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TRICARE Operations Manual 6010.62-M, April 2021
Program Integrity
Chapter 13
Section 5
Administrative Remedies And Actions (Provider Exclusions, Terminations, Suspension Of Claims Processing, Reinstatement, Conflict Of Interest, Reporting Refunds, Self-Disclosure)
Revision:  
1.0  SCOPE AND PURPOSE
1.1  This section specifies which individuals and entities may, or in some cases must, be excluded from the TRICARE program. It outlines the authority given to the Department of Health and Human Services/Office of Inspector General (DHHS/OIG) to impose exclusions from all Federal health care programs, including TRICARE.
1.2  This section also outlines the Defense Health Agency (DHA) authority for exclusions and terminations.
1.3  In addition, this section states the effect of exclusion, factors considered in determining the length of exclusion, and provisions governing notices, determinations, and appeals.
1.4  This section also outlines procedures and protocol for suspension of claims processing, conflict of interest, Voluntary Self-Disclosure protocol, and provider self-reported refunds.
2.0  DHA AUTHORITY FOR SUSPENSION OF CLAIMS PROCESSING
2.1  DHA may suspend claims processing based on 32 CFR 199.9 provisions.
2.2  The Director, DHA or designee may suspend claims processing without prior notification to the provider or beneficiary of the intent to suspend payments.
2.2.1  Within 30 calendar days of the claims suspension, DHA will provide written notice advising the beneficiary or provider that a temporary suspension has been ordered and a statement of the basis of the decision to suspend payment.
2.2.2  The suspension of claims processing will be for a temporary period pending the completion of investigation and any ensuing legal or administrative proceedings, unless sooner terminated by the Director, DHA or designee. See 32 CFR 199.9 for additional guidance.
2.2.3  DHA Program Integrity Office (PI) is responsible for advising the contractor of any suspension of claims processing.
2.2.4  The contractor shall then issue special notifications. (Addendum A, Figure 13.A-6, Figure 13.A-7, and Figure 13.A-8.)
3.0  DHA AUTHORITY FOR EXCLUSIONS AND TERMINATIONS
3.1  DHA may exclude any individual or entity based on 32 CFR 199.9 provisions.
3.2  The contractor shall provide written notice to DHA PI within 10 calendar days of any situation involving a TRICARE provider, pharmacy, or entity whose actions warrant exclusion under DHA authority related to fraudulent or abusive behavior.
3.3  The Director, DHA or designee, has the authority to exclude an authorized TRICARE provider, pharmacy, or entity. The period of exclusion is at the discretion of DHA. (See 32 CFR 199.9.)
3.4  DHA PI is responsible for coordinating and issuing notification of exclusion action. DHA PI will send written notice to the provider of the proposed exclusion, and the potential effect thereof. The individual or entity may submit evidence and written argument regarding the proposed exclusion.
3.5  DHA PI has sole authority to issue an Initial Determination of Exclusion. Written notice of this decision will include the basis for the exclusion, the length of the exclusion, as well as the effect of the exclusion. The determination also outlines the earliest date on which DHA PI will consider a request for reinstatement, the requirements for reinstatement, and appeal rights available.
3.5.1  DHA PI will notify appropriate agencies, including contractors, of all DHA exclusion actions taken.
3.5.2  DHA PI will be responsible for initiating action based on reversed or vacated decisions. Exclusion of a provider, pharmacy, or entity will be effective 15 calendar days from the date of the initial determination.
3.5.3  The Director, DHA or designee has sole authority for approval of any request for reinstatement.
4.0  CONTRACTOR ACTIONS UNDER TRICARE EXCLUSION AUTHORITY - 32 CFR 199.9
4.1  The contractor shall provide supporting documentation to DHA PI within 10 calendar days when recommending any provider exclusion.
4.2  DHA PI will notify the contractor of an exclusion action.
4.3  The contractor shall:
4.3.1  Ensure that no payment is made to an excluded provider, pharmacy, or entity for care provided on or after the date of the DHA action (15 calendar days from the date of the Initial Determination as noted in paragraph 3.5). Neither the provider, pharmacy, entity, nor the patient will be entitled to TRICARE cost-sharing once the exclusion is in effect.
4.3.2  Notify DHA PI if a provider, pharmacy, or entity attempts to bill the program after the effective date of exclusion.
