The TRICARE Management Activity (TMA) likes to blame TