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Fraud or Abuse

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 are an important partner in the ongoing fight against fraud and abuse. Your explanation of benefits (EOB) is a  statement of services/supplies received, and its one of the first lines of defense against health care fraud. Each EOB inclues a toll-free number to call if you have questions about services you believe are billed fraudulently. Read your EOBs carefully and to visit your regional contractor's website to view your EOBs, get your claims history and track TRICARE costs paid.

Report Fraud or Abuse

Medical 

Contact your regional contractor's fraud and abuse office or submit a fraud report to the Defense Health Agency Program Inegrity Office.

Pharmacy

Contact Express Scripts:

Last Updated 3/25/2014