4.3.3  Ensure that an excluded provider, pharmacy, or entity is not included in the network and provider directory.
4.3.3.1  The contractor shall ensure that the network provider, pharmacy, or entity whose contract has been canceled clearly understands his or her status if cancellation of a network provider, pharmacy, or entity agreement is required.
4.3.3.2  Provide written notice within 15 business days, sent by certified mail, return receipt requested, that the network provider’s or network pharmacy’s agreement has been canceled.
4.3.3.3  Provide DHA PI a copy within 15 business days.
4.3.4  Notify, in writing within 10 calendar days, the beneficiary who submitted a claim that the provider has been excluded from the TRICARE program.
4.3.5  Ensure the enforcement of all exclusion action taken, and notify appropriate parties of the application of exclusions. For example, any claim received from an excluded third party billing agent shall be returned to the provider with instructions to resubmit the claim directly or through another third party billing agent. The provider remains entitled to reimbursement for covered services as long as they remain an authorized TRICARE provider.
5.0  DHHS/OIG APPLICATION OF SANCTION AUTHORITY
5.1  DHHS/OIG can exclude individuals or entities from participation in any federal health care program to include the Department of Defense (DoD) Military Health System (MHS), and TRICARE. Authority and exclusion categories can be found on the DHHS/OIG website.
5.2  DHHS/OIG has sole responsibility for issuing a written notice of its intent to exclude a provider, pharmacy, or entity, the basis for the exclusion, the effective date, the period of exclusion, and the potential effect of exclusion.
5.3  DHHS/OIG has sole authority for terminating an exclusion imposed under their authority. DHHS/OIG will handle notifications of approval or denial of a request for reinstatement and are responsible for reversing or vacating decisions.
5.4  DHHS/OIG exclusions and reinstatements are issued on a monthly basis. DHHS/OIG will provide DHA PI with immediate access to this information, which will be forwarded to each contractor.
5.5  Exclusions taken by DHHS/OIG are binding on Medicare, Medicaid, and all Federal health care programs with the exception of the Federal Employee Health Benefit Program (FEHBP) (42 USC 1320a-7b(f)). No payment will be made for any item or service furnished on or after the effective date of exclusion until an individual or entity is reinstated by DHHS/OIG, and subsequently meets the requirements under 32 CFR 199.6.
6.0  CONTRACTOR ACTIONS UNDER DHHS/OIG EXCLUSION AUTHORITY
6.1  DHA PI will provide the contractor the monthly issuance of DHHS/OIG exclusion and reinstatement actions.
6.2  The contractor shall ensure that no payment is made to an excluded provider, network pharmacy, or entity for care provided on or after the date of the DHHS/OIG action. The provider, pharmacy, or entity, nor the patient will not be entitled to TRICARE cost-sharing once the exclusion is effective.
6.2.1  The contractor shall notify DHA PI should a provider, network pharmacy, or entity attempt to bill the program or if payment has been issued after the effective date of exclusion.
6.2.2  It is not necessary for the contractor to issue a separate letter notifying the provider, network pharmacy, or entity of the exclusion action.
6.3  The contractor shall ensure that an excluded provider, pharmacy, or entity is not included in the network.
6.3.1  The contractor shall ensure that the network provider or network pharmacy whose contract has been canceled understands his or her status, if the cancellation of a network, or if applicable, participating provider agreement is required.
6.3.2  The contractor shall accomplish this by providing written notice, within seven calendar days, sent by certified mail, return receipt requested, that the network provider’s or network pharmacy’s agreement has been canceled.
6.3.3  The contractor shall send a copy to DHA PI within seven calendar days.
7.0  CONTRACTOR APPLICATION OF SANCTION AUTHORITY
7.1  The contractor shall ensure the enforcement of all sanction action(s) taken, and notify appropriate parties of the application of sanctions. For example, any claim received from an excluded third party billing agent shall be returned to the provider with instructions to resubmit the claim directly or through another third party billing agent.
7.2  The provider remains entitled to reimbursement for covered services as long as they remain an authorized TRICARE provider.
8.0  PROVIDER, NETWORK PHARMACY, OR ENTITY TERMINATION OF AUTHORIZED PROVIDER STATUS
8.1  The contractor shall terminate the authorized provider status of any provider, network pharmacy, or entity determined not to meet program requirements. The request for reinstatement will be processed under the procedures established for initial requests for authorized provider or network pharmacy status. See paragraph 10.0 for further information.
