WASHINGTON – TriWest Healthcare Alliance Corp. has agreed to pay the United States $179,700,000 to resolve claims that it received overpayments from the U.S. Department of Veterans Affairs (VA) in connection with its administration of certain VA health care programs, the Department of Justice announced today.
TriWest, an Arizona corporation headquartered in Phoenix, is in the business of administering government health care programs, including those operated by the VA. TriWest is responsible for administering certain portions of the VA Patient-Centered Community Care Program (PC3) and the VA’s former Veterans Choice Program (Choice). Both programs have enabled veterans to obtain medical care from providers in their communities. As an administrator of these programs, TriWest is paid by the VA to coordinate medical appointments and make payments to health care providers.
The settlement resolves allegations that TriWest retained overpayments from the VA in connection with its administration of the PC3 and Choice Programs. The alleged overpayments included payments by the VA to TriWest twice for the same services as well as payments for services for which TriWest received full or partial reimbursement from certain health care providers.
“The VA’s PC3 and Choice Programs have provided significant benefits to our nation’s veterans,” said Acting Assistant Attorney General Jeffrey Bossert Clark of the Justice Department’s Civil Division. “The department will continue to support the VA and its Office of Inspector General in ensuring that the VA’s programs are administered properly and that taxpayer funds are used as intended.”
“The VA provides invaluable assistance to those who have sacrificed on our behalf,” said U.S. Attorney Michael Bailey for the District of Arizona. “It is vital that those who administer programs for the VA be held accountable to do so with the utmost care and integrity.”
“The VA Office of Inspector General works tirelessly to promote the economy, efficiency, and integrity of the VA’s programs and operations,” said VA Inspector General Michael J. Missal. “This settlement is integral to ensuring that the VA’s funds are spent for the benefit of our nation’s veterans. I appreciate the teamwork and dedication that led to this significant recovery.”
The settlement was the result of a coordinated effort by the U.S. Attorney’s Office for the District of Arizona, the Department of Justice Civil Division’s Commercial Litigation Branch, and the VA and its Office of Inspector General. The claims resolved by the settlement agreement are allegations only, and there has been no determination of liability.