Fighting Fraud and Abuse

Health care fraud and abuse cost American taxpayers billions of dollars each year. TRICARE and Humana Military Healthcare Services, Inc. (Humana Military) are committed to ensuring you receive care from trustworthy providers and that taxpayer money is used appropriately.
   

What Is Fraud and Abuse?

Fraud is an intentional deception or misrepresentation of fact that enables someone to obtain an unauthorized benefit or payment. 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 within the TRICARE program.
        

Here's How You Can Help:

• Always review the explanation of benefits (EOB) you receive after health care services. The EOB should list the services and supplies you received.
• If you notice any differences between the services reflected on your EOB and the services you received, call the toll-free number listed on the EOB.

Differences do not always indicate fraud, but they can indicate mistakes that may result in improper claims reimbursement from TRICARE or cause your medical record to be incorrect.  If you have any concerns about your medical record, you should follow up with your provider to ensure the services you received are reflected properly. To learn more about how TRICARE and Humana Military combat fraud and abuse, visit the TRICARE Fraud and Abuse web site or Humana Military's Fraud and Abuse section.

To report fraud or abuse regarding the TRICARE Pharmacy Program, contact Express Scripts, Inc. at 1-800-332-5455, ext. 367079, or by e-mail at fraudtip@express-scripts.com.

To report TRICARE Dental Program fraud or abuse, contact United Concordia Companies, Inc. at 1-877-968-7455 or online by visiting the United Concordia web site. Click on “Enrollees” then “Fraud and Abuse” and complete the Online Fraud Complaint Form.