8.2  Other Listings
Other listings of actions affecting provider authorization status (e.g., Federation of State Medical Boards of the United States (US)) will be sent to each contractor. A provider who has licenses to practice in two or more jurisdictions and has one or more licenses suspended or revoked shall be terminated as a TRICARE provider in all jurisdictions.
9.0  CONTRACTOR REQUIREMENTS FOR TERMINATION
9.1  The contractor shall initiate termination action based on a finding that the provider, pharmacy, or entity does not meet the qualifications to be an authorized provider when status as an authorized provider, authorized network pharmacy or authorized entity is ended.
9.2  Separate termination action by the contractor is not required for a provider, pharmacy, or entity sanctioned under the exclusion authority granted DHHS/OIG.
9.3  The period of termination will be indefinite and will end only after the provider, pharmacy, or entity has successfully met the established qualifications for authorized status under TRICARE and has been reinstated as outlined in paragraph 10.0.
9.4  The contractor shall notify the provider, pharmacy, or entity in writing of the proposed action to terminate them.
9.4.1  The contractor shall specifically notify the provider, pharmacy, or entity of the proposed action to terminate their status as an authorized TRICARE provider when the provider, pharmacy, or entity falls within the contractor’s certifying responsibility and the provider, pharmacy, or entity fails to meet the requirements of 32 CFR 199.6 (Addendum A, Figure 13.A-9).
9.4.1.1  The contractor shall not terminate the provider, pharmacy, or entity when he or she fails to return certification packets but flag the provider as ‘inactive’.
9.4.1.2  The contractor is not required to send a copy of the notice to DHA PI.
9.4.1.3  The contractor shall send the notice to the provider’s, pharmacy’s or entity’s last known business or office address.
9.4.2  The pharmacy contractor shall notify the pharmacy in writing of the proposed action to terminate the pharmacy status as a network pharmacy when it is not in compliance with its agreement and the pharmacy fails to meet the requirements of 32 CFR 199.6 (Addendum A, Figure 13.A-9).
9.4.3  The notice shall state that the provider, pharmacy, or entity will be terminated as of the effective date of the termination notice.
9.4.4  The notice shall also inform the provider, pharmacy, or entity of the situation(s) or action(s) which form the basis for the proposed termination.
9.4.5  For network providers, the notice shall inform the provider that his or her patients will be referred to another provider pending final action.
9.4.6  For a network pharmacy, the notice shall inform the pharmacy that beneficiary prescriptions may not be filled and any claims submitted will be denied.
9.4.7  The notice shall offer the provider, pharmacy, or entity an opportunity to respond within 30 calendar days from the date of the notice. An extension to 60 calendar days may be granted if a written request is received during the 30 calendar days showing good cause.
9.4.8  The provider, pharmacy, or entity may respond with either documentary evidence and written argument contesting the proposed action or a written request to present in person evidence or argument to a contractor’s designee at the contractor’s location. Expenses incurred by the provider, pharmacy, or entity are their responsibility.
9.4.9  Once the notice of proposed action to terminate is sent, the provider’s claims will be suspended from claims processing until an Initial Determination is issued. The provider, pharmacy, or entity will be notified via the proposed notice that the claims will be suspended from claims processing. However, beneficiaries will not be notified of the suspension.
9.4.10  For pharmacy claims, once the notice of proposed action to terminate is sent, the pharmacy’s claims will not be processed as network claims until an Initial Determination is issued.
9.4.10.1  The pharmacy will be notified via the notice that the claims will not be processed as network claims.
9.4.10.2  Beneficiaries will be advised by the pharmacy that it is no longer a network pharmacy and that any prescription filled there will require submittal of a claim for reimbursement by the beneficiary.
9.5  Initial Determination
9.5.1  The contractor shall invoke an administrative remedy of termination if after the provider, pharmacy, or entity has exhausted, or failed to comply with the procedures for appealing the proposed termination and the decision to terminate remains unchanged.
9.5.2  The contractor shall accomplish this by issuing a written notice of the Initial Determination via certified mail to the effective entity.
9.5.3  The contractor shall send a copy of the Initial Determination to DHA PI along with supporting documentation within seven calendar days.
9.5.4  The contractor shall include the following in the Initial Determination written notice:
9.5.4.1  A Unique Identification Number (UIN) indicating the fiscal year of the Initial Determination, a consecutive number within that fiscal year and the contractor’s name. A sample letter is found at Addendum A, Figure 13.A-10.
