 |
You Can Help Prevent Fraud and Abuse
|
Health care fraud and abuse not only are costly, dishonest and deceptive, but they also are preventable. Identifying and preventing fraud and abuse helps save valuable benefit dollars and also ensures that TRICARE beneficiaries receive the quality of care that they are entitled to receive. Fraud is defined as the intentional deception or misrepresentation of facts, resulting in unauthorized benefits or payments. When undetected, fraud can negatively impact patient care. Examples of fraud include the following:
-
Billing for services at a higher level than provided or necessary
-
Collecting amounts from TRICARE beneficiaries that exceed the TRICARE-allowable amount
-
Failing to disclose coverage under other health insurance (OHI)
-
Falsifying claims or medical records
-
Falsifying eligibility
-
Misrepresenting the dates, frequency, duration or description of services rendered
-
Misrepresenting who provided the services
-
Submitting claims for services not rendered/used
Abuse is practicing improper or inappropriate actions, having less than acceptable standards of professional conduct or performing services that are not medically necessary. Examples of abuse include the following:
-
A pattern of claims for services not medically necessary
-
A pattern of waiving cost-shares and/or deductibles
-
Failure to maintain adequate medical or financial records
-
Improper billing practices
-
Refusal to furnish or allow access to medical records
To report suspected fraud or abuse by nother provider or a TRICARE beneficiary, call the Humana Military Healthcare Services, Inc. (Humana Military) Fraud and Abuse Hotline at 1-800-333-1620.
You can also access the online Humana Military Program Integrity Referral Form under “ Fraud and Abuse ” in the “Tools and Resources” section of the beneficiary services portal of the Humana Military Web site or contact the TRICARE Program Integrity Office at:
TRICARE Management Activity
Attn: Program Integrity
16401 East Centretech Parkway
Aurora, CO 80011-9066
Fax: 1-303-676-3981
E-mail: fraudline@tma.osd.mil
Web: www.tricare.mil/fraud
TRICARE strives to provide quality, affordable health care to all of its benefi ciaries. Preventing fraud and abuse is one way to keep costs down and ensure that all benefi ciaries receive the optimal care they deserve. We ask for your cooperation in preventing and reporting fraud and abuse.
Back to Top
|
