VA Community Care Contractors: Who Gets Paid, Who Runs Them, and What VA Could Do Itself

Checked October 31, 2026. We started with two contractor names and a reasonable question: why pay private companies to administer care the government funds?

The records support a more useful question: which work must VA contract for, which work has it chosen to outsource, and what are we getting for the money? 38 USC 1703 38 USC 1703D

The short version

• TriWest runs provider networks. The insurer-and-hospital-owned company administers legacy Community Care Network, or CCN, Regions 4 and 5, while Optum covers Regions 1 through 3. GAO ownership decision VA contracts
• Signature Choice III supplies administrative support. Its $517 million award covers claims and customer services; that is a maximum contract value, not $517 million already paid. VA award notice Award data
• The famous 24% figure is historical. ProPublica and PolitiFact reported nearly $2 billion in overhead, including profit, across TriWest and Health Net under Veterans Choice in 2018, not today's CCN. 2018 investigation
• The leadership claim needs updating. David J. McIntyre Jr. remains TriWest's president and CEO, but Signature Performance named David Isaacks CEO in February 2026 and moved founder Allen Fredrickson to executive chairman. McIntyre biography Leadership announcement
• VA is not legally barred from processing claims. Federal law requires contracted provider networks but permits outsourced claims processing and calls for a comparison with VA's own capacity. 38 USC 1703 38 USC 1703D
• The budgets are much larger than administration alone. VA's latest budget lists $40.718 billion in FY2025 Medical Community Care obligations, a $50 billion FY2026 estimate, and a $57 billion FY2027 request. VA budget, Volume II
• Defense connections are documented business history. TriWest has administered TRICARE, while Signature Performance has Air Force contract history; these relationships do not, by themselves, establish improper influence. TriWest TRICARE statement Air Force order

What community care actually means

Community care lets eligible veterans receive VA-funded care from providers outside VA's own facilities, including when VA cannot supply the needed service or meet applicable access conditions. 38 USC 1703

We need to separate three jobs: delivering treatment, arranging a network of providers, and administering authorizations, claims, and payments; VA's current guidance assigns different parts to VA, community providers, and its third-party administrators. VA network guide VA claims guide

A doctor treating a veteran is therefore not interchangeable with the company paying that doctor's claim, and a payment passing through an administrator is not automatically that company's fee or profit. OIG payment audit

VA also retains care-coordination responsibilities and authorization authority under section 1703, so hiring a network contractor does not transfer the whole program out of government. 38 USC 1703

Fact check: the claims we started with

TriWest: a network administrator with several contract eras

TriWest's VA history spans Patient-Centered Community Care, known as PC3, Veterans Choice, and the later CCN; VA's 2018 announcement extended and expanded its PC3 work as Health Net's contract closed out. VA PC3 announcement

Those names matter because fees, responsibilities, and performance findings from one program cannot simply be relabeled as findings about another contract. VA PC3 announcement OIG payment audit

VA currently identifies TriWest's Region 4 contract as 36C10G19D0038 and its Alaska Region 5 contract as 36C10G21D0001. VA contracts

USAspending's linked-order totals show cumulative obligations of $47.60 billion for Region 4 and $1.46 billion for Region 5, against parent ceilings of approximately $58.32 billion and $5 billion; these are lifetime contract figures, including medical care, not annual administrative revenue. Region 4 obligations Region 5 obligations Region 4 vehicle Region 5 vehicle

The next-generation vehicle is a separate award, 36C10G26D0025, signed August 31, 2026, with a recorded January 1, 2027 start and December 31, 2036 end date. Next-generation award

Its displayed $1 trillion maximum needs particular care: the conformed solicitation says the ceiling applies across all awardees and task orders, rather than being multiplied by the number of contractors. Copy of VA solicitation 36C10G26R0003 posted by a veterans site, p. 8 Find the official notice on SAM.gov

The parent record showed zero obligations when checked; that is a snapshot of this contract vehicle, not evidence that TriWest has received no federal money under other awards. Next-generation award

