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What Is Fraud and Abuse?

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. This also includes identity theft (e.g., if someone else utilizes your TRICARE card to obtain services).

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.

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Fraud and Abuse Resources

International SOS, the TRICARE Overseas Program (TOP) contractor, is committed to detecting, correcting, and preventing health care fraud and abuse.

Click here for more information regarding protecting your identity.

The following information will help you identify and report any suspected cases of fraud or abuse as they relate to TOP health care services.

Beneficiaries Click here for more information about Understanding Fraud and Abuse.
Providers Click here for more information about Understanding Fraud and Abuse.
  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.

  Please report, anonymously or by name, any suspected fraudulent or abusive behavior by beneficiaries or providers using one of the following   options. Please provide as much information as possible to assist in the investigation. Any information you provide will remain strictly   confidential.
Fraud Tip Hotline 877-342-2503 (Direct)

+1-215-354-5020 (Toll-free)

Fax +1-215-354-2395
Postal Mail

ATTN: TRICARE Program Integrity
1717 W. Broadway
P.O. Box 7635
Madison, Wisconsin 53707 (USA)

Fraud and Abuse Report Form Click here to download and complete a Fraud & Abuse Report Form.
  Note: It is current Hotline Policy not to respond directly to written communications.