Fraud happens when a person or organization deliberately deceives others to gain some sort of unauthorized benefit. 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 with your most effective tool being 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 fraud and abuse reporting office. Through Humana Military’s
MyHMHS for Beneficiaries portal, you can use claims tools to view your EOBs, claims history and track TRICARE costs paid.
We strongly encourage you to read your EOBs carefully.
Report suspected fraud and abuse to Humana Military. See Figure 6.4 for details. To report fraud or abuse regarding the pharmacy program, contact ESI:
