<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">TOP Regional Call Center</a>&nbsp;anytime (listen carefully to the prompts for the best option to serve you) for TOP 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>