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Tricare is a special healthcare program devised to cater to the medical needs of people associated with the US armed forces in different capacities. Apart from the people serving the military currently, the program also covers the person retired from the services, their families, and dependents. It also covers the National Guard and Reserve members, those enrolled in the Defense Enrollment Eligibility Reporting System and the recipients of the Medal of Honor and their families. While the program is wide-ranging, the program has been rocked by news of fraudulent claims. According to https://www.forbes.com, the FBI says that healthcare fraud costs the nation tens of billions of dollar every year. Considering the enormity of the problem and the seriousness with which the investigating authorities are clamping down on these illegal activities, the owners and providers of healthcare services may find themselves under investigation and thus need to have a strategic plan of defense against charges of submission of fictitious or false claims.
Who Investigates Fraud under the Tricare Program?
There are quite a few agencies that are empowered to investigate fraud under the Tricare program. Primarily they are the Department of Defense, the Department for Health and Human Services (HHS), the Office of Inspector General (OIG), and the Federal Bureau of Investigation (FBI). It is also quite common for the Drug Enforcement Administration (DEA) to be also involved in the investigation.
Types of Investigation and Prosecution
Criminal charges: Sometimes the investigating authorities may institute criminal charges on individuals they think to be responsible for Tricare fraud. The federal government will bring the fraud case before a U.S. District Court and seek to indict the charged individuals so that they can be sent to jail. Criminal healthcare fraud cases can be very complex and require the defense attorney to understand both federal criminal procedure and the legal framework of healthcare.
Civil liability: Generally imposed on companies held responsible for medical fraud, the penalties may involve requests for recoupment, fines up to $11,000 per claim held to be false, non-payment of claims in the future, exclusion from the healthcare programs of the federal government, reimbursement of fees of the government attorneys, as well as treble damages. The civil liability may arise even if there had been no specific intent to break the law, and in fact, the government has no need to prove the responsible people had any knowledge of the illegality of the transaction.
Who May Be Prosecuted?
Any business or person that is under contract with the U.S. Government, directly or indirectly, or is paid the federal government for services rendered is covered under the healthcare statutes. The most common targets of investigation are pharmacies, compound pharmacies, hospitals, toxicology laboratories, entities owned by physicians, physicians, nurses, staff, and companies manufacturing and marketing medical devices.
If you are being investigated by any of the empowered authorities for fraud under the Tricare program, the first thing you should do is to engage an attorney who is both competent and experienced in such cases. Their understanding of the nuances and complexities of healthcare law as well as the Tricare program will help you to get the case dismissed quickly.