Is my doctor taking advantage of Tricare?
March 23rd, 2010 | TriCare Help | Posted by Military Times
Q. My wife and I feel that our doctor is taking advantage of Tricare by scheduling us for unnecessary appointments and services. Is there an organization such as the Better Business Bureau for doctors that I should contact?
Billing Tricare for excessive and unnecessary services is called abuse and is illegal. Tricare takes such matters very seriously.
I suggest you write a letter to the Tricare office that processes your claims. The address is on your explanation of benefits forms. In your letter, provide as many examples and other details as possible, including names and dates. If other providers are involved — as in a case of excessive laboratory tests —include their names, as well.
Also include copies of any pertinent documents relating to your complaint. Because of provisions of the Privacy Act, both you and your wife should sign the letter. Don’t forget to include a daytime phone number.
Cheating on Tricare forms isn’t worth it
December 16th, 2009 | TriCare Help | Posted by Military Times
Q. You’re going to think I’m crazy, but I figure you’re probably a safe person to ask: The Tricare claim form asks if I have other health insurance, and I always report my other policy. But, if I didn’t report it, I could collect from both policies and offset some things that don’t get paid. So, please satisfy my curiosity. What are my chances of getting caught if I don’t report the other policy, and what would happen if I did?
Your question isn’t new and neither is my reply. It’s a legitimate question, and an important one. So, no, you aren’t crazy. Unless you do it, of course.
Deliberate failure to report your other health insurance on your claim form is illegal. Additionally, stating falsely that all information on the form is correct, when you know it is not, is illegal. That is not an auspicious beginning.
Your signature on the Tricare claim form affirms, “under penalty of perjury,” that the information on the form is true. If the information is untrue, it is a false sworn statement used to obtain something of value you are not legally entitled to. That being true, I don’t think the claim would be different from any other false claim against the government. It wouldn’t be special, or somehow different, because it involved Tricare. The prosecuting authority would probably call it fraud.
Some very elaborate and sophisticated insurance fraud schemes appear from time to time. And it goes without saying that you never hear about the successful ones. So, what are your chances of getting caught, and what would happen next? I don’t know your chances of getting caught. I’ve never seen any statistics on the subject. When I worked for Tricare, I wasn’t involved with the folks who investigated fraud. Minor offenses aren’t often reported in the newspapers.
Considering the millions of Tricare claims processed every year, and the fact that bad guys vastly outnumber good guys – the examiners and auditors – you would probably get away with it for a while; maybe for a long time. But once discovered, all of your claims would be audited, forever.
And, once caught, what would happen? I have to guess that it could be anything from a fine to a sudden lifestyle change. But, that would be up to a federal prosecutor and a court. If you decide to do it, and if you get caught, drop me a line from
wherever. It will be your turn to satisfy my curiosity.