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defending clients in tricare fraud investigations lawyers

June 30, 2020

The U.S. Department of Defense Military Health System is known as Tricare. Tricare provides many different forms of coverage including prescriptions, surgery and minor medical procedures. Tricare is for military members who are on active-duty right now. It also covers those who are retired from the military as well as those who all reserve service members. While this form of coverage is diverse and complicated, it has much in common with other programs designed to administer healthcare to large groups of people such as Medicare and Medicaid. All recipients and those who administer the program need to be well aware of the kind of rules and regulations that govern how the program is administered. Violations of any such rules and regulations can result in all sorts of penalties including being banned from the program and even the possibility of jail time and large fines.

A Very Serious Offense

Federal prosecutors take a very dim view of anyone violating laws pertaining to Tricare. Enormous efforts have been made to ensure that no one is breaking the law. Tricare service providers need to be especially alert when it comes to issues such as billing, working with patients and interacting with other program vendors. A federal investigation into any vendor or provider working with Tricare can result in the temporary suspension of all activities. If found guilty of these kinds of violations, the vendor or provider may face both civil and criminal punishment.

This kind of fraud has been very expensive for the military. Officials estimate that billions of dollars in public funding that is intended to assist military personnel have been lost. Federal officials have brought charges against some very high profile providers. They have brought them to the attention of the wider public in an effort to make clear just how much damage any given provider can expect if they are found guilty of any form of legal violation. All providers should be aware of the kinds of defenses possible under these circumstances. Informed legal counsel can make all the difference between a great defense and one that fails to fulfill such aims.

A Good Defense

A really good defense against allegations of Tricare fraud can take many forms. It is imperative to find a lawyer who knows all areas of Tricare laws. Unlike civilian courts, all matters pertaining to the military fall under specific laws that may not apply in other circumstances. Regulations pertaining to military procedures are not only complex. They are also subject to change rapidly. What is true in any given quarter may not be true a few months later.

This is why there are generally several elements to an effective defense. In general, it’s best to get in touch with layers as soon as possible. The mere whisper of an allegation of fraud can lead to problems with the company’s image in the public mind as well as issues with providing service for members of the military. All companies facing these allegations need to know certain things as the process continues.

There are varied federal agencies. Any company facing these allegations should know which particular federal agency is making such allegations. This can help them determine how to work with agency as different federal agencies have different procedures. It’s also crucial to understand the kind of charges being brought. Under law, violations of Tricare can take the form of civil issues. They can also take the form of criminal penalties. Each allegation is serious by itself. A provider may also be facing the possibility of both civil and criminal penalties. Many providers can be charged under varying statues that combine both.

A Tricare provider can offer many different types of defenses. A single employee may have misread the regulations and acted inappropriately. A few employees may have deliberately conspired to knowingly engage in fraud. One division of the company may have acted improperly as part of company wide policy to ignore and deliberately discard federal regulations pertaining to the administration of Tricare billing. Each client is different and faces different issues when crafting a defense. At our firm, we recognize these issues and understand how to offer the best possible legal defense.



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