New Tricare requirement for proof of payment takes effect overseas
By CHARLIE REED | STARS AND STRIPES Published: September 21, 2012
This story has been corrected
YOKOTA AIR BASE, Japan — All military retirees living overseas must now provide proof of payment for any healthcare costs before Tricare will reimburse them.
The policy has been in effect for veterans in the Philippines and Panama since 2009 following a Defense Department Inspector General’s report that found widespread corruption in those countries. It was expanded by the military healthcare agency to other countries this month.
The 2009 action by the U.S. taxpayer-funded system did away with what had been an honor system of sorts. In addition to the crackdown in the Philippines and Panama, it began requiring all retirees — in the U.S. and abroad — to show proof of payment for out-patient treatments over $5,000 and hospitalizations over $10,000.
It wasn’t enough, said Kathy Larkin, chief of Tricare’s Health Plan Policy division.
“They keep looking at us,” Larkin said. “The IG suggested we implement” the new policy requiring proof of payment for all overseas claims.
The aim is to not only stop fraud but also to improve claims payment accuracy and provide additional controls to safeguard government funds, Larkin said.
Tricare spends about $366 million annually in overseas healthcare costs outside military hospitals, where retirees are not eligible for care unless they are U.S. government civilian employees.
The top three places where military veterans retire outside the 50 U.S. states are Puerto Rico, Germany and the Philippines, according to Tricare.
For healthcare and pharmacy claims under $1,000, Tricare beneficiaries need only provide an invoice or bill from the provider or pharmacy as long as it identifies the amount paid. Claims over $1,000 also require a copy of a receipt from a check, credit card, electronic fund transfer or cash withdrawal for each service provided.
Tricare spokesman Chris Hober said bundled claims must include proof of payment for each transaction.
While it may seem like an extra burden, some of those already affected by the new rules say they have adjusted.
“I don’t really have a problem with it,” said Albert Shelton, a retired Navy master chief who has lived in the Philippines since 2007.
For his wife’s dialysis treatment, Shelton gets to skip the proof-of-payment process because the facility agreed to bill Tricare directly — a service that healthcare providers and hospitals outside the U.S. are not always willing to provide.
The Philippines is the only place where Tricare requires all doctors to be certified through an on-site visit and anti-fraud background check before paying out claims, according to the agency.
“Back in the day in the Philippines, they found some beneficiaries were in collusion with providers,” said Hober, the Tricare spokesman. “They want to keep that from happening.”
The country is a top focus of Tricare’s fraud department, which saw billings balloon from $15 million in 1999 to $59 million in 2009, even as the number of beneficiaries remained the same. In 2008, a Philippine hospital was shut down after cashing in more than $100 million in fake Tricare claims.
“Proof of payment is a smart move on their part. The Philippines has had their problems with corruption, and there’s been some really bad Tricare scams,” Shelton said. “Proof of payment is not hard.”
Getting an itemized bill for a hospital stay that distinguishes between administrative charges, provider fees and medication costs can sometimes be “tricky,” Shelton said. “But all you have to do is ask, no matter what country you’re in.”
Fraud is not limited to outside of the United States.
TriWest Healthcare Alliance — a former Tricare contractor — was ordered to pay a $10 million fine after a court found it “systematically defrauded” Tricare in various ways, USA Today reported earlier this year.
Tricare awarded an estimated $20 billion contract to UnitedHealth Military & Veterans to replace TriWest in March, according to the newspaper.
Questions about Tricare proof of payment requirements
For questions about proof of payment, submitting claims or the status of a claim, email or call a Tricare Oversea Program Regional Call Center. If calling, press Option 2 for claims assistance.
1.877.678.1207 (toll-free from U.S.)
Latin America & Canada
1.877.451.8659 (toll-free from U.S.)
1.877.678.1208 (toll-free from U.S.)
1.877.678.1209 (toll-free from U.S.)
Original version stated the top three places where military veterans retire outside the 50 U.S. states are Germany, South Korea and Puerto Rico, based on information from Tricare.