GAO: TRICARE Likely Missing Mistakes

Mistakes involving claims payments that are too high or too low are being missed by the TRICARE audit system, according to a report by the Government Accountability Office. The report was the subject of an article in Stars and Stripes last week.

According to the GAO study, TRICARE does not routinely examine records to determine if a bill was accurate. Because of that, TRICARE reported “improper payments” of $68 million in 2013, an error rate of 0.3 percent. GAO pointed out that Medicare reported improper payments at a rate of 10.1 percent for the same time.

Many of the same providers use both programs. And coverage and payment policies are often the same. The difference, GAO reported, is that TRICARE does not perform the same review process of medical records that Medicare does.

The report says TRICARE’s method of reviewing claims has not changed in 20 years and is likely missing mistakes that would be found by a more rigorous review process.

– Taken from the February 24 issue of the NGAUS Washington Report, a weekly e-newsletter