in memoriam - Fleet Reserve Association

Either, the claims were lost, disallowed for unexplained reason, additional documentations needed, and payment
made to the hospitals in spite of the fact that the TRICARE beneficiary paid the hospital bill with his/her funds. Others
enroll with the TRICARE providers in the area with full knowledge of fraud and abuse committed by the provider
just to get a free ride, a waiver of deductibles and co-pays.
I have written several times, and also several other TRICARE beneficiaries in the area to WPS TRICARE
regarding the fraudulent and abusive practices of a TRICARE provider in Iloilo namely, Global Medical Network,
however, we have yet to see any action taken by WPS TRICARE to investigate the report of violations. Global
Medical Network continues to operate, milking the precious financial resources of TRICARE. Verification with
other TRICARE beneficiaries residing in other areas of the Philippines shows that TRICARE providers in the Philippines
as a whole are defrauding the U.S. government and TRICARE Standard. The following are lists of abusive
and prohibited practices violated by TRICARE providers operating in the Philippines which is in violation of the
Code of Federal Regulations (32 CFR 199.9):
Charging WPS TRICARE for medical services and supplies provided to TRICARE beneficiaries using the
maximum amount allowed under the Puerto Rico rate which is 10-20 times higher than what is routinely charged to
the general public for the same services. Examples; Doctors consultation which locally cost $6-$10, TRICARE providers
bills WPS TRICARE $60-$120. In most cases WPS TRICARE pays without questions. TRICARE beneficiaries
just sign in exchange for non-payment required deductibles and co-pays;
TRICARE providers, illegally and knowingly waiving TRICARE beneficiaries deductibles and co-pays
with the basic knowledge that the practice is prohibited under the Code of Federal Regulations;
Several TRICARE providers created a sham TRICARE Supplemental Insurance, collecting insurance premiums
from TRICARE beneficiaries, where as, the insurance company never existed. Pocketing the insurance premiums
paid by the TRICARE beneficiaries and waiving deductibles and co-pays;
Design a scheme to inflate medical bills and supplies from what was actually paid to the medical subcontractors.
These medical sub-contractors were paid by the TRICARE provider using the local reimbursement rate
generally charged to the general public. However, the TRICARE provider bill WPS TRICARE the maximum
amount allowable under the Puerto Rico rate;
In some cases, TRICARE providers and the TRICARE beneficiaries enter into a kickback agreement.
Medical supplies, procedures and services that were already paid by the TRICARE beneficiary, which he/she could
file directly to WPS TRICARE for reimbursement. However, the TRICARE provider will convince the TRICARE
beneficiary to allow them to file claims to WPS TRICARE using the maximum amount allowed under the Puerto
Rico rate. When payment was received from WPS TRICARE by the TRICARE providers, the profit over what was
actually paid based on the prevailing local rate will be shared with the TRICARE beneficiary.
There are other violations, however, the list above has been verified, though most TRICARE beneficiaries are hesitant
to talk in fear of retaliation from the TRICARE providers. I felt that there are several factors that allow these
abusive and prohibited practices from flourishing:
1. The direct cooperation of many TRICARE beneficiaries are hesitant to talk in fear of retaliation from the
TRIACRE provider to commit fraud, thus bleeding the direct cooperation of many TRICARE beneficiaries to sign
billing documents without any regard to the fraudulent aspect in exchange for the waiving of deductibles and copays;
2. The historical inept and slow response from WPS TRICARE investigators in acting to stop the fraudulent
and abusive practices right away, thus allowing greedy TRICARE providers to operate and milk the financial resources
of TRICARE illegally for many years before action is taken by WPS to stop payment of billings;
3. The very light sentences meted out to erring TRICARE providers, through plea bargain for lesser penalties
in exchange for pleading guilty to the offense;
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