TriWest presents its role as expanding access and supporting VA, and its public overview reports strong clean-claim processing performance; we treat that as the company's position and assess it alongside independent oversight. TriWest overview OIG payment audit

Signature Choice III: the claims-support contract

VA awarded single-award vehicle 36C10G26D0030 to Signature Choice III on September 29, 2026, with a $517 million base-and-options maximum and a recorded contract period ending April 30, 2029. Award data VA award notice

VA's justification describes continuity during a follow-on transition, while Signature calls this a sole-source bridge and says its technology supports claims modernization; those performance benefits are company claims. VA bridge justification Company bridge announcement

The public notice says VA's existing resources cannot manage the required workload, and describes checking eligibility and authorizations, adjudicating claims, providing billing guidance, supporting associated systems, and answering customer inquiries. VA award notice

That is evidence of VA's stated capacity problem for this procurement, not proof that government could never develop sufficient staff or systems. VA award notice 38 USC 1703D

The notice's 24/7 requirement concerns an emergency-care notification line; we should not turn that into a claim that every customer-service channel operates continuously. VA award notice

The linked order 36C10G27N0011, signed October 28, showed $226,106,338.16 obligated and $418,223,061.63 potential value, with performance from November 1, 2026 through a current October 31, 2027 end and potential April 30, 2029 end. Order data

An obligation is a legal commitment, not a payment already disbursed, and the order sits under the parent ceiling rather than adding a second independent $418 million program. Order data Award data

There is a record discrepancy worth preserving: SAM labels the notice as an SDVOSB set-aside, while the award data identifies a one-source procurement with no set-aside used; readers should consult the award documents before treating those labels as interchangeable. VA award notice Award data

The money over time

Here are the numbers we can use without confusing provider payments, administrative costs, and proposed budgets. 2018 investigation VA budget, Volume II

The 2018 reporting was by ProPublica and PolitiFact, and combined TriWest with Health Net rather than assigning the entire overhead figure to TriWest. 2018 investigation

TriWest told the reporters that its work included manual scheduling and medical-record coordination, and offered a different calculation yielding 13% to 15%; the article reported both the critique and the company's response. 2018 investigation

An earlier VA inspector general audit documented PC3 authorization fees of $45 to $123 and negotiated Choice fees of approximately $295 to $300 per authorization. OIG Choice audit

By contrast, OIG describes CCN administration as a fee per active member per month, tiered so the member fee falls as volume increases; we did not verify each contractor's current dollar rates. OIG payment audit

The budget table's much larger totals include purchased care and other program costs, not just contractor administration, and the FY2028 proposal moves direct and indirect costs from other accounts into a new category. VA budget, Volume II

CRS's FY2027 appropriations review also distinguishes the administration's proposal from congressional action, including the House's decision not to adopt the proposed two-account FY2028 restructuring. CRS appropriations review

It describes a continuing resolution through December 11, 2026 that generally preserves prior FY2027 advance appropriations; the requested spending table is not a substitute for that funding record. CRS appropriations review

We therefore cannot read the jump from $57 billion to $74.829 billion as a clean measure of like-for-like growth, much less as an increase in contractor profit. VA budget, Volume II CRS appropriations review

At a January 2026 congressional hearing, VA projected next-generation savings of 8% to 14%, roughly $54 billion to $100 billion over a decade; those were forecasts, not realized savings. January 2026 hearing

Why VA uses contractors, and whether it has to

The legal answer has two parts: 38 U.S.C. 1703(h) requires consolidated, competitively bid contracts to establish provider networks, while 38 U.S.C. 1703D(g)(1) permits VA to use outside entities for claims processing. 38 USC 1703 38 USC 1703D

The latter section also directs VA to seek an independent review comparing its own processing capacity and costs with an outside processor, which makes blanket claims of legal impossibility particularly hard to defend. 38 USC 1703D

There is a practical history behind outsourcing: GAO found that VHA reported processing about 66% of claims within 30 days in FY2015, compared with about 99% for Medicare and TRICARE contractors. GAO processing review

