Medical personnel who are part of the Uniformed Services- active duty, Reserve/Guard on active duty, civil service and government-contracted employees cannot receive dual compensation for services provided to TRICARE beneficiaries. If the medical personnel are actively being compensated through normal pay by the government, it is a conflict of interest for the medical personnel to “treat” TRICARE beneficiaries in a civilian setting and receive payment for those services. The Department of Defense and other government departments are responsible to ensure appropriate dispersion of funds in the payment of TRICARE benefits.
Federal Law prohibits moonlighting Active Duty Service Members (ADSM) and civilian government employed healthcare providers from billing TRICARE for any professional fees incurred in treating TRICARE-eligible beneficiaries. Civilian medical facilities who employ military or government civilian moonlighting healthcare providers are also prohibited from billing TRICARE for any professional fees incurred by the above providers.
Note: DHA has authorized exceptions on a case-by-case basis for DVA providers.
Per U.S. Title 32, Code of Federal Regulations (CFR) and TRICARE policy, ADSM and government employed civilian providers who moonlight are prohibited from serving as authorized TRICARE providers. As a result, these providers may not bill TRICARE for professional services furnished to eligible beneficiaries, regardless of location served.
Electronic and paper CMS-1500 and UB-04 claim forms distinctly cite, “For Civilian Health and Medical Program of the Uniformed Services (CHAMPUS) claims, I further certify that I (or any employee) who rendered services am not an active duty member of the Uniformed Services or a civilian employee of the United States Government or a contract employee of the United States Government, either civilian or military.” Billing TRICARE for services or supplies as described above will result in denied claims, recoupment and/or possible fraud investigation.