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MTF Compliance With DoD Instruction 5505.12 Establishment of an Anti-Fraud Program

Health Budgets & Financial Policy. MTF Compliance With DoD Instruction 5505.12 Establishment of an Anti-Fraud Program. Presented by: [name redacted] Health Care Fraud Specialist TMA Program Integrity Office Dial in: 1-800-960-7130 Conf code: 8442672. Health Budgets & Financial Policy.

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MTF Compliance With DoD Instruction 5505.12 Establishment of an Anti-Fraud Program

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  1. Health Budgets & Financial Policy MTF Compliance WithDoD Instruction 5505.12Establishment of an Anti-Fraud Program Presented by: [name redacted] Health Care Fraud Specialist TMA Program Integrity Office Dial in: 1-800-960-7130 Conf code: 8442672

  2. Health Budgets & Financial Policy Objectives • Introduce TRICARE and Program Integrity (TMA PI) • Requirements of DoDI 5505.12 • Explain a TMA PI fraud/abuse lead referral • Provide resources for submitting lead referrals • Questions

  3. TRICARE Agency for DoD purchased care Administration for 9.2 million beneficiaries worldwide Supports DoD beneficiaries in U.S. and overseas Health Budgets & Financial Policy 3

  4. Health Budgets & Financial Policy Program Integrity • Addresses fraud & abuse in the MHS • Liaison with MHS, DoJ, investigative agencies • 2008 recovery for DoD – court judgments $123 million, administrative recoupments $3 million • October 2006 MTFs instructed to implement Anti-Fraud Program • http://www.tricare.mil/fraud/

  5. DoDI 5505.12 October 2006 MTF Commanders instructed to implement and oversee Anti-Fraud Program TMA PI responsible for receipt of fraud referrals from MTFs http://www.tricare.mil/fraud/_Globals/documents/550512p.pdf http://www.tricare.mil/fraud/ Health Budgets & Financial Policy 5

  6. Fraud Referrals Conflict of Interest Licensing Violations Practice Violations Overutilization Suspect Billing Practices Patterns of Care Patient Eligibility Monetary/Patient Harm Health Budgets & Financial Policy 6

  7. Fraud ReferralComposition Name(s) of Provider, Beneficiary, Involved Person, Office Summary of Allegation(s) Source(s) of Information Monetary Impact on MTF Copy of Audit Findings and Other Relevant Documents Health Budgets & Financial Policy 7

  8. TMA PI Contacts Phone 303-676-3573/3824 Fax 303-676-3981 fraudline@tma.osd.mil Program Integrity Office TRICARE Management Activity 16401 East Centretech Parkway Aurora, CO 80011 Health Budgets & Financial Policy 8

  9. DODI 5505.12 Questions? Health Budgets & Financial Policy 9

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