Massage therapists in the Department of Veterans Affairs (VA) Community Care Network (VACCN) face substantial financial harm as TriWest Healthcare Alliance demands recoupment for authorized massage therapy services previously billed and paid. Some demands involve hundreds of claims and tens of thousands of dollars. WSMTA’s November 2026 provider survey documents financial hardship, disruptions in veteran appointments, and concerns about providers leaving the network.

What happened?

TriWest administers VACCN Regions 4 and 5, including Washington. The dispute involves Multiple Procedure Payment Reduction (MPPR), a Medicare-based methodology that reduces the practice-expense component of additional eligible therapy units or procedures.

According to TriWest’s recoupment notice, it began applying MPPR to massage therapy on July 15, 2025, but now seeks recoupment for services dating back to 2021. Optum began applying MPPR in late 2023—roughly 19 months earlier. Washington providers began receiving recoupment notices on payments made for this historical services in August 2026, more than 380 days after TriWest’s change, and additional notices have continued. Notices demand “payment” in 30 days of the notice date.

Providers report unanswered review requests followed by offsets withholding 100% of reimbursement for newly authorized care. In plain language, a therapist may treat a veteran today and receive $0 because TriWest applies the entire payment to the disputed historical balance. Chiropractors who employ massage therapists report offsets involving reimbursement for chiropractic services for veterans as well and chiropractic services are not part of the recoupment issue.

Four questions the VA must answer

WSMTA’s November 9 memorandum to VA Secretary Douglas Collins asks: What reimbursement instructions did VA originally give its contractors in 2021, and did VA approve payment without MPPR? Who authorized the later changes and retroactive recovery? What separate legal and contractual authority makes providers liable for payment differences calculated by the contractor? How will the VA protect actual veteran appointment availability and continuity of care?

These questions are distinct. Even if MPPR should have applied historically, that does not automatically establish an enforceable provider debt or require collection. Providers delivered VA-authorized services, accurately billed under established procedures, and relied in good faith on TriWest’s payment determinations. Independently practicing massage therapists generally do not bill Medicare for massage services and were not responsible for configuring the VACCN payment system.

Why veteran access is at risk

Providers report cutting back or discontinuing veteran appointments, considering alternative employment, and struggling to cover payroll, rent and family expenses. A directory listing alone cannot show whether veterans can actually obtain appointments with established clinicians. The VA must assess available appointments, geographic access and continuity of care.

What WSMTA is requesting

WSMTA requests permanent discontinuation of MPPR for VA-authorized medical massage therapy, separate rescission of historical demands recoupment demands, cancellation of alleged debts, and restoration of funds already collected or withheld. If permanent relief cannot be granted promptly, WSMTA requests an immediate systemwide suspension of disputed demands, deadlines and offsets; normal reimbursement for current care; meaningful consolidated review; claim-level accounting; and written identification of the officials authorized to grant relief, while our questions are being reviewed.