Fraud and Abuse

Fraud occurs when a person or organization deliberately deceives others to gain an unauthorized benefit.

Abuse is the improper or excessive use of program benefits, resources, or services by providers or beneficiaries.

Anyone can identify potential fraud and abuse. Please be alert to anything that "doesn't look right." Types of activities that should be reported include:

• A provider billing for services when services were not rendered.
• Services billed do not match the services rendered.
• A provider waiving copayments or deductibles.
• Someone you know is not TRICARE eligible but is receiving benefits.

Report Fraud and Abuse

E-mail PI@triwest.com, call 1-888-584-9378 or fax 1-602-564-2171 to anonymously report suspected fraud and/or abuse.

When reporting fraud and abuse, provide as much information as possible, including:

• Who committed the fraud
• When the fraud occurred (time frame)
• Where the fraud occurred
• Detailed description of the fraudulent activity