Fraud and Abuse
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. 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 questions about services you believe are billed fraudulently. In addition, each regional contractor has a fraud and abuse reporting office to which you can report possible fraud or abuse.
We strongly encourage you to read your EOBs carefully and to visit your regional contractor's Web site where you can view your EOBs, access claims history and track TRICARE costs paid.
Reporting Fraud and Abuse
To report medical fraud or abuse:
- Contact your regional contractor's fraud and abuse office
- Send an e-mail to TRICARE at fraudline@tma.osd.mil
To report pharmacy fraud or abuse, contact Express Scripts, Inc.:
- 1-800-332-5455
- fraudtip@express-scripts.com
For additional information, please visit the TRICARE Fraud and Abuse Website.
Last Modified: June 19, 2012
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