9.5.4.2  A statement of the action being invoked and the effective date of the action. The effective date shall be the date the provider, pharmacy, or entity no longer meets the regulatory requirements. If there is no documentation the provider ever met the requirements, the effective date will be either June 10, 1977 (the effective date of the Regulation) or the date on which the provider, pharmacy or entity was first approved, whichever date is later. In the case of a pharmacy, it would be the date on which the pharmacy first became part of the network.
9.5.4.3  A statement of the facts, circumstances, or actions that form the basis for the termination and a discussion of any information submitted by the provider, pharmacy, or entity relevant to the termination.
9.5.4.4  A statement of the provider’s, pharmacies, or entity’s right to appeal.
9.5.4.5  The requirements and procedures for reinstatement.
9.6  Providers Failing To Return Recertification Documentation
9.6.1  The contractor shall not terminate the provider, pharmacy, or entity failing to return recertification documentation but shall be placed on the inactive provider listing.
9.6.2  The contractor shall first verify that the recertification package was mailed to the correct address and was not returned by the US Postal Service (USPS).
9.6.3  The contractor shall ensure that no claims are paid and shall deny claims for services regardless of who submits the claim.
9.6.4  The contractor shall advise the provider, pharmacy, or entity shall be advised that such action will be taken within 15 calendar days.
9.7  Requirement To Recoup Erroneous Payments
9.7.1  The contractor shall, after the Initial Determination letter has been issued, initiate recoupment in accordance with Chapter 10, Section 2 for any claims cost-shared, paid for services, or supplies furnished by the provider (including pharmacies) on or after the effective date of termination, even when the effective date is retroactive, unless a specified exception is provided by 32 CFR 199. This also applies to claims processed by previous contractor(s).
9.7.2  The contractor shall transfer all monies recouped, including those paid by previous contractor(s), to DHA Contract Resource Management (CRM) in accordance with Chapter 3.
9.8  File Requirements For A Terminated Provider, Pharmacy, Or Entity
The contractor shall include the following in the Initial Determination file for the provider, pharmacy, or entity:
9.8.1  Initial Determination of Termination Action as well as Proposed Notice to Terminate.
9.8.2  Provider certification file (i.e., the documentation upon which the original certification of the provider was based) or network pharmacy agreement.
9.8.3  All correspondence and documentation relating to the termination (copies of the enclosures must be attached to the copy of the original correspondence).
9.8.4  Documentation that the contractor considered or relied upon for issuing the determination.
9.9  Special Action or Notice Requirements When An Institution Is Terminated
9.9.1  The contractor shall take appropriate action when a DHA determination is made that an institutional provider does not meet qualifications or standards to be an authorized TRICARE provider.
9.9.2  Provider And Beneficiary Notification
9.9.3  The contractor shall:
9.9.3.1  Instruct the institution by certified mail to immediately give written notice of the termination to any TRICARE beneficiary (or his or her parent, guardian, or other representative) admitted to or receiving care at the institution on or after the effective date of the termination.
9.9.3.2  Notify any beneficiary (or their parent, guardian, or other representative) admitted prior to the date of the termination by certified mail that TRICARE cost-sharing ended as of the termination date when the termination effective date is after the date of the initial determination.
9.9.3.3  Advise the beneficiary (or their parent, guardian, or other representative) of their financial liability.
9.9.3.4  Use a fast, effective means of notice (e.g., phone, fax, express mail, or regular mail, depending on the circumstances).
9.9.3.5  Notify any beneficiary (or his or her parent, guardian, or other representative) admitted prior to the grace period of the violation that TRICARE cost-sharing of covered care will continue during that period. Cost-sharing is to continue through the last day of the month following the month in which the institution is terminated if an institution is granted a grace period to effect correction of a minor violation.
9.9.3.6  Notify any beneficiary (or their parent, guardian, or other representative) admitted prior to a grace period of the institution’s corrective action, when such has been determined to have occurred, and the continuation of the institution as an authorized TRICARE provider.
9.9.4  Cost-Sharing Actions
9.9.5  The contractor shall deny cost-sharing for any:
9.9.5.1  New patient admitted after the effective date of the termination.
9.9.5.2  Beneficiary admitted during a grace period granted an institution involved in a minor violation.
9.9.5.3  Beneficiary already in an institution involved in a major violation beginning with the effective date of the termination.
10.0  PROVIDER REINSTATEMENTS
10.1  Reinstatement of an excluded individual or entity is not automatic once the specified period of exclusion ends.
10.2  The individual or entity must apply for reinstatement and receive written notice from DHA that reinstatement has been granted.
