Billing for Services Not RenderedThe Scenario
The auditor was reviewing Defense Hotline referrals and noted numerous Tricare Management Activity members were submitting complaints indicating that their recent Explanation of Benefit reports contained charges for medical treatments that were not received. The auditor contacted Tricare Management Activity management to determine if they were aware of allegations of phony charges for medical treatments. Tricare Management Activity representatives stated that their recent member survey showed a pattern of complaints from members for medical charges and claims for medical treatments that were not received by members or theirdependents.
Login to download the sample fraud scenario and indicators (Federal DoD)