Tricare is a massive insurance program that more than 9.5 million people utilize each year in the United States. This program is government-funded and is available for military families and some government officials. Although we would like to think programs like Tricare are used honestly all of the time, this is far from the truth. In fact, more than $50 billion in claims each year are considered suspicious and subjected to fraud investigations. Given the substantial amount of money at stake, it is no surprise that some providers may find themselves the subject of a fraud investigation. It is crucial that providers are aware of what is considered Tricare fraud and what the potential consequences of a conviction for this crime are.
What is Tricare Fraud?
Similar to Medicare and Medicaid, Tricare is a government-funded program for healthcare benefits provided to specific recipients across the United States. Tricare fraud is a term used to describe situations where false or fictitious claims are submitted to the federal government with the demand for payment. Like Medicare, Tricare beneficiaries are among healthcare programs within the United States Department of Defense Military Health System. As a result, investigations surrounding Tricare fraud are under the jurisdiction of the Department of Defense.
The Consequences of Tricare Fraud
Several agencies are responsible for investigating Tricare fraud. Generally, the United States Department of Health and Human Services, the Department of Justice, the Federal Bureau of Investigations, and the Department of Defense all join together in investigations. In some instances, the Drug Enforcement Administration joins into the investigation as well. The consequences of Tricare fraud can be criminal or civil in nature. The outcome of the investigation will determine how a provider is punished for their actions.
Tricare fraud can lead to criminal charges in severe cases. These cases are brought before US District Courts and can result in imprisonment and steep fines. These unique cases require the assistance of a criminal defense attorney who can provide aggressive legal representation to ensure providers have their best chances of beating their cases.
Conversely, Tricare fraud cases can result in civil liability as well. In these cases, some providers may be required to pay civil fines to the affected party. Each claim can result in up to $11,000 in fines, the exclusion from the federal healthcare programs, attorney’s fees, treble damages, and a variety of other consequences.
It is crucial to understand that liability does not require intent. A provider can be found liable for Tricare fraud without actually intending to commit the crime.
Tricare Fraud Targets
Tricare fraud allegations can impact a variety of businesses. We often see providers in the following areas exposed:
- Pharmacies / Compound Pharmacies
- Toxicology Labs
- Doctors, Nurses, and Staff
- Physician-Owned Entities
- Medical Device Companies
Being subjected to a Tricare fraud investigation can have a jeopardizing impact on a provider’s career and personal life.
A Criminal Defense Attorney Can Help You
If you were accused of Tricare fraud, or your facility is the subject of an investigation, it is crucial that you reach out to our healthcare fraud defense attorneys at the Healthcare Fraud Group at (888) 402-4054 to explore legal options available for you.