10.3  32 CFR 199.9 provides that the Director, DHA or a designee, will have the authority to reinstate providers, pharmacies, or entities previously excluded or terminated under TRICARE. For providers sanctioned by Department of Health and Human Services (DHHS), see paragraph 3.0.
10.4  DHHS/OIG provides monthly updates for reinstated providers, individuals, pharmacies, and entities. The information includes exclusion date and reinstatement date when a previously excluded provider, pharmacy, or entity is reinstated by DHHS/OIG.
10.5  The contractor shall, before initiating reinstatement action:
10.5.1  Determine if any erroneous payments have been made to provider, pharmacy or   entity during period of sanction.
10.5.1.1  The contractor shall certify the provider, pharmacy or entity as an authorized provider, and determine the effective date of the reinstatement if no funds have been paid for services to the provider while excluded or are otherwise owed the Government for claims paid prior to the exclusion.
10.5.1.2  If erroneous payments have been made to a provider, pharmacy, or entity during the period of exclusion, restitution of the payments shall be made before a request for reinstatement will be considered.
10.5.1.3  The contractor shall determine, if any payments have been made, and initiate restitution of the payments.
10.5.2  The contractor shall send the certification package to the provider, entity, or pharmacy for completion to ensure that the provider meets the requirements to be an authorized TRICARE provider under 32 CFR 199.6.
10.5.3  Verify that pharmacies has all required state licenses to operate as a pharmacy.
10.5.4  Ensure the exclusion or suspension shall remain in effect until the provider completes and returns the certification package and the determination is made by the contractor that the provider meets the requirements of an authorized TRICARE provider under 32 CFR 199.6.
10.5.5  Provide in writing of the reinstatement date, once the determination is made that the provider meets the requirements of a TRICARE Authorized provider under 32 CFR 199.6.
10.5.6  If pharmacy, provide in writing that the pharmacy has met the state licensing requirements and advise the pharmacy of the date it is eligible to negotiate a new network agreement with the contractor, as determined by DHA.
10.6  The contractor shall notify the provider in writing with an explanation on why the provider did not meet the requirements and advise the provider of their appeal rights if the provider does not meet the requirements of a TRICARE Authorized Provider under 32 CFR 199.6.
10.6.1  The contractor shall provide DHA PI a copy of the letter within seven calendar days.
10.6.2  The contractor shall provide in writing to the pharmacy within seven calendar days, that the pharmacy does not have the required state licenses and provide notification to the pharmacy why the pharmacy is not eligible to be a network pharmacy and advise pharmacy of appeal rights.
10.6.3  A copy of the letter shall be provided to the DHA PI within seven calendar days.
10.6.4  The contractor shall provide notification to Beneficiary Counseling and Assistance Coordinators (BCACs) at Markets/Military Medical Treatment Facilities (MTFs) within the provider’s service area of provider status within seven calendar days.
11.0  CONFLICT OF INTEREST
11.1  The contractor shall document and refer suspected violations of conflict of interest to the DHA PI within 15 calendar days.
11.1.1  Conflict of interest includes any situation where an active duty member of the Uniformed Services (including a reserve member while on active duty, active duty for training, or inactive duty training) or civilian employee (which includes employees of the Department of Veterans Affairs/Veterans Health Administration (DVA/VHA)) of the US Government, through an official federal position has the apparent or actual opportunity to exert, directly or indirectly, any influence on the referral of beneficiaries to himself or herself or others with some potential for personal gain or the appearance of impropriety.
11.1.2  Although individuals under contract to the Uniformed Services are not considered employees, such individuals are subject to conflict of interest provisions by express terms of their contracts and, for purposes of the 32 CFR 199.9 may be considered to be involved in conflict of interest situations as a result of their contract positions.
11.1.3  In any situation involving potential conflict of interest of a Uniformed Service employee, the Director, DHA, or a designee, may refer the case to the Uniformed Service concerned for review and action.
11.2  Federal Employees And Active Duty Military
11.2.1  32 CFR 199.6 prohibits active duty members of the Uniformed Services or employees (including part-time or intermittent), appointed in the civil service of the US Government, from authorized TRICARE provider status.
11.2.2  This prohibition applies to TRICARE payments for care furnished to TRICARE beneficiaries by active duty members of the Uniformed Services or civilian employees of the Government.
