Skip subpage navigation
What is fraud and abuse?
- Fraud - when a person or organization deliberately deceives others to gain some sort of unauthorized benefit.
- Abuse - when providers supply services or products that are medically unnecessary or that do not meet professional standards.
You're an important partner in the ongoing fight against fraud and abuse. If you suspect anything out of the ordinary, report it!
Report Suspected Fraud or Abuse
To report suspected fraud or abuse within the TRICARE Program, you should report directly to the appropriate contractor (see table below for direct links and information)
Any other suspected fraud or abuse should be reported to the DHA Office of the Inspector General.
| Type of Care/Program |
Who to Contact |
| Medical |
All TRICARE Plans except TRICARE For LifeMedicare-wraparound coverage for TRICARE-eligible beneficiaires who have both Medicare Part A and B.TRICARE For Life and the US Family Health Plan:
TRICARE For Life (Wisconsin Physicians Service):
US Family Health Plan:
|
| Pharmacy |
Contact Express Scripts:
|
| Active Duty Dental Program |
Contact United ConcordiaGo to United Concordia Fraud and Abuse:
United Concordia Companies Inc.
Special Investigations Unit
1800 Center Street, Suite 2B 220
Camp Hill, PA 17011
Fax: 1-877-603-6091
|
|
Federal Employee Dental and Vision Insurance Program (FEDVIP)
|
Contact Office of Personnel Management OIGOPM OIG
or
Contact BENEFEDS:
- Call the "Fraud Hotline" at 1-603-433-3815
|
You also may be interested in...
Fact Sheet
Nov 1, 2024
Medisca Inc., an ingredient supplier entered a settlement agreement to resolve allegations of inflating the Average Wholesale Price for ingredients used in compound prescriptions. This pricing scheme allowed compounding pharmacies to bill the inflated prices to federal healthcare programs, often costing thousands of dollars for one compound ...
Fact Sheet
Oct 11, 2024
Dr. Janette Gray owned and operated The Center for Health & Wellbeing in San Diego and entered a civil settlement agreement to resolve allegations of False Claims Act violations for improperly billing Medicare and TRICARE for uncovered and unnecessary medical services, mispresenting who provided the care, and unbundling services to maximize ...
Fact Sheet
Sep 27, 2024
Durable medical equipment supplier Electrostim Medical Services, Inc. and its Founder and Chairman Mario Garcia, Jr. have together agreed to pay, $20 million to resolve allegations that they violated the False Claims Act by billing federal healthcare programs for excessive and medically unnecessary supplies associated with Transcutaneous Electrical ...
Report
Jun 5, 2024
.PDF |
1.36 MB
Calendar year 2023 Health Care Fraud and Abuse Report
Article
Feb 14, 2024
Fraud and abuse can target your TRICARE medical, pharmacy, and dental coverage. If you think someone is committing fraud or abuse related to your TRICARE benefits, you should report it.
Report
Oct 26, 2023
.PDF |
714.75 KB
Calendar year 2022 Health Care Fraud and Abuse Report
Report
Oct 25, 2023
.PDF |
891.51 KB
Calendar year 2021 Health Care Fraud and Abuse Report
Report
Jun 10, 2021
.PDF |
500.88 KB
Calendar year 2020 Health Care Fraud and Abuse Report
Report
Apr 17, 2020
.PDF |
1.09 MB
Calendar year 2019 Health Care Fraud and Abuse Report
Report
May 3, 2019
.PDF |
1.08 MB
Calendar year 2018 Health Care Fraud and Abuse Report
You are leaving Health.mil
The appearance of hyperlinks does not constitute endorsement by the Department of Defense of non-U.S. Government sites or the information, products, or services contained therein. Although the Defense Health Agency may or may not use these sites as additional distribution channels for Department of Defense information, it does not exercise editorial control over all of the information that you may find at these locations. Such links are provided consistent with the stated purpose of this website.
You are leaving Health.mil
View the external links disclaimer.
Last Updated: December 30, 2024