Understanding Fraud and Abuse

<h4>What is Fraud and Abuse?</h4> <p>Fraud is the intentional deception or misrepresentation that an individual knows to be false, when that individual knows the deception could result in some unauthorized benefit or payment.</p> <p>Abuse involves actions that are inconsistent with accepted, sound medical, business, or fiscal practices.&nbsp;Abuse directly or indirectly results in unnecessary costs to the program through improper payments, or in reimbursement of services that are not medically necessary or fail to meet professionally recognized standards of health care.&nbsp;&nbsp;</p> <p>International SOS, the TRICARE Overseas Program (TOP) contractor, is committed to detecting, correcting, and preventing health care fraud and abuse. Fraud happens when a person or organization takes action to deliberately deceive others to gain an unauthorized benefit. Health care abuse occurs when Providers supply services or products that are medically unnecessary or that do not meet professional standards.</p> <p>The health care profession (both stateside and overseas) is marked by honest, compassionate, ethical Providers. As with all industries however, the health care field also has individuals and institutions who conduct dishonest practices that can be harmful to beneficiaries and the medical community as a whole. Health care fraud and abuse can result in serious criminal investigation and prosecution.</p> <p><a href="https://tricare-overseas.com/providers/understanding-fraud-and-abuse/examples" target="_blank">Click here for examples of Fraud and Abuse.</a></p> <p><a href="https://tricare-overseas.com/report-fraud-and-abuse" target="_blank">For more information on how to report Fraud and Abuse, click here.</a></p>