11.2.3  The prohibition does not apply to individuals under contract to the Uniformed Services or the Government.
11.3  Exceptions
11.3.1  National Health Service Corps
TRICARE payment may be made for services furnished by organizations to which physicians of the National Health Service Corps (NHSC) are assigned. However, direct payments to the NHSC physician are prohibited by the dual compensation provisions.
11.3.2  Emergency Rooms
11.3.2.1  Any off-duty Government medical personnel employed in an emergency room of an acute care hospital will be presumed not to have had the opportunity to exert, directly or indirectly, any influence on the referral of TRICARE beneficiaries; therefore, TRICARE payments may be made to the employing hospital provided the medical care was not furnished directly by the off-duty Government medical personnel in violation of dual compensation provisions.
11.3.2.2  The contractor shall not cost-share professional services by the provider since they cannot be recognized as TRICARE-authorized providers.
11.3.3  Reserves Generally Exempt
11.3.3.1  Conflict of interest provisions do not apply to medical personnel who are Reserve members of the Uniformed Services or who are employed by the Uniformed Services through personal services contracts, including contract surgeons.
11.3.3.2  Although Reserve members, not on active duty, and personal service contract medical personnel are subject to certain conflict of interest provisions by express terms of their membership or contract with the Uniformed Services, resolution of any apparent conflict of interest issues which concern such medical personnel is the responsibility of the Uniformed Services, not the DHA.
11.3.3.3  National Guard and reservists on active duty are not exempt during the period of their active duty commitment.
11.3.4  Part-Time Physician Employees Of The US Government
Refer to Chapter 4, Section 1.
11.3.5  Referrals From Uniformed Services Facilities
11.3.5.1  Referrals from Uniformed Services facilities to individual civilian providers should, in every practical instance, be made to participating providers. However, referrals of TRICARE beneficiaries by Uniformed Services personnel to selected individual providers in the civilian community when other similar participating providers are available may involve a conflict of interest.
11.3.5.2  The contractor shall document any apparent problem of this nature and refer the case to the DHA PI for investigation.
11.3.5.3  In any situation involving potential conflict of interest of a Uniformed Service employee, the Director, DHA, or a designee, may refer the case to the Uniformed Service concerned for review and action.
12.0  REPORTING PROVIDER REFUNDS - PROVIDER REFUNDS (SINGLE CLAIM AND MULTIPLE CLAIMS)
12.1  Providers have a requirement to return overpayments to the TRICARE program (voluntary or requested). Possible reasons for provider refunds (single or multiple claims) may include: Other Health Insurance (OHI), Third Party Liability (TPL), Payment sent to incorrect provider, Duplicate Payment, Provider Billing Error, or TRICARE overpaid.
12.2  The contractor shall notify DHA PI within 30 business days of receiving reported refund when a Provider Billing Error refund is made to the contractor (single or multiple).
12.3  For reporting submission requirements, see DD Form 1423, Contract Data Requirements List (CDRL), located in Section J of the applicable contract.
13.0  VOLUNTARY SELF-DISCLOSURE
13.1  Congress through the Fraud Enforcement and Recovery Act of 2009 (FERA) amended the False Claims Act (FCA) to cover the identification and return of overpayments to federal programs. Specifically, FERA expanded the scope of the FCA to provide liability for “knowingly” retaining an overpayment. Accordingly, the FCA now imposes liability on any provider who received overpayments (accidentally or otherwise) and then knowingly fails to return the overpayment to the Government. The amended statute allows for knowingly retaining an overpayment to be the sole allegation of a complaint under the FCA. Additionally, failure to timely report and return an overpayment under the amended FCA exposes a provider to liability. This includes TRICARE claims and payments.
13.2  Individuals or entities who wish to voluntarily disclose self-discovered potential fraud to DHA-PI may do so under the Self-Disclosure Program (SDP). Disclosing parties may report by sending to DHA PI or may also report online.
13.3  Non-health care matters, should be reported to the DHA Office of Inspector General (OIG) Hotline, or if military, to the DoD OIG Hotline or the respective military service OIG Hotline.
13.4  Disclosing parties already subject to a Government inquiry (including investigations, audits, or other oversight activities) are not automatically precluded from using the SDP. The disclosure, however, must be made in good faith and must not be an attempt to circumvent any ongoing inquiry. Disclosing parties under Corporate Integrity Agreements (CIA) with DHA may also use the SDP in addition to making any reports required in the CIA.
13.5  Disclosing parties are advised that the self-disclosure may be shared with other Federal agencies.
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