All TRICARE requirements regarding program
integrity shall apply to the TRICARE Overseas Program (TOP) unless
specifically changed, waived, or superseded by this section; the
TRICARE Policy Manual (TPM),
Chapter 12;
or the TRICARE contract for health care support services outside
the 50 United States (U.S.) and the District of Columbia (hereinafter
referred to as the “TOP contract”). See
Chapter 13 for
additional instructions.
1.1 In addition to the requirements
outlined in
Chapter 13, the Government may implement additional
requirements as necessary to prevent or detect fraud in overseas
locations.
1.1.1 The contractor shall perform
12 Statistically Valid Random Sample (SVRS) audits per option period
to examine and verify the accuracy of claims. See
Chapter 13, Section 3 for additional information
regarding case development audits. The contractor shall ensure that
an SVRS is done in accordance with
Chapter 13, Section 3, paragraph 3.2.2. Those
audits meeting the dollar threshold for case referrals shall be
handled in accordance with
Chapter 13 provisions.
1.1.2 For those audits not meeting the dollar threshold
for case referrals, recoupment action shall be taken on actual damages
determined as a result of errors identified in an SVRS. See
Chapter 13 for further guidance.
Note: TRICARE guidance regarding anti-fraud programs
at Military Treatment Facilities (MTFs) is contained in Department
of Defense Instruction (DoDI) 5505.12 (October
3,
2013).
This instruction is located at:
https://www.hsdl.org/?view&did=744970.