1.0 Litigation
1.1 The Defense
Health Agency (DHA) Office of General Counsel (OGC) shall be notified
by telephone immediately upon receipt of any summons, writ, or other
legal process which develops as a result of performance under a
TRICARE contract. In no event, shall the telephonic notice to DHA
OGC be more than three workdays following receipt of any such legal
process which could involve TRICARE. Such notice shall include the
nature of the legal process, the name of the court of jurisdiction,
the parties named in the suit, the type of TRICARE issue or claim
involved, the amount involved and any other relevant information.
Additionally, copies of all documentation shall be transmitted to
DHA by facsimile as soon as possible and followed up with hardcopy
mailed to DHA OGC on the same workday as telephone notice is given.
1.2 The United
States (U.S.) reserves the right to render a determination concerning
whether the Government should be a party to the legal process. Additionally,
DHA will determine if the contractor is to be indemnified against
judgments, settlements and costs in favor of an individual, or his
or her assignee, in accordance with any applicable indemnification
clauses in the TRICARE contract.
1.3 In some cases, DHA OGC may
determine that the Government is the real party in interest to an action
which challenges a TRICARE determination. In such a case, the suit
may be removed from a State court to the appropriate U.S. District
Court, however, such action must be taken immediately. Therefore,
it becomes imperative that the contractor fully cooperates with
DHA counsel assigned to direct the case. DHA counsel may request
the appropriate U.S. Attorney to the district court of the U.S. for
the district and division embracing the place wherein the action
is pending, dismiss the contractor, and substitute the United States
of America (USA) as defendant in its place. In other cases, DHA
OGC may determine the issue is a private matter between the plaintiff
and the defendant contractor or subcontractor. Additionally, the
court may decline to substitute parties. Nevertheless, in some cases, the
contractor may remain fully responsible for defending the case.
1.4 Acts of
fraud, theft, embezzlement, or sabotage involving TRICARE funds
or materials, may constitute violations of the U.S. Criminal Code
and ensuing investigations may be matters within the jurisdiction
of the Federal Government. In such cases, as stated above, immediate
notice shall be given to DHA OGC. When the act clearly involves
only contractor funds, action should be instituted by the contractor
under the laws of the state with jurisdiction.
2.0 Subpoenas
Department of Defense (DoD) regulations restrict
contractor disclosure of information obtained in carrying out its
TRICARE functions. When a contractor is served with a subpoena in connection
with its TRICARE responsibilities, DHA OGC shall be notified in
a timely manner to safeguard against the unauthorized disclosure
of information. This procedure will be followed whether the subpoena
is for reproduction of records which are, or may be protected, or
for the personal appearance of a representative of the contractor.
If a contractor is served a summons by the U.S. Internal Revenue Service
(IRS) to produce and disclose any file, record, report or other
paper, or information in connection with TRICARE and federal tax
laws, the summons must be honored. The assistance of DHA shall be
requested immediately if the contractor encounters any problems
in complying with the IRS request (e.g., machine capability, cost).
3.0 Assignments
Of Providers’ Rights To Payment
A provider
of services in need of funds might arrange for a commercial loan
from a bank or other lending institution and, as collateral on the
loan, attempt to assign its TRICARE payments to the creditor. Such
TRICARE benefit payments shall be made only to providers of services
which are eligible to file for such payment. The authorization given
by Congress to expend TRICARE funds does not permit compliance with
a commercial assignment, even though such arrangement may otherwise
be in full compliance with the law of the appropriate state.