Tribe accuses health care provider of overcharging members

By Seth Klamann

Casper Star-Tribune

Via Wyoming News Exchange

CASPER — The Eastern Shoshone Tribe has accused Fremont County’s SageWest Health Care and its ownership of overcharging tribal members to the tune of a 700 percent profit margin. The hospital denies the allegations. 

“We want to remind Apollo Global Management that Indian Country will not tolerate medical services being rendered to tribal communities and charging jaw-dropping rates that have allowed them to profit at an exorbitant and inappropriate rate,” the tribe’s business council said in a statement. 

Last year, Apollo — a New York-based equity firm with nearly $250 billion in assets — acquired LifePoint, the for-profit owner of SageWest, which has hospitals in Lander and Riverton. 

Matt Silverstein, the CEO of FirstNation Health, said the tribe conducted an audit of the tribe’s hospital bills and found errors in roughly 20 percent of the charges from SageWest. Profits reaped by the company from tribal patients topped 700 percent, he said. For one member, SageWest charged more than $120,000 to the tribe’s plan for services that cost the provider about $12,700. 

“I could give you 30 more examples just like that,” said Silverstein, whose company provides support to tribes in understanding and administering health plans.

Tribal leadership declined to comment beyond their statement and said through a spokeswoman that Silverstein would speak on behalf of the business council. Silverstein, who is a member of the Choctaw Nation, said the results of the audit were supported by two other independent analyses. 

Cynthia Hom, a vice president of one of the firms who performed that independent analysis, said the company had performed an analysis but directed further comment to Silverstein. He declined to provide the name of the other company, citing a nondisclosure agreement. 

He said it appears that tribal members have been uniquely targeted by SageWest for higher billing. He said he works with tribes in 20 states and that SageWest’s billing is uniquely “egregious.” 

“This correlates with the acquisition by Apollo,” he said of the price increases. “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.” 

Eric Kuo, who works for a public relations firm hired by Apollo, declined to comment and directed questions to LifePoint after the Star-Tribune sent him the tribe’s statement. In turn, Michelle Augusty, LifePoint’s vice president for communications, directed comment to SageWest itself. 

In a statement sent in response to detailed questions from the Star-Tribune, SageWest’s marketing director Lindsey Anderson said the hospital was not aware 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,” Anderson wrote. “In fact, we have had a provider agreement in place since September 2017 that offers a substantial discount to Eastern Shoshone tribal members.” 

Silverstein said no such agreement was ever signed in September 2017 for tribal members, only nonmembers covered by the tribe’s plan. What’s more, he said that SageWest officials admitted to the tribal business council that the hospital charged more than that pay schedule. 

“SageWest remains the only hospital among hundreds the plan pays who is demanding such lavish profit margins for medical services,” Silverstein wrote in a follow-up email after reviewing SageWest’s statement. 

Silverstein added that Apollo should comment on the behavior of its hospitals. 

“The tribe believes that the hospital is exclusively focused on their profits right now,” he said. 

He said health care is the second-highest expense for the tribe and that 70 percent of the Eastern Shoshone’s plan’s costs were from SageWest. 

The tribe’s business council met with SageWest’s CEO and CFO for several hours on Tuesday, with Silverstein present and David Archambault II — who works with Silverstein and is the former chairman of the Standing Rock Indian Reservation and a critical part of the pipeline protests there — participating via phone. 

Silverstein said the tribe and the company “agreed on a process to move forward” but that any progress would “require Apollo to render a final decision.” 

The controversy is just the latest for SageWest. In the fall, prominent members of the Riverton community told the Star-Tribune that they suspected SageWest’s leadership was siphoning off services from Riverton in favor of the Lander location. They say the SageWest wants to eventually turn Riverton’s hospital into an outpatient clinic. 

In 2017, the Star-Tribune reported on state findings that the Lander hospital had failed to clean its surgical tools despite repeated warnings.