Texas AG Paxton investigates military healthcare contractor over denied claims

Texas Attorney General Ken Paxton has opened an investigation into a major military healthcare contractor over wrongfully denied medical claims. Paxton’s office said in a release this week that complaints have surged against TriWest Healthcare Alliance because the company is denying claims due to errors that incorrectly listed some beneficiaries as having “Other Health Insurance,” or OHI. “Health insurance companies cannot promise health care coverage and then wrongfully deny patients the benefits they are entitled to receive,” Paxton said in the release. The investigation will examine whether TriWest’s handling of the claims violated Texas consumer protection law. TriWest is one of the contractors that administers TRICARE, the military’s healthcare program for active-duty service members, retirees and their families. In May, NBC News reported on persistent problems beneficiaries have faced since 2025, when TRICARE transitioned its contract from Health Net Federal Services to TriWest. The reporting included the case of Guy Shoemaker, 65, of Fort Worth Texas, who said he had tens of thousands of dollars in previously approved claims overturned and money clawed back from paid providers because of an OHI error. Shoemaker, a retired Army sergeant first class and recruiter who spent a year in Afghanistan, was diagnosed with Stage 2 throat cancer in 2021 and has since needed ongoing therapy to ensure he can speak and swallow safely. The lull in coverage led to serious deterioration of his condition. Another 13 beneficiaries also spoke to NBC News, describing problems with their TRICARE coverage following the transition to TriWest. Paxton, who is currently running for Senate as a Republican against Democrat James Talarico, mentioned Shoemaker in his press release. “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 press release said. “The Shoemakers’ situation is not unique and TriWest has acknowledged the OHI denials are [a] problem.” Shortly after NBC News’ story on Shoemaker aired, TriWest President and CEO David McIntyre Jr. apologized to those who had experienced problems with OHI errors under the company’s watch. “I want to personally take this opportunity to apologize to those of you who have experienced challenges with Other Health Insurance on our watch,” McIntyre wrote in a letter to beneficiaries in May. In an emailed statement Friday, TriWest said the company is reviewing Paxton’s investigative demand. “We and the 146,000 providers in our Texas network are committed to military families, helping ensure they receive the care they have earned,” the statement said. In an interview Friday, Shoemaker, who is now covered by Medicare, said the Texas investigation is “nice to see,” but believes the issue should be addressed nationally. For him, however, “the damage is done” — even though his coverage problems were resolved, his condition is “going to progressively get worse,” Shoemaker said. “I know the issue still exists for other veterans,” Shoemaker said. “I’ll give Ken Paxton credit. I appreciate the fact that he’s taking it up, but again, it should be more than just state level.” Paxton’s office said it had issued civil investigative demands to TriWest seeking information from the company and plans to interview consumers and employees. The investigation will determine whether TriWest violated the Texas Deceptive Trade Practices Act.