Fraud happens when a person or organization deliberately deceives others to gain some sort of unauthorized benefit or compensation. Health care abuse occurs when providers supply services or products that are medically unnecessary or that do not meet professional standards.
You are an important partner in the ongoing fight against fraud and abuse, and your most effective tool is your Explanation of Benefits (EOB). Since an EOB is a tangible statement of services/supplies received, it is one of the first lines of defense against health care fraud. Each EOB provides a toll-free number to call if you have questions about services you believe are billed fraudulently. You also can access the TRICARE Program Integrity Web site for direct links to each contractor's fraud and abuse reporting office. We strongly encourage you to read your EOBs carefully.
Report suspected fraud and abuse to Humana Military. See Figure 5.4 for details.
Report pharmacy program fraud or abuse by calling 1-800-332-5455. You also can report any fraud or abuse issues directly to TRICARE at fraudline@tma.osd.mil.
