Ken Paxton Launches Investigation Into TriWest Over Health Care Claim Denials

Texas Attorney General Ken Paxton (R) has launched an investigation into TriWest Healthcare Alliance Corp. over allegations that the company wrongfully denied health care claims by incorrectly identifying patients as having other health insurance.

Why is Paxton investigating TriWest?

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

The investigation follows a surge in complaints alleging TriWest incorrectly denied health care claims by falsely determining that patients had other health insurance (OHI).

What happened to one Texas couple?

One case involves the Shoemakers, a Texas husband and wife who served the country for more than 20 years. Mr. Shoemaker was battling cancer when TriWest allegedly identified his vision plan as OHI, resulting in denied claims for necessary treatments and appointments.

The couple spent nearly two years trying to correct the issue with TriWest. According to the Attorney General's Office, Mr. Shoemaker received relief only after NBC aired a report on his situation.

TriWest has acknowledged that OHI-related denials are a problem, according to the announcement.

What does Paxton want to determine?

Paxton's office has issued Civil Investigative Demands to TriWest and plans to interview consumers and company employees as part of the investigation.

The investigation will determine whether TriWest violated the Texas Deceptive Trade Practices Act.

AG Ken Paxton: "Health insurance companies cannot promise health care coverage and then wrongfully deny patients the benefits they are entitled to receive. I will not allow health insurance companies to take advantage of Texans through deceptive or unlawful practices."