1.0 Litigation
1.1 The
Defense Health Agency (DHA) Office of General Counsel (OGC) shall
be notified by telephone immediately upon receipt of any summons,
writ, or other legal process which develops as a result of performance
under a TRICARE contract. In no event, shall the telephonic notice
to DHA OGC be more than three workdays following receipt of any
such legal process which could involve TRICARE. Such notice shall
include 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. Additionally, copies of all documentation shall be
transmitted to DHA by facsimile as soon as possible and followed
up with hardcopy mailed to DHA OGC on the same workday as telephone
notice is given.
1.2 The
United States (U.S.) 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 U.S. District
Court, however, such action must be taken immediately. Therefore, it
becomes imperative that the contractor fully cooperates with DHA
counsel assigned to direct the case. DHA counsel may request the
appropriate U.S. Attorney to the district court of the U.S. 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.
1.4 Acts of fraud, theft, embezzlement,
or sabotage involving TRICARE funds or materials, may constitute
violations of the U.S. Criminal Code and ensuing investigations
may be matters within the jurisdiction of the Federal Government.
In such cases, as stated above, immediate notice shall be given to
DHA OGC. 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. When a contractor is served
with a subpoena in connection with its TRICARE responsibilities,
DHA OGC shall be notified in a timely manner to safeguard against
the unauthorized disclosure of information. This 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. If a contractor is served a
summons by the U.S. 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, the summons must
be honored. The assistance of DHA shall be requested immediately
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
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.
Such TRICARE benefit payments shall be made only 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.