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.