GAO cautioned that VA's figures likely overstated performance because the clock missed paper-scanning delays, and identified manual work, technology limitations, and staffing shortages. GAO processing review

That comparison supports the case for fixing a struggling operation, but it is not a controlled demonstration that a modern public operation must cost more than a private one. GAO processing review

GAO recommended a modernization plan with costs, milestones, and performance measures, rather than concluding that government employees were inherently unable to process claims. GAO processing review

GAO later closed that recommendation as implemented after VA's 2019 consolidation, transfer of claims work to contractors, and documentation of its reimbursement system. GAO processing review

VA still directs providers to submit Veterans Care Agreement and local-contract claims to VA, along with unauthorized emergency-care claims; its Financial Services Center remains a government financial-services organization. VA claims guide VA financial center

The strongest case for using contractors is access to established networks and processing capacity when VA cannot meet demand; VA's next-generation announcement argues for competition, stronger oversight, and replacing contractors that fail requirements. VA network guide VA procurement rationale

The strongest case for retaining or rebuilding public capacity is accountability for the entire patient journey, with costs, staffing, scheduling, and payment performance measured together; GAO's 2025 testimony called for better network oversight, staffing assessments, and reliable access measures. GAO access testimony

Neither approach eliminates oversight work: a February 2025 OIG audit found CCN outpatient payments generally accurate and timely, but estimated overpayments of $105.1 million to Optum for FY2020 through FY2022 and $73.4 million to TriWest for FY2020 through FY2023. OIG payment audit

The report identified about $783.4 million for Optum and $127.3 million for TriWest in dental reimbursements above what they paid providers for FY2020 through May 2024 services; those are contract-pricing findings, not an overall profit margin. OIG payment audit

GAO's July 2026 review reported a $608 million FY2025 community-care improper-payment estimate, or 2.4% of relevant outlays, and credited VA's corrective-action processes while finding its fraud-risk assessment incomplete. GAO payment integrity

Improper payments are not synonymous with fraud, and that estimate uses a different population and method from the OIG dental review, so we should not add the figures together. GAO payment integrity OIG payment audit

Our reading is that the evidence supports selective contracting with measurable results and a serious in-house comparison, not a claim that either ownership model automatically wins. 38 USC 1703D GAO processing review GAO payment integrity

Who owns and runs the companies

GAO's 2023 TriWest bid-protest decision described ownership by 17 nonprofit health insurers and university hospital systems, and Blue Shield of California publicly identified itself as an owner in 2018. GAO ownership decision Insurer ownership statement

GAO also discussed shareholder management in place of a board under TriWest's close-corporation structure, a dated governance finding rather than a complete current organization chart. GAO ownership decision

University of New Mexico Hospital's FY2025 financial statements also disclose a noncontrolling TriWest equity interest, but these records do not give us a complete October 2026 ownership register or voting agreement. Hospital financial statements GAO ownership decision

McIntyre's company biography identifies him as a cofounder in 1996 and current president and CEO. McIntyre biography

One USAspending award record lists $3,567,659 as reported executive compensation for McIntyre; the record does not establish that figure as his current annual salary, so we cannot honestly say either that all compensation is secret or that this is his 2026 pay. Reported compensation

Signature Performance says Fredrickson founded it in 2004, and its current leadership roster names Isaacks as CEO, Fredrickson as executive chairman, and Karen Hudgins as executive adviser to the chairman. Signature leadership

Signature describes itself as privately held; we did not verify a complete shareholder register or current executive-compensation schedule. Company ownership statement

Principle Choice's SBA record identifies an active SDVOSB certification; the JV's own entity identifiers are UEI SEA1J4KKHTN4 and CAGE 1ABM5, which help distinguish it from similarly named businesses. SBA certification SBA venture profile

Under 13 CFR 128.402, the qualifying SDVOSB must manage an eligible venture and own at least 51% of a separate legal entity, with profits commensurate with its work or a higher agreed share; these eligibility rules do not reveal this venture's private profit split. 13 CFR 128.402

For qualifying set-aside performance, the SDVOSB generally must perform at least 40% of the venture's work, and the venture need not hold a separate SBA certification if the rule's conditions are met. 13 CFR 128.402

The documented defense backgrounds

TriWest held TRICARE contracts from 1996 through 2013, initially in the Central Region, and returned for the 26-state West Region on January 1, 2025. TriWest TRICARE statement Congressional biography

McIntyre's congressional biography describes nearly nine years in Senate health-policy work, most recently as a senior aide to John McCain, while Terry Moulton's company biography describes a 37-year Navy career ending as Deputy Surgeon General. Congressional biography Moulton biography

Signature Performance's Air Force order BU01, under FA701407D0010, covered medical-clinic appointment clerks and records $202,719.62 in obligations for 2007 through 2012 performance, one example rather than its total defense business. Air Force order

VA's profile documents Isaacks' Marine Corps service from 1997 through 2005, and his company biography documents later leadership of VA's Sunshine Healthcare Network. VA service profile Leadership announcement

Principle Choice identifies Dan Coleman as CEO and a retired Air Force Medical Service Corps officer and hospital administrator, with Amy Carbajal as president and chief operating officer. Coleman biography Principle Choice leadership

We can describe these careers and contracts without inferring that someone influenced an award improperly, which the cited records do not establish. McIntyre biography Leadership announcement Air Force order

What to watch next

Watch task orders and actual obligations under the next-generation CCN awards, rather than treating selection for an umbrella contract as guaranteed revenue. Next-generation award Copy of VA solicitation 36C10G26R0003 posted by a veterans site, p. 8 Find the official notice on SAM.gov

For Signature Choice III, watch amendments, exercised options, and the difference between the order's October 2027 current end and April 2029 potential end. Order data

Also track the separate national dental contract VA announced for Optum in September 2026, worth up to $30 billion over ten years, rather than folding it into the medical ceiling. VA dental award

For the budget, compare enacted appropriations and eventual obligations with the requests, especially if Congress changes the account structure. VA budget, Volume II CRS appropriations review

For performance, we would look for independent follow-up on dental reimbursement, improper-payment controls, network access, and VA's own capacity comparison. OIG payment audit GAO payment integrity GAO access testimony 38 USC 1703D

How to check USAspending and SAM yourself

In USAspending, search the exact award identifiers above, open the parent contract and its linked orders, and keep obligations, outlays, and potential value in separate columns. Award data Order data

Record the retrieval date, agency, recipient UEI, NAICS classification, start date, current end date, and potential end date before comparing two awards. Award data Order data

For example, Signature Choice III's award uses NAICS 524114, while its SBA entity profile lists primary NAICS 524292; an award's classification and a firm's primary classification need not match. Award data SBA venture profile

In SAM, search the contract number in Contract Opportunities and read the notice and attachments; a public award notice and an entity registration answer different questions. VA award notice SBA venture profile

For veteran-owned eligibility, cross-check SBA's certification record and the joint-venture rules rather than treating a company description or a notice's set-aside label as conclusive. SBA certification 13 CFR 128.402

Fact-check notes and sources

• Observations were made October 31, 2026, in UTC; contract and company records are snapshots, and historical findings retain their original review periods. Award data OIG payment audit
• The principal legal sources are sections 1703 and 1703D, with VA's provider guidance showing the present division of processing work. 38 USC 1703 38 USC 1703D VA claims guide
• Money comparisons use VA's FY2027 budget, CRS's appropriations review, and the separately identified 2018 investigation, rather than applying one overhead percentage to every program. VA budget, Volume II CRS appropriations review 2018 investigation

Related reading

• How government contract vehicles work
• Maximus and government services
• Wildfire contractors, ownership, and service backgrounds

This post is informational, not legal, financial, or medical advice. Company names identify the public records being discussed. No affiliation is implied.