With the high number of TRICARE fraud cases in the United States, it is no wonder that healthcare fraud is the second highest priority of focus for the U.S. Department of Justice. The $2.7 trillion healthcare industry is an enticing target for those wanting to commit healthcare fraud, which is defined as purposefully misrepresenting a medical treatment or product in order to receive a higher benefit. In fact, Humana Military has estimated that 7-10% of the $2.7 trillion industry is fraudulent. If you suspect your doctor is committing TRICARE fraud, call an experienced qui tam lawyer at The Brod Law Firm today to learn more about how you can report your case as a whistleblower.
What is TRICARE?
TRICARE is a federal healthcare program, similar to Medicare, for uniformed service members, retirees, and their families. TRICARE provides comprehensive coverage to its beneficiaries, including general health plans, special programs customized for beneficiaries, prescriptions, and dental plans.
Common TRICARE Fraud Schemes
By familiarizing yourself with common TRICARE fraud schemes, you may be better able to identify if and when your healthcare provider is committing TRICARE fraud. Below are a few TRICARE fraud schemes that you may be able to spot by keeping a closer eye on your explanation of benefits (EOB) after visits with your healthcare provider.
Fraudulent billing in TRICARE can take many different forms, including billing for services that were never performed, billing at a higher rate than the service provided, billing for a service that was never required, and billing for the same service twice. It can be easy and tempting for healthcare providers to add an extra service code or an extra 30 minutes of patient care to their billing without thinking about the consequences, which can be severe.
Prescribing Unnecessary Drugs
Even more dangerous than fraudulent billing is fraudulent diagnoses. Sometimes physicians will misdiagnose patients in order to prescribe more expensive drugs to the patient. Not only is this considered healthcare fraud, it also can be detrimental to a patient’s health and, in severe cases, result in death.
Misrepresenting Nature of Service
Another way in which healthcare providers commit fraud is by misrepresenting the location of service or the medical professional who administered the service. For example, physicians may give patients at home treatments to administer on their own rather than taking the time to administer the treatment in the office, yet they may still bill for in-office treatment to TRICARE. Alternatively, physicians may also bill for physician service time when in fact the service was performed by a nurse or other medical professional.
How to Report TRICARE Fraud and Abuse
If you suspect your healthcare provider is committing TRICARE fraud or abuse, the first thing you should do is contact an experienced TRICARE fraud attorney. An experienced qui tam attorney can advise you as to your next steps after detecting TRICARE fraud. The legal professionals at The Brod Law Firm have helped healthcare whistleblowers report their claims and obtain compensation for their qui tam actions. Contact us online or at (800) 427-7020 to schedule your free consultation today.
(image courtesy of Israel Palacio)