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.