TRICARE beneficiaries

Fraud and abuse

If you, in good faith, have a suspicion that a TRICARE provider or a beneficiary has committed an act of fraud or abuse, you may report this suspicion to Humana Military. All allegations of fraud and abuse are investigated to determine whether there is sufficient evidence to report the case to the government for further investigation.

To report fraud and abuse

When submitting a report, you may remain anonymous; however, it may be beneficial to the program integrity unit to contact you for additional information, if possible. You can make a report through any of the three resources listed below.

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Call and report

Call to report fraud and abuse.

Call (800) 333-1620
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Go online

Report fraud and abuse online.

Submit report now
Mail icon

Mail in report

Mail in your report of fraud and abuse.

Get mailing address

Mail report to:

Humana Military
Attn: Program Integrity
Forum III, 305 N Hurstbourne Pkwy
Louisville, KY 40222

Be sure to include the name of the subject to be investigated and their city and state, as well as a detailed allegation, how you became aware of the allegation and your phone number for follow-up purposes.

Preventing fraud and abuse

Understanding your Explanation of Benefits (EOBs)

Always review your EOBs and medical bills to ensure that the services billed were actually performed by the provider indicated and on the date specified.

Help prevent fraud and abuse

Keep track of every bill received or paid by your insurance provider to make sure that you are not billed more than once for the same service. Do not be afraid to question your healthcare provider about the necessity of each procedure that is being ordered for you, especially if it seems excessive and do not accept a discount of medical payments or the waiver of your co-payment unless you see the discounted amount reflected on your bill. If you have questions regarding your bill, please contact the doctor who provided the services.

More information is available about preventing fraud and abuse from these resources:

What does fraud and abuse mean to you?

Why program integrity?

Most healthcare providers subscribe to the highest code of ethical standards. However, as in any large population, some individuals intentionally seek to defraud the system. In fact, estimates indicate that between seven to ten percent of the $2.7 trillion annual healthcare expenditures in the US are fraudulent.

By actively coordinating with government officials and other insurers, our fraud investigators work to identify and investigate every individual attempting to defraud or seriously jeopardize the quality of patient care.

Crimes involving healthcare fraud lead to higher taxes, higher cost-shares for medical services and has the potential for false medical histories in patients' records. Military formed the program integrity department to help combat this fraud and other attempted abuses committed within the TRICARE health program. Our fraud investigators are committed to the prevention, detection and investigation of every alleged fraud and abuse case.

Did you know?

  • Healthcare expenditures in the U.S. are approximately $2.7 trillion annually
  • This is a very alluring target for those who would choose to perpetrate fraud schemes
  • Every dollar lost to healthcare fraud is one dollar less for national defense
  • Healthcare fraud is defined as intentionally misrepresenting a service or supply in order to receive a higher benefit
  • The crime of healthcare fraud is the second priority of the United States Department of Justice

What is healthcare fraud?

Healthcare fraud is defined as: "An intentional act of misrepresentation or deception that results in a higher benefit to the beneficiary, the provider or some other entity."

What is abuse?

Any practice that is inconsistent with accepted and sound, fiscal business or any professional practice which results in a TRICARE claim cost for TRICARE payment for services or supplies that is: (1) not within the concepts of medically necessary and appropriate care or (2) fails to meet professionally recognized standards for healthcare providers.

Examples of fraudulent and abusive medical practices include:

  • Charging more than once for the same service (double billing)
  • Charging for services never performed or medical equipment/supplies never ordered
  • Performing inappropriate or unnecessary services
  • Offers of free services or medical equipment in exchange for your policy number
  • Providing lower cost or used equipment while billing TRICARE for higher cost or new equipment
  • A supplier completing a certificate of medical necessity form for a physician
  • Awareness of an ineligible beneficiary on someone's plan, i.e. girlfriend listed as a spouse
  • A provider solicits a "free" consultation or service, which is then billed to TRICARE
  • Someone offering you an incentive to sell your insurance information, i.e. policy numbers
  • A provider offers to conceal noncovered services by using a different allowable description