Report No.: DODIG-2026-053
Report Type: Audit
Component: Audit

What We Did:

This management advisory provides the results of the DoD Office of Inspector General's review of "TRICARE Payments for Enteral Formula," Project No. D2024-D000AW-0034.004.

The DoD OIG found that the DHA's CY 2024 reimbursement rate for B4161 formula exceeded retail market pricing for all 66 formula products on the DHA's enteral foods list and also exceeded other Federal and state pricing benchmarks. This occurred because the DHA did not perform market research when establishing the reimbursement rate for B4161 formula. Instead, the DHA developed the reimbursement rate for B4161 formula by calculating the average amount previously billed nationwide.

As a result, the DHA paid health care providers and suppliers within the 48 contiguous United States at least $13.6 million more than necessary for providing B4161 formula in CY 2024. If the DHA maintains its current methodology for determining reimbursement rates for this formula, it could pay at least an additional $67.9 million in unnecessary costs for B4161 formula from FY 2026 through FY 2030.