<h2>UNDERSTANDING FRAUD AND ABUSE</h2> <p>{marginbottom=24: }</p> <h4>{nomargin: What is Fraud and Abuse?}</h4> <p>Fraud is the intentional deception or misrepresentation that an individual knows to be false, when that individual knows the deception could result in some unauthorized benefit or payment.</p> <p>Abuse involves actions that are inconsistent with accepted, sound medical, business, or fiscal practices.&nbsp;‎ Abuse directly or indirectly results in unnecessary costs to the program through improper payments, or in reimbursement of services that are not medically necessary or fail to meet professionally recognized standards of health care.</p> <h4>{lineheight=1;nomargin:Health Care Program Integrity: Background Information}</h4> <p>{marginbottom=32: }</p> <p>International SOS and the TOP Claims Processor’s Program Integrity Teams actively work with the Defense Health Agency to identify, investigate, and cease abusive and fraudulent activities in an effort to protect beneficiaries, the TRICARE benefit, and taxpayers, leading to cost savings worth millions of dollars annually.&nbsp;<a href="https://www.health.mil/Military-Health-Topics/Access-Cost-Quality-and-Safety/Quality-And-Safety-of-Healthcare/Program-Integrity" target="_blank">Click here for more information.</a></p> <p><a href="https://tricare-overseas.com/beneficiaries/resources/understanding-fraud-and-abuse/examples" target="_blank">Click here for examples of Fraud and Abuse and learn more about how you can protect yourself.</a></p> <p><a href="https://tricare.mil/Privacy/PPI" target="_blank">Click here to learn about Identify Theft.</a></p> <p><a href="https://tricare-overseas.com/report-fraud-and-abuse" target="_blank">For more information on how to report Fraud and Abuse, click here.</a></p>