Unlock Your Health: How to Report Fraud and Abus...

FALLS CHURCH, Va. - Health care fraud and abuse harms everyone. Fraud and abuse can drive up costs and divert resources. TRICARE is committed to protecting the health information of service members, retirees, and their family members. You can help by knowing how to spot fraud or abuse-and by reporting it when you see it.

"Most TRICARE providers act with honesty and integrity," said Jennifer Dietz, director of Health Care Fraud Resolution for the Defense Health Agency Office of the Inspector General. "But when fraud or abuse happens, it diverts resources that should be used to provide access to appropriate and quality medical care."

Here's what you should know to recognize, report, and help prevent fraud and abuse.

What is fraud?

Fraud happens when a person or organization knowingly deceives TRICARE to gain a benefit--or payment--they aren't entitled to.

Examples of fraud include:

• Billing for services that weren't provided
• Falsifying medical records or claims
• Misrepresenting services to charge a higher rate
• Using someone else's information
• Hiding other health coverage

What is abuse?

Abuse involves improper practices that may or may not be intentional but result in unnecessary costs to TRICARE.

Examples of abuse include:

• Waiving copayments or cost-shares without proper documentation
• Billing for services that aren't necessary
• Keeping poor or incomplete records
• Repeated improper billing practices
• Refusing medical record requests

How to spot suspected fraud or abuse

Pay attention if you see anything suspicious or unfamiliar on your bill. One example is if you receive a bill for a service you never received. You should also be cautious if a provider offers you a "free" service but asks for your TRICARE information in return-this could be a scam.

Keep an eye out for duplicate charges for the same procedure, which may signal improper billing. Also, be wary if you feel pressured into accepting treatments or services that weren't requested. These are all potential signs of fraud or abuse.

Lastly, you should review your explanation of benefits regularly. This is the best way to spot fraud or abuse. Your EOB lists the care you received, what's been billed, and what TRICARE paid. If something doesn't match, contact your regional contractor.

How to report fraud or abuse

If you suspect fraud or abuse, report it right away. Here's how:

• Contact your TRICARE contractor:
  • This may be your TRICARE regional or overseas contractor, TRICARE For Life, TRICARE Pharmacy Program, or TRICARE Dental Program. Visit Report Fraud or Abuse for a complete list of contacts.
• Contact the Defense Health Agency Office of the Inspector General:
  • File a report through the DHA OIG.

When making a report, include as much detail as you can, such as:

• Names of providers or organizations involved
• Dates of service or incidents
• Description of the suspected fraud or abuse

You can choose to remain anonymous. All reports are confidential.

How you can help prevent fraud and abuse

The FBI offers some tips for preventing health care fraud and abuse. To ensure you don't become a victim of fraud or abuse, you should:

• Protect your personal information: Treat your personal information like your Social Security card. Only share it with trusted health care providers.
• Be cautious about "free" services: Be wary of anyone offering you free medical equipment, prescriptions, or services in exchange for your TRICARE information.
• Review your EOBs and bills carefully: Make sure you recognize all services and charges listed. If you spot an error, first call your provider. If they can't resolve it, report it to your TRICARE contractor.
• Stay informed about common scams: TRICARE will never contact you asking for your Social Security number, banking information, or personal health details over the phone or email.

Your attention helps protect not just your own health information, but also the entire military community. Unlock your health by remaining vigilant. Prevent suspected fraud and abuse by reporting as soon as possible.