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Tricare Cracking down on Healthcare Fraud and Abuse

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Providers servicing military populations and accepting TRICARE should be wary. TRICARE and the Department of Justice are ramping up efforts to crack down on TRICARE fraud and abuse. Providers in Florida, Hawaii, Texas, North Carolina, California and other states with heavy military populations will see increased scrutiny by the Department of Justice, Defense Criminal Investigative Service and the FBI for improper billing of TRICARE services. In 2017, Attorney General Jeff Sessions announced the largest healthcare fraud “takedown” in United States history. 412 individual defendants were indicted for unlawfully submitting fraudulent claims. These claims include Medicare, Medicaid, and Tricare for treatments that weren’t rendered, not medically necessary, or improperly billed. Many of those cases were related to physicians and pharmacies who improperly billed TRICARE for services that were not rendered.

While TRICARE fraud cases were previously limited mostly to compounding pharmacy cases. The investigations have recently expanded into occupational therapy, speech therapy, physical therapy, and other outpatient services. When a provider submits a bill to TRICARE, it is certifying that it has complied with all of TRICARE’s rules and regulations contained in its TRICARE provider manual. This includes rules related to reimbursement, coding, and credentialing. Failure to abide by the TRICARE provider manual, according to the government, can equate to TRICARE fraud. You may be charged for health care fraud under 18 U.S.C. 1347 which is a Federal Criminal Statute. The providers who are accused of TRICARE fraud can also be charged with wire fraud, making false statements related to healthcare, and even RICO (an organized crime statute).

What Should I Do?

If you feel that you may have billed TRICARE in error you should contact an experienced TRICARE fraud attorney today. Here at Chapman Law Group, our team of healthcare fraud and TRICARE fraud attorneys are here to help. Our attorneys include former healthcare fraud prosecutors, seasoned defense attorneys, health law experts, and a former military prosecutor that can assist you with the best possible resolution to your case.  While many firms boast criminal defense experience, few understand the complexity of healthcare billing, coding, and reimbursement. Our team includes experienced attorneys with advanced degrees in health law that understand the complex regulatory environment.

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Whether you are facing an audit, indictment, or suspect that TRICARE may have over-paid you. It is imperative to seek skilled health care advice as soon as possible. TRICARE is responsible for over 9.4 million beneficiaries across the United States and reimburses over 70.5 million outpatient visits a year. No wonder the Department of Justice and Federal Law enforcement agencies are targeting TRICARE fraud abuse. In recent months, DCIS, HSMA, FBI and other investigative bodies have increased efforts to crack down on TRICARE fraud. Providers in Hawaii, California, North Carolina, Florida and Texas who treat large populations of TRICARE beneficiaries are facing increased investigations.

If you bill Tricare and feel that you may be the target of an audit, investigation, or indictment you don’t need just any criminal defense attorney, you need one who understands the complexity of health care and TRICARE. Chapman Law Group is a team of skilled healthcare attorneys including former healthcare fraud prosecutors, health law attorneys, and seasoned criminal defense attorneys who are well equipped to understand the complexity of the healthcare industry and effectively work to resolve allegations of TRICARE fraud. Chapman Law Group has achieved fantastic results drastically reducing overpayments during audits and obtaining, in some cases, dismissal of health care fraud charges.