TRICARE Operations Manual 6010.59-M, April 1, 2015 Chapter 13 Program Integrity Revision: Section/Addendum Subject/Addendum Title 1 General 2 Controls, Education, and Conflicts of Interest 3 Case Development And Action 4 Reports 5 Provider Exclusions, Terminations, And Suspension of Claims Processing 6 Provider Reinstatements A Figures Figure 13.A-1 Violation Of The Participation Agreement (Sample) Figure 13.A-2 Violation Of The Participation Agreement - Follow-Up (Sample) Figure 13.A-3 Violation Of Reimbursement Limitation (Balance Billing) (Sample) Figure 13.A-4 Violation Of Reimbursement Limitation (Balance Billing) Follow-Up (Sample) Figure 13.A-5 Statistical Sampling For Overpayment Determinations And Identification Of Probable False Claims Figure 13.A-6 Special Notice To Provider/Pharmacy When The Provider’s Or Network Pharmacy’s Claims Are Suspended (Sample) Figure 13.A-7 Special Notice To Beneficiary When The Beneficiary’s Claims Are Suspended (Sample) Figure 13.A-8 Special Notice To Beneficiary’s When A Beneficiary’s Claims Are Suspended (Provider/Pharmacy Sample) Figure 13.A-9 Notice Of Proposed Action Terminating A Provider/Pharmacy (Sample) Figure 13.A-10 Initial Determination Terminating A Provider/Pharmacy (Sample)