Pvt Charles J Shutt Detachment VAVS

TRICARE was honored with the 2008 Investigation of the Year Award, presented annually by the National Health Care Anti-Fraud Association (NHCAA). The award was given for the ongoing investigation involving fraudulent TRICARE claims in the Philippines and TRICARE was selected unanimously by the NHCAA Awards Committee from numerous nominations from both the public and private sector.

TRICARE was part of a collaborative investigation team of individuals and organizations that received this honor. The investigation team was composed of TRICARE Program Integrity, U.S. Attorney’s Office (Western District of Wisconsin), Defense Criminal Investigation Service, U.S. Postal Service, DoD-IG Audit, and TRICARE’s overseas contractor, Wisconsin Physicians Service (WPS).

TRICARE pursued a 5-year investigation into the largest overseas TRICARE fraud case in the history of the program. The investigation required frequent travel to the Philippines, coordination with the Philippine National Police to locate numerous documents and witnesses and arranging for special visas so witnesses could travel to the United States.

“When the fraudulent practices came to light, TRICARE Management Activity worked diligently to modify claims processing requirements and has aggressively instituted additional claims processing controls,” said Army Maj. Gen. Elder Granger, deputy director, TRICARE Management Activity.

The review of thousands of documents related to TRICARE indicated that the Philippine corporation consistently increased the dollar amount, by over 200 percent, on claims from seven hospitals they represented. As a result of this investigation the defendants have been indicted on 75 counts for defrauding TRICARE of over $1 billion.

“This investigation is a perfect example of everyone working together to protect the TRICARE program against fraud,” added Granger. “When any criminal activity is suspected we involve the appropriate law enforcement agencies right away. We will continue to vigorously pursue designed to reduce fraud.”