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<h4><strong>FRAUD &amp; ABUSE EXAMPLES</strong></h4> <p><strong><span></span></strong>The following are examples of Fraud and Abuse:</p> <ul> <li>Providers billing for medical services not provided (e.g., reported on your Explanation of Benefits)</li> <li>Providers routinely waiving beneficiary cost shares</li> <li>Medical/health insurance identity theft&nbsp;</li> <li>Providers billing for more expensive services than performed, i.e., up-coding of more comprehensive services than received, as reported on your Explanation of Benefits</li> <li>Providers performing (or beneficiaries receiving) medically unnecessary services solely for the purpose of reimbursement</li> <li>Providers billing and masking non-covered services as other covered services for reimbursement (e.g., cosmetic procedures not covered being billed as medically necessary)</li> <li>Falsifying/altering medical claims</li> <li>Providers billing for all authorized services prior to beneficiary receiving them</li> <li>Falsifying/altering medical diagnosis to justify unnecessary services/treatments</li> <li>Overutilization of services</li> <li>Providers billing for the same services on the same date of service more than once Anyone other than your physician filling out a certificate of medical necessity form</li> </ul> <p>To help protect yourself from Fraud and Abuse, please follow these tips:</p> <ul> <li>Always safeguard your TRICARE benefit identification card and keep all medical records in a safe place.</li> <li>Always be vigilant of anyone trying to obtain your medical information, such as “free” services requiring you to provide your health care insurance information.&nbsp;</li> <li>Know your medical provider!&nbsp;Do your research to ensure your medical well-being is in the hands of a reputable provider who has only YOUR health in mind.</li> <li>Read and understand your TRICARE Explanation of Benefits (EOB). If you have questions always ask for help.&nbsp;&nbsp;‎Contact your&nbsp;<a href="https://tricare-overseas.com/contact-us" target="_blank">ºÚÁϲ»´òìÈ Regional Call Center</a>&nbsp;anytime (listen carefully to the prompts for the best option to serve you) for ºÚÁϲ»´òìÈ Claims Assistance or with any questions regarding your EOB. Your EOB contains information reported by your medical provider; any inconsistencies may be reflected on the EOB.</li> <li>Always report any activity that may appear suspicious! The best defense against fraud and abuse are the beneficiaries who report it.&nbsp;</li> <li>If you are not sure if the treatment/tests/procedures your provider has ordered are necessary for your condition, it’s OK to question your provider.&nbsp;You are your own best health care advocate.</li> </ul>