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Senator wants top-level review of Tricare West transition

Jun. 21, 2013 - 06:24PM   |  
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The leader of the Senate Budget Committee is calling for an investigation into the transition between contract managers of Tricare’s West Region.

Sen. Patty Murray, D-Wash., sent a letter Thursday to U.S. Comptroller General Gene Dodaro requesting a review of the transition of the contract to UnitedHealthcare Military & Veterans, which assumed management of the West region on April 1.

Murray said she has “serious concerns” about the company’s preparation for and oversight of the transition.

“Many problems have been conveyed to me and my staff ... service members, family members, providers, government officials, and stakeholder groups all have expressed extreme dissatisfaction with the performance and transparency of the transition process,” Murray said.

Immediately after taking over the contract from TriWest Healthcare Alliance, UnitedHealthcare began experiencing delays in customer care and problems with referrals and payments to providers.

The concerns were so pervasive that the Pentagon on May 2 took the unprecedented step of waiving referral authorization requirements for Tricare Prime beneficiaries in the West region.

To help solve the problem, UnitedHealthcare hired additional personnel and authorized unlimited overtime. It also transferred the company CEO to another UnitedHealthCare subsidiary and installed Tina Jonas, a former Defense Department’s chief financial officer, as president of the company.

The company has largely cleared the backlog of referral authorizations and is showing “real measurable progress in many aspects of contract compliance,” according to Tricare.

But Pentagon officials this week decided they would extend the waiver period through July 2 because there was a “need for additional progress in the area of specialty care referrals,” according to a memo signed by a representative of Dr. Jonathan Woodson, assistant secretary of defense for health affairs.

Murray asked the Government Accountability Office to assess whether:

■UnitedHealthcare was prepared for the transition.

■The company did enough to inform patients and providers on the transition.

■The referral waiver was necessary and appropriate and how much that initiative has cost the government.

Murray also wants the review to assess UnitedHealthcare’s performance in the transition as compared with other Tricare contract transitions.

“The results of your assessment will help to inform the decision on whether to exercise the option years in the contract,” Murray wrote.

UnitedHealthcare is the first new company to take over a Tricare contract since the military health program’s regions were consolidated in 2004.

It was awarded the Tricare West region contract, worth up to $21 billion over the next five years, in July 2012 after a prolonged contract award and protest process that began in 2009.

That year, the company was given the contract to manage the Tricare South region, but that decision later was overturned, opening up a chance for UnitedHealthcare to bid for the West region contract against TriWest Healthcare Alliance.

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