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.

Beneficiaries are important partners in the ongoing fight against fraud and abuse. Because an explanation of benefits (EOB) is a tangible statement of services and/or 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, or you can access the TRICAre Program Integrity Web site  for direct links to each contractor’s fraud and abuse reporting office. Through Humana Military's 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 7.5 for details.

To report fraud or abuse regarding the pharmacy program, contact ESI:

Phone: 1-800-332-5455
E-mail: fraudtip@express-scripts.com

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