TriWest Healthcare Alliance is a

Phoenix, Arizona Phoenix ( ; nv, Hoozdo; es, Fénix or , yuf-x-wal, Banyà:nyuwá) is the List of capitals in the United States, capital and List of cities and towns in Arizona#List of cities and towns, most populous city of the U.S. state of Arizona, with 1 ...

based corporation that manages health benefits under the

United States Department of Veterans Affairs The United States Department of Veterans Affairs (VA) is a Cabinet-level executive branch department of the federal government charged with providing life-long healthcare services to eligible military veterans at the 170 VA medical centers a ...

(VA) VAPCCC program in Regions 3, 5, and 6. On October 1, 2018, TriWest's contract for VAPCCC was expanded to cover Regions 1, 2, and 4.

History

In 1996, TriWest Healthcare Alliance was established in order to compete for a

U.S. Government The federal government of the United States (U.S. federal government or U.S. government) is the national government of the United States, a federal republic located primarily in North America, composed of 50 states, a city within a fede ...

contract to manage civilian health care benefits under the newly established

TRICARE Tricare (styled TRICARE) is a health care program of the United States Department of Defense Military Health System. Tricare provides civilian health benefits for U.S Armed Forces military personnel, military retirees, and their dependents, in ...

program within the 16-state TRICARE Central Region, also known as Regions 7 and 8. In 1996, TriWest was awarded the contract for the TRICARE Central Region and began operations. The TRICARE Central Region included the following states: *

Arizona Arizona ( ; nv, Hoozdo Hahoodzo ; ood, Alĭ ṣonak ) is a state in the Southwestern United States. It is the 6th largest and the 14th most populous of the 50 states. Its capital and largest city is Phoenix. Arizona is part of the Fou ...

Colorado Colorado (, other variants) is a state in the Mountain West subregion of the Western United States. It encompasses most of the Southern Rocky Mountains, as well as the northeastern portion of the Colorado Plateau and the western edge of t ...

* Southern

Idaho Idaho ( ) is a state in the Pacific Northwest region of the Western United States. To the north, it shares a small portion of the Canada–United States border with the province of British Columbia. It borders the states of Montana and Wyom ...

Iowa Iowa () is a state in the Midwestern region of the United States, bordered by the Mississippi River to the east and the Missouri River and Big Sioux River to the west. It is bordered by six states: Wisconsin to the northeast, Illinois to the ...

Kansas Kansas () is a state in the Midwestern United States. Its capital is Topeka, and its largest city is Wichita. Kansas is a landlocked state bordered by Nebraska to the north; Missouri to the east; Oklahoma to the south; and Colorado to the ...

Minnesota Minnesota () is a state in the upper midwestern region of the United States. It is the 12th largest U.S. state in area and the 22nd most populous, with over 5.75 million residents. Minnesota is home to western prairies, now given over to ...

Missouri Missouri is a U.S. state, state in the Midwestern United States, Midwestern region of the United States. Ranking List of U.S. states and territories by area, 21st in land area, it is bordered by eight states (tied for the most with Tennessee ...

Montana Montana () is a state in the Mountain West division of the Western United States. It is bordered by Idaho to the west, North Dakota and South Dakota to the east, Wyoming to the south, and the Canadian provinces of Alberta, British Columbi ...

Nebraska Nebraska () is a state in the Midwestern region of the United States. It is bordered by South Dakota to the north; Iowa to the east and Missouri to the southeast, both across the Missouri River; Kansas to the south; Colorado to the southwe ...

Nevada Nevada ( ; ) is a U.S. state, state in the Western United States, Western region of the United States. It is bordered by Oregon to the northwest, Idaho to the northeast, California to the west, Arizona to the southeast, and Utah to the east. N ...

New Mexico ) , population_demonym = New Mexican ( es, Neomexicano, Neomejicano, Nuevo Mexicano) , seat = Santa Fe , LargestCity = Albuquerque , LargestMetro = Tiguex , OfficialLang = None , Languages = English, Spanish ( New Mexican), Navajo, Ker ...

North Dakota North Dakota () is a U.S. state in the Upper Midwest, named after the Native Americans in the United States, indigenous Dakota people, Dakota Sioux. North Dakota is bordered by the Canadian provinces of Saskatchewan and Manitoba to the north a ...

