-West and Health Net that has never been sent to the service providers. So now we have thousands of Veterans being forced to pay those bills that were suppose to be paid by Tri-West and Health Net.
Today’s topic reinforces my hypothesis that absolute corruption such as the VA corrupts absolutely…now those Choice Billing Partners were likely greedy scumbags before Choice Contracts, but they got hungrier and greedier via exposure to the master assholes at the VA swamp. Drop a truckload of ‘Care Bears’ into the VA and I propose that before lunch hour those Care Bears will have been corrupted and found ribbing all the vending machines and likely the pharmacy. ACCA=”Absolute Corruption Corrupts Absolutely” (think bad apples)
**robbing** not *ribbing*, but who knows? They’re GMO Care Bears.
Ben has a link to a Department of Veterans Affairs Memorandum signed by Michael J. Missal the VAIG Dated September 12, 2017. The memorandum has some key information on why the contractors were unable to set up reasonable ‘networks of providers’ able to provide adequate care for Veterans.
While the VA was paying these contractors Medicare Rates for Medical Care the contractors were only sending Veterans to providers that would sign contracts to accept payments lower than Medicare Rates. The contractors were then allowed to keep the difference.
No wonder why normal Medicare Providers refused to work with the contractors.
I like the idea that someone somewhere saw enough evidence of wrong doing to take it to a grand jury….which, now that I think of it, doesn’t square with the article.
If TriWest discovered this on their own, why would any evidence be presented to a grand jury? Are there claims of no wrong doing? Or are they disputing the amounts? Or is there some other reason?
I will have to read the report later since I would also like to know how they determined it was an over bill. Was it a case of TriWest or Health Net having an authorization and billing the VA for that, but the veteran never being told so no appointment was held?
Does the report say anything about auditing all the way through the process to see that a provider was paid what TriWest or Health Net billed for?
The info that took it to the Grand Jury Level was provided by an anonymous online poster at a web blog. The following post is an extract of the news article Ben links to in his blog article. The post should answer most of your questions.
But the post raises more questions about why Michael J. Missal issued his memorandum making Tri-West look like good guys for reporting the overpayments.
The article that Ben linked to is:
“Arizona-based VA contractor collected ‘tens of millions’ in over payments, federal audit says”
Dennis Wagner, The Republic | azcentral.comPublished 11:54 a.m. MT Nov. 13, 2017
“https://www.azcentral.com/story/news/local/arizona-investigations/2017/11/13/va-inspectors-question-millions-dollars-paid-triwest-veterans-healthcare-contract/737341001/”
That article contained the following section of information on how the case led to the Grand Jury
“Anonymous comments lead to subpoena”
“The grand jury inquiry was the subject of a 9th U.S. Circuit Court of Appeals decision last week in favor of prosecutors who are seeking “witnesses to potential unlawful conduct.”
According to the appellate ruling, the U.S. Attorney’s Office in Phoenix obtained a subpoena in March to identify anonymous authors who posted comments on glassdoor.com, an Internet site where employees critique their workplaces.
As reported in The Wall Street Journal, Glassdoor attempted to quash the subpoena based on First Amendment protections for anonymous free speech, but a federal judge in Phoenix ruled against the company. The 9th Circuit decision upheld that finding.
TriWest was the subject of those anonymous posts.
Though the company’s name has been redacted from legal files, its identity was clearly identifiable by contents of court documents.
The 9th Circuit ruling says the subpoena stems from a grand jury investigation of possible wire fraud and misuse of government funds by a Phoenix company that administers two VA healthcare programs.”
Another section of the article Ben linked:
“Contractor’s past missteps”
TriWest, incorporated in Delaware, is operated by a consortium of nonprofits. The founder, McIntyre, is a former aide to Sen. John McCain, R-Ariz., who has been a staunch advocate for the Choice Program.
This is not the first time TriWest’s billing methods have come under scrutiny.
In 2011, the company paid $10 million to settle a Justice Department lawsuit that alleged the company “systematically defrauded” the TRICARE health system for uniformed military personnel.
In that case, the company was accused of multiple improper billing tactics similar to those reported by VA auditors.
TriWest lost the TRICARE contract and nearly went out of business before taking on the VA healthcare assignments two years later. Today, the company boasts 3,500 employees in 10 operation centers.
McIntyre contends the VA billing process is to blame for overpayments, not TriWest. He declined to divulge TriWest’s income for each VA medical appointment, claiming the amount is “market competitive.”
