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TRICARE Operations Manual 6010.62-M, April 2021
Administration
Chapter 1
Section 6
Legal Matters
Revision:  
1.0  LITIGATION
1.1  The contractor shall notify the Defense Health Agency (DHA) Office of General Counsel (OGC) by telephone within three business days upon receipt of any summons, writ, or other legal process which develops as a result of performance under a TRICARE contract.
1.1.1  The contractor shall include in the notice 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.
1.1.2  The contractor shall transmit copies of all documentation to DHA OGC within one business day by facsimile and follow-up with hardcopy mailed to DHA OGC on the same business day as telephone notice is given.
1.2  The United States (US) Government 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 United States (US) District Court; however, such action must be taken immediately.
1.4  The contractor shall fully cooperate with DHA counsel assigned to direct the case. DHA counsel may request the appropriate US Attorney to the district court of the US 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.
1.5  The contractor shall notify DHA OGC within two to four business hours of any acts of fraud, theft, embezzlement, or sabotage involving TRICARE funds or materials, which may constitute violations of the US Criminal Code and ensuing investigations may be matters within the jurisdiction of the Federal Government. 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.
2.1  The contractor shall notify DHA OGC initially by telephone within two business days and a follow-on email within one business day when it is served with a subpoena in connection with its TRICARE responsibilities to safeguard against the unauthorized disclosure of information.
2.2  The above 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.
2.3  The contractor shall comply if served a summons by the US 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.
2.4  The contractor shall request DHA OGC assistance within two to four business hours 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
3.1  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.
3.2  The contractor shall only make benefits payments 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.
4.0  BANKRUPTCY
4.1  The contractor shall follow the instructions in Chapter 10, Section 2 when any TRICARE debtor files a petition in bankruptcy.
4.2  The contractor shall follow the applicable laws of the state in which the bankruptcy was filed when a TRICARE provider files a petition in bankruptcy, regardless of whether there is an outstanding recoupment action against that provider.
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