South Dakota South Dakota (; Sioux language, Sioux: , ) is a U.S. state in the West North Central states, North Central region of the United States. It is also part of the Great Plains. South Dakota is named after the Lakota people, Lakota and Dakota peo ...

El Paso, Texas El Paso (; "the pass") is a city in and the county seat, seat of El Paso County, Texas, El Paso County in the western corner of the U.S. state of Texas. The 2020 population of the city from the United States Census Bureau, U.S. Census Bureau w ...

Utah Utah ( , ) is a state in the Mountain West subregion of the Western United States. Utah is a landlocked U.S. state bordered to its east by Colorado, to its northeast by Wyoming, to its north by Idaho, to its south by Arizona, and to it ...

Wyoming Wyoming () is a U.S. state, state in the Mountain states, Mountain West subregion of the Western United States. It is bordered by Montana to the north and northwest, South Dakota and Nebraska to the east, Idaho to the west, Utah to the south ...

TriWest was awarded an extension to this contract, which continued until 2004. On August 21, 2003, TriWest was awarded the TRICARE Managed Care Support Contract for the TRICARE West Region. The five-year contract, valued at approximately $10 billion, expanded TriWest's service area to 21 states and 2.7 million beneficiaries with the addition of

Alaska Alaska ( ; russian: Аляска, Alyaska; ale, Alax̂sxax̂; ; ems, Alas'kaaq; Yup'ik: ''Alaskaq''; tli, Anáaski) is a state located in the Western United States on the northwest extremity of North America. A semi-exclave of the U.S., ...

California California is a U.S. state, state in the Western United States, located along the West Coast of the United States, Pacific Coast. With nearly 39.2million residents across a total area of approximately , it is the List of states and territori ...

Hawaii Hawaii ( ; haw, Hawaii or ) is a state in the Western United States, located in the Pacific Ocean about from the U.S. mainland. It is the only U.S. state outside North America, the only state that is an archipelago, and the only stat ...

, northern Idaho,

Oregon Oregon () is a U.S. state, state in the Pacific Northwest region of the Western United States. The Columbia River delineates much of Oregon's northern boundary with Washington (state), Washington, while the Snake River delineates much of it ...

, and

Washington Washington commonly refers to: * Washington (state), United States * Washington, D.C., the capital of the United States ** A metonym for the federal government of the United States ** Washington metropolitan area, the metropolitan area centered on ...

. On July 13, 2009, TriWest was awarded the contract (also known as the "T-3 contract") to continue providing military families access to health care and manage the 21-state TRICARE West Region for the Department of Defense (DoD). On March 16, 2012, it was announced that the T-3 West Region contract was awarded to Minnesota-based

UnitedHealth Group UnitedHealth Group Incorporated is an American multinational managed healthcare and insurance company based in Minnetonka, Minnesota. It offers health care products and insurance services. UnitedHealth Group is the world's seventh largest c ...

. The contract was worth $20.5 billion On March 26, 2012, it was announced that TriWest will protest the Department of Defense award of the contract to UnitedHealth. David McIntyre (President and CEO of the TriWest Healthcare Alliance) cited the long history of performance and legal problems with the subsidiary which would handle the T-3 contract. On July 2, 2012, it was announced that TriWest lost its appeal to keep the West Region contract. In September 2011, TriWest paid $10 million to settle a Justice Department lawsuit after whistle-blowers claimed TriWest "systematically defrauded" Tricare by billing the government higher rates than they had negotiated with health care providers. The lawsuit also said TriWest sent 3,000 claims through one location a day to intentionally bypass checks to avoid late-payment fees and that it paid claims for ineligible beneficiaries. In September 2017, VA Inspector General Michael Missal issued a memorandum that listed four major "errors" that had resulted in excess payments to TriWest. These were: * Duplicate Errors–Payments for medical claims that have been paid more than once * Other Health Insurance (OHI) Errors–Payments that were not adjusted for the amount OHI was responsible to pay the provider * Pass-Through Errors–Payments to reimburse the TPA that were more than the TPA paid the provider * Rate Errors–Payments that did not use the appropriate Medicare or contract adjusted rate. Missal stated in his memorandum that duplicate payments alone racked up almost $40 million in overpayments to TriWest.

References

External links

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History

See also

References

External links