”
Although they claim that they are market competitive the true is spelled out in Michael J. Missal memorandum. The contractors are paid at Medicare Rates and they then pay medical providers less then the rates collected. All while the medical providers have to fight for payment and resort to billing Veterans to collect what they are owed.
What is really interesting in the article is the following section from it.
“TriWest: ‘We’re the ones’ who caught error”
“He asserted that TriWest brought the over-payments to light in a July letter to the VA, identifying 58,000 incorrect medical claims that netted $35 million. About $13 million of that sum already has been paid back, he said.
“We’re the ones who actually brought it to the government’s attention,” McIntyre said. “We were seeking a process to return the funds. There was no process in place. We now have returned some of the money.”
In written statements, VA representatives said the July letter from TriWest “did not contain new information” and excess payments already had been identified. The company’s notification letter was delivered three months after the grand-jury subpoena to Glassdoor, and 18 months after inspector general inquiries began.
Amid those developments, the VA gave TriWest and Healthnet extensions through Sept. 30 of 2018, explaining that the federal agency “has no other immediate options available to perform the functions of current contracts.””
Makes one wonder if they only got “caught” or “turned-in” by someone that found out they could recover a % of recovered Gov’t. fraud, waste and abuse of funds…it exists, and the pot is large and gold and could very well see months down line they disclose it was an inside job all along…milking the cookie jars dry, milking paul to milk and pay peter…
I live in Delaware. If you need any paperwork served on someone, let me know. Delaware is a corporate haven for corruption.
Good to know it just wasn’t the IG figuring out how to do their jobs.
Interesting though that they chose to investigate a whistle blowers post rather than firing the whistle blower.
Seymore, thanks for pointing that out. I skipped over the link, but have read it now.
WOW that article is eye-opening.
I get the impression whoever made the Glass door post tipped off the media to it since the reporters questions to the TriWest CEO suggested that.
That makes me wonder if the Glassdoor poster was the one who called the IG, and saw nothing happen. It shows just how pathetic congressional oversight and the IG office is.
Roe can write letters and the IG office can investigate for 18 months, but a Glassdoor post gets them to finally move their ass.
Roes comments in his letter to Shulkin about urgency are a joke. Shulkin failing to do anything substantial shows he didn’t care about oversight, likely because he had cover from politicians making money.
I also find it ridiculous about the TriWest CEO whining about how much money the VA owes them.
Gee, I bet a small town provider seeing vets through Choice getting stiffed $100,000 over a years worth of appointments are worse.
Or the vet with bills turned over to collections because these assholes refuse to pay a proper bill.
What was also very eye-opening in that article is that there seems to be a difference in total billing investigators looked at to find $90 million in overbilling, and the $2 billion the VA paid Health Net and TriWest in bulk payments without matching them to bills or other evidence of it being owed.
If there is $90 million in overpayments based on $500 million in submitted bills, how much overpayment is there on $2 billion when bills are not even looked at?
Why is the jackass that decided to pay bulk payments without seeing proof not in prison?
Its too bad Roe can’t do more substantive oversight than writing a whiny letter, and Isakson can’t get his ass off the Stairmaster long enough to even write a letter.
Pretty sure tech exists where Isaacson could dictate a letter while not missing a step on his Stairmaster, or something that rhymes with dictate.
I’m sure its more than that and I know why….The neurologist Veteran’s Choice sent me to wanted me to sign three papers that I refused to sign:
1) Agreement that I allow anyone in their entire Neuro practice group do anything they want to do, so I have no say so and can’t say NO to anything, they just do it;
2) Agreement that I would pay for anything not covered by VA insurance, which includes them bouncing consults around to each other and their friends, unnecessary tests and procedures and overbilling appointments and whatever, so I pay and the VA pays them;
3) Agreement that I would pay a $250 no-show or appointment cancellation fee, so if that’s the cancellation fee, how much is the appointment? probably twice that to see the doctor;
These guy are double-billing the veteran and the veteran’s choice program. The first agreement is a “pay all” which means I have no right to say “NO” to anything, they just do it and bill me and the VA. They never need my signature again or permission for anything. I had a Veteran’s Choice dentist do that, too. He made me sign a document that stated similar and he didn’t finish my dental work, but presented that signed document as if everything had been done and got paid. He also charged the VA $7,000 to clean my teeth. That’s just ridiculous. The government is so rotten, it attracts and does business with these crooks. Like I always said, The VA is broken and can’t be fixed. The only thing to do is abolish it and turn it over to the general public providers and let them compete. With the Veteran’s Choice program, there is no competition, that’s why once they get on the VA provider list, its a free for all. As usual, no oversight.