The Washington State Massage Therapy Association (WSMTA) has intensified its advocacy efforts on behalf of solo practice massage therapists and clinic owners facing substantial retroactive recoupment demands from TriWest Healthcare Alliance, the contractor administering the Department of Veterans Affairs (VA) Community Care Network (VACCN) in Washington state.

As part of this effort, WSMTA has formally reached out to VA Secretary Douglas Collins and Washington Department of Veterans Affairs Director David Puente Jr., requesting intervention to protect massage therapists, their practices, and veterans’ continued access to care.

We are sharing both memoranda with Washington’s massage therapy community to explain the issues we are raising, the relief we are requesting, and the federal and state leadership we are engaging.

Why WSMTA is taking action

Since August 2026, Washington solo practice massage therapists and clinic owners have received notices demanding recoupment of portions of reimbursements for VA-authorized services provided as far back as 2021.

The demands stem from TriWest’s retroactive application of Multiple Procedure Payment Reduction (MPPR), a Medicare-based reimbursement methodology that TriWest began applying to massage therapy on July 15, 2025. Providers who delivered authorized care, followed established billing procedures, and accepted payments calculated by TriWest are now being held financially responsible for alleged overpayments dating back several years. Some providers have received demands totaling tens of thousands of dollars, involving hundreds of claims. They are given 30 days to respond and pay the alleged debts.

Even more concerning, providers report that TriWest has begun withholding 100% of their current reimbursements, applying money owed for newly delivered veteran care toward disputed historical balances. This leaves providers working without receiving payment for current services.  The consequences extend beyond financial hardship. Some massage therapists have reduced or discontinued veteran appointments, while others are considering leaving the VA Community Care Network altogether.

WSMTA TriWest recoupment survey — key findings

• 34 massage therapy practices/clinics reported a combined $337,139.10 in recoupment demands, with 33 providing specific dollar amounts.
• More than 9,400 claims or claim line items are affected. The actual number may be higher because some larger clinics did not provide claim counts.

Providers report that TriWest has begun offsetting, or holding 100% of current reimbursements for newly provided services. WSMTA's survey did not establish a reliable count of practices currently experiencing offsets.

A VA document states that at the start of 2026 there were 1,640 massage therapy providers in our state.  The Washington State Chiropractic Association has documentation for another 31 clinics.  New TriWest recoupment notifications to providers continue arrive in our state on a daily basis at this point.

Source: WSMTA provider survey, data through November 7, 2026 -- click to see full details.

These figures exclude approximately $70,000 in additional, earlier reported recoupment demands not included in the current database.

Our outreach to VA Secretary Collins

On November 9, WSMTA submitted a formal memorandum requesting immediate intervention by Secretary Collins.

Our primary request is that the VA permanently discontinue MPPR for VA-authorized medical massage therapy, independently rescind historical recoupment demands, cancel alleged debts, and restore funds already collected.  If permanent relief cannot be granted promptly, we are requesting an immediate suspension of disputed recoupments, repayment deadlines, and offsets while the VA investigates.

The memorandum presents four foundational questions:

• Original payment policy: What reimbursement methodology did the VA establish when massage therapists entered the Community Care Network in 2021?
• Implementation and authorization: Why did Optum begin applying MPPR in late 2023 while TriWest waited until July 2025, and who authorized retroactive recovery?
• Legal responsibility: What authority permits recovering historical payment differences from providers who followed established billing procedures and accepted contractor-calculated payments?
• Veterans’ access to care: How will the VA maintain an adequate massage therapy provider network if recoupments and withheld reimbursements drive providers away?

These questions distinguish an essential issue: Even if MPPR should have applied historically, that does not automatically establish that providers owe enforceable debts or that retroactive recovery is required.

Our outreach to Director Puente

WSMTA has also contacted David Puente Jr., Director of the Washington Department of Veterans Affairs, requesting his assistance and advocacy.

Our outreach seeks state-level support in bringing these concerns to federal VA leadership and identifying opportunities for coordinated action through the National Association of State Directors of Veterans Affairs (NASDVA). Director Puente’s position provides an important opportunity to emphasize that this is not simply a reimbursement dispute. It is also a veterans’ healthcare access issue affecting Washington communities.

What happens next?

WSMTA is continuing to collect provider information, support affected massage therapists and clinic owners, and pursue congressional and administrative oversight.

Our advocacy emphasizes two separate objectives: ending the disputed historical recoupments and ensuring that current reimbursement policies do not undermine veterans’ access to massage therapy. We encourage massage therapists to review the two memoranda and participate in WSMTA’s ongoing efforts.

Read WSMTA’s outreach memoranda:

Memorandum to VA Secretary Douglas Collins — November 9, 2026

Memorandum to WDVA Director David Puente Jr. — November 6, 2026

WSMTA remains committed to protecting massage therapists from unjustified financial burdens while preserving the availability of medically necessary massage therapy for the veterans who depend on these services.