Attorney General Ken Paxton Investigates TriWest Over Alleged Wrongful Denial of TRICARE Claims

The following information was released by the office of the Attorney General of Texas:

Attorney General Ken Paxton launched an investigation into TRICARE Insurance's TriWest Healthcare Alliance Corp. ("TriWest") over the company's conduct in its insurance policies. This investigation stems from reports and admission that the company wrongfully denied health care claims.

TriWest is a private company contracted by the U.S. government to administer health care programs for military members, veterans, and their families. It manages the U.S. Department of Veterans Affairs ("VA") Community Care Network and serves as the support contractor for the Defense Health Agency's TRICARE West Region.

Recently, complaints have surged against TriWest claiming that the company is incorrectly denying numerous healthcare claims. This is said to be done by falsely claiming that the insured has other health insurance ("OHI"). One example is the Shoemakers, a Texas husband and wife who served our county for over 20 years. Mr. Shoemaker was battling cancer, but because TriWest falsely read his vision plan as OHI, his claims for necessary treatments and appointments were denied for lack of coverage. Mr. Shoemaker tried to correct the issue with TriWest for almost two years. He only received relief after NBC aired a news story covering his situation. The Shoemakers' situation is not unique and TriWest has acknowledged the OHI denials are problem.

"Health insurance companies cannot promise health care coverage and then wrongfully deny patients the benefits they are entitled to receive," said Attorney General Paxton. "I will not allow health insurance companies to take advantage of Texans through deceptive or unlawful practices. If TriWest broke the law or wrongfully denied patients care, we will use the full force of the law to stop them."

As part of the investigation, the Office of the Attorney General has issued Civil Investigative Demands ("CIDs") to the company. Additionally, the OAG plans to conduct interviews with consumers and employees of the company. The investigation seeks to determine whether TriWest violated the Texas Deceptive Trade Practices Act ("DTPA").