Fraud happens when a person or organization deliberately deceives others to gain an unauthorized benefit. Health care abuse occurs when providers supply services or products that are medically unnecessary or that do not meet professional standards.

Beneficiaries are important partners in the ongoing fight against fraud and abuse. Because an explanation of benefits (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 concerns about services you believe are billed fraudulently.  You can also visit the TRICARE Program Integrity Web site for direct links to each contractor’s fraud and abuse reporting office.  Through MyHMHS for Beneficiaries 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 Express Scripts, Inc. by phone at 1-800-332-5455, ext. 367079, or by email at fraudtip@express-scripts.com.

You also can report fraud or abuse issues directly to TRICARE at fraudline@tma.osd.mil.