Texas AG Probes TriWest for Alleged Wrongful Denial of Military Healthcare Claims
Texas AG Ken Paxton investigates TriWest over claims denial errors affecting military families.
Texas Attorney General Ken Paxton has launched an investigation into TriWest Healthcare Alliance, a contractor responsible for administering TRICARE, the military’s healthcare program. The probe follows allegations of wrongful denial of medical claims due to administrative errors.
Investigation Triggered by Beneficiary Complaints
Paxton's office announced the investigation after numerous complaints surfaced against TriWest. The complaints center around the company incorrectly listing beneficiaries as having 'Other Health Insurance' (OHI), leading to denied claims. Paxton emphasized that health insurance companies must honor their commitments to provide coverage, stating, "Health insurance companies cannot promise health care coverage and then wrongfully deny patients the benefits they are entitled to receive."
The investigation aims to determine whether TriWest's actions violated Texas consumer protection laws, specifically the Texas Deceptive Trade Practices Act. This follows an NBC News investigation highlighting ongoing issues since TRICARE transitioned its contract from Health Net Federal Services to TriWest in 2025.
Impact on Military Families
Among those affected is Guy Shoemaker, a retired Army sergeant first class from Fort Worth, Texas, diagnosed with Stage 2 throat cancer in 2021. Shoemaker experienced significant hurdles in receiving necessary therapy due to claim denials linked to the OHI error. "Mr. Shoemaker tried to correct the issue with TriWest for almost two years," Paxton noted, adding that Shoemaker only saw resolution after NBC News covered his story.
TriWest has acknowledged the errors, with President and CEO David McIntyre Jr. issuing an apology to those affected. In a letter to beneficiaries, McIntyre expressed regret over the challenges faced by military families due to the OHI error.
TriWest's Response and Ongoing Issues
In response to the investigation, TriWest stated that they are reviewing the demands from Paxton’s office. The company reiterated its commitment to military families and the 146,000 providers in its Texas network, emphasizing their dedication to ensuring beneficiaries receive their entitled care.
Shoemaker, now covered by Medicare, expressed mixed feelings about the state-level investigation. "The damage is done," he remarked, acknowledging that while his issues have been resolved, others continue to face similar challenges. He called for the problem to be addressed on a national scale.
Paxton's office has issued civil investigative demands to obtain information from TriWest and plans to interview affected consumers and employees as part of the probe. The outcome will determine if TriWest violated any consumer protection laws, potentially impacting how military healthcare claims are managed in the future.