Report Fraud and Abuse
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Report Fraud and Abuse
International SOS, as part of the TRICARE Overseas Program (TOP), is committed to detecting, correcting and preventing health care fraud and abuse.
You are the most important link in finding and reporting fraud and abuse; not only to save valuable benefit dollars, but also to make certain that beneficiaries receive appropriate medical care.
The following information will help you identify and report any suspected cases of fraud or abuse as they relate to the TOP health care benefits you receive or administer.
You can also reference the TRICARE 32 Federal Code of Regulations (CFS 199.9), Administrative Remedies for Fraud, Abuse & Conflicts of Interest by clicking here.
Fraud Tip Hotline
Please report, anonymously or by name, any suspected fraudulent or abusive behavior by beneficiaries or providers using one of the following options:
* Note: It is current Hotline Policy not to respond directly to written communications.
What is Fraud?
Fraud is intentional deception or misrepresentation that an individual knows to be false or does not believe to be true, when that individual knows that the deception could result in some unauthorized benefit to himself or herself or some other person. The most frequent kind of fraud arises from a false statement or misrepresentation in order to obtain some benefit or payment for which no entitlement would otherwise exist. These acts may be committed either for the person’s own benefit or for the benefit of some other party. In order to prove that fraud has been committed against the Government, it is necessary to prove that fraudulent acts were performed knowingly, willfully, and intentionally.
What is Abuse?
Abuse involves actions that are inconsistent with accepted, sound medical, business, or fiscal practices. Abuse directly or indirectly results in unnecessary costs to the TRICARE program through improper payments. Abuse does not necessarily involve fraud, violation of laws, regulations, or provisions of a contract or grant agreement.
International SOS, as part of the TRICARE Overseas Program (TOP), is committed to detecting, correcting and preventing health care fraud and abuse.
You are the most important link in finding and reporting fraud and abuse; not only to save valuable benefit dollars, but also to make certain that beneficiaries receive appropriate medical care.
The following information will help you identify and report any suspected cases of fraud or abuse as they relate to the TOP health care benefits you receive or administer.
You can also reference the TRICARE 32 Federal Code of Regulations (CFS 199.9), Administrative Remedies for Fraud, Abuse & Conflicts of Interest by clicking here.
Fraud Tip Hotline
Please report, anonymously or by name, any suspected fraudulent or abusive behavior by beneficiaries or providers using one of the following options:
- Call the Fraud Tip Hotline toll free or direct:
- 877-342-2503
- +1-215-354-5020
- Fax correspondence to:
- +1-215-354-2395
- Send an email to: TOPProgramIntegrity@internationalsos.com
- Click here to download and complete a Fraud and Abuse Report form.
- Mail correspondence to:
ATTN: TRICARE Program Integrity
1717 W. Broadway
P.O. Box 7635
Madison, Wisconsin 53707
USA
* Note: It is current Hotline Policy not to respond directly to written communications.
What is Fraud?
Fraud is intentional deception or misrepresentation that an individual knows to be false or does not believe to be true, when that individual knows that the deception could result in some unauthorized benefit to himself or herself or some other person. The most frequent kind of fraud arises from a false statement or misrepresentation in order to obtain some benefit or payment for which no entitlement would otherwise exist. These acts may be committed either for the person’s own benefit or for the benefit of some other party. In order to prove that fraud has been committed against the Government, it is necessary to prove that fraudulent acts were performed knowingly, willfully, and intentionally.
What is Abuse?
Abuse involves actions that are inconsistent with accepted, sound medical, business, or fiscal practices. Abuse directly or indirectly results in unnecessary costs to the TRICARE program through improper payments. Abuse does not necessarily involve fraud, violation of laws, regulations, or provisions of a contract or grant agreement.
