TRICARE and CareSource Military & Veterans Enroll Check Eligibility
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Fraud, Waste & Abuse

TRICARE and CareSource Military & Veterans

Our Program Integrity Department handles cases of managed care fraud, waste or abuse. It can be done by providers, pharmacies, or beneficiaries.

  • Fraud means the purposeful misuse of or for gain of benefits.
  • Waste means overusing benefits when they are not needed.
  • Abuse is action that causes unneeded costs to TRICARE Prime® Demo by CareSource Military & Veterans™.

Report Fraud, Waste & Abuse

You do not have to give us your name when you write or call. If you are not concerned about giving your name, you may also send an email* or fax us. Please give us as many facts as you can. Add names and phone numbers. If we do not get your name, we will not be able to call you back for more information. This will be kept private as allowed by law.

*Others may read your email without you knowing or saying it is okay if your email is not secure. Please do not use email to send a beneficiary ID number, social security number or any health information. Please use the form or phone number above. This can help protect your privacy.

Employee Ethics

It is also important for you to tell us if a CareSource Military & Veterans (CSMV) employee acts inappropriately. Some examples are:

  • Receiving gifts or kickbacks from vendors for goods or services purchased
  • Inappropriately marketing our company to potential beneficiaries
  • Behaving in an unethical or dishonest manner while performing company business

Corrective action of any identified fraud, waste and/or abuse are available in the provider manual. For provider terminations/suspensions information, see the TRICARE Prime Demo Fair Hearing Plan (coming soon).

Prohibited Affiliations / 42 C.F.R. § 438.610

TRICARE Prime Demo is prohibited by federal and/or state provider agreements from knowingly having relationships with persons who are debarred, suspended or otherwise excluded from participating in federal procurement and non-procurement activities. Relationships must be terminated with any trustee, officer, employee, provider or vendor who is identified to be debarred, suspended or otherwise excluded from participation in federal or state health care programs. If you or your office management employees are excluded, you must notify us immediately.

From the Office of the Inspector General

The Office of the Inspector General (OIG) has free educational materials to help providers learn about federal laws designed to protect Medicaid and Medicare programs and program beneficiaries from fraud, waste and abuse.