Riverton, Wyo.-based SageWest Health Care faces allegations that the two-hospital system and its owners overcharged Eastern Shoshone Tribe members to boost profits, according to a Casper Star-Tribune report.
An audit by the tribe of its hospital bills revealed that about 20 percent of the charges from SageWest contained errors, according to Matt Silverstein, CEO of FirstNation Health, a health insurance firm that provides help to tribes.
As a result of overcharges, Mr. Silverstein said SageWest saw a 700 percent profit margin from tribal patients.
He told the Star-Tribune results of the audit conducted by the tribe were supported by independent analyses. He also contends that overcharges correlate with the November merger of SageWest's parent company, Brentwood, Tenn.-based LifePoint Health, with RCCH HealthCare Partners, owned by private equity firm Apollo Global Management.
"They are now asking the tribe for more money, above and beyond what the plan was traditionally paid and above and beyond what SageWest has accepted from the tribe for years," he said.
Hospital officials deny the allegations. SageWest's marketing director Lindsey Anderson told the Star-Tribune the hospital was unaware of any billing errors and that it expected the tribe to pay "many patient claims that have not been paid to date."
"First and foremost, we are confident that we fairly and acceptably bill our tribal patients," she wrote in an email to the publication. "In fact, we have had a provider agreement in place since September 2017 that offers a substantial discount to Eastern Shoshone tribal members."
Mr. Silverstein said only an agreement for nontribal members covered by the tribe's plan was signed, not one for tribal members.
According to the report, the tribe's business council recently met with SageWest executives, and Mr. Silverstein said the tribe and the company "agreed on a process to move forward" but that Apollo would have to make a final decision for things to move forward.
Access the Star-Tribune's full report here.
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