US DoD IG: Global TRICARE Services Vulnerable to Fraud
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TRICARE is becoming a lot more expensive for the US Department of Defense, in part because of greater usage, and in part because of benefits increases with long-term cost implications. Military health care costs, which have doubled since 2001, could double again by 2015. See “TRICARE Trials and Tribulations” and “US DoD Trying to Slow Ballooning Prescription Drug Costs” for more background.
One of the factors that makes TRICARE harder to control is its global scope…
The Supplemental Health Care Program, for instance, will cover services from overseas civilian doctors to certain TRICARE members. Inspector General scrutiny was triggered in part by the saga of the Philippines firm Health Visions Corp. whose fraud under this system amounted to $100 million between 1998 and 2004. To date, about three dozen U.S. military veterans and foreign workers have been charged.
At present, several organizations using independent processes pay for overseas referred health care claims. On Sept 30/08, the US Department of Defense Inspector General submitted a follow-up report. They tracked over 22,000 payments, and found 90 instances involving $55,081 in duplicate payments. That’s a small percentage, but their report says the total risk is greater:
“Under the current, completely separate payment processes, the organizations processing and paying overseas health care claims do not view or track invoices being paid by other organizations…. In a previous audit of TRICARE overseas controls, we found that controls were not adequate to ensure third-party billing agencies were properly submitting overseas claims [mentions Health Visions]. Health care providers and patients could similarly exploit the weaknesses we identified in this report.”
In response, they make 2 main recommendations.
One is the suggestion that DoD transfer responsibility for processing and paying claims for overseas referred health care to a qualified health care claims processor.
The other is a recommended directive to the Surgeons General of the Army, Navy, and Air Force, stating that overseas military treatment facilities should not deposit checks from TRICARE health care claims processors into military treatment facility accounts.
See: Military.com | DoD IG Report: “Payments for Patients Referred to Overseas Providers Under the Supplemental Health Care Program” [#D2007-D000LF-0227.000, 3.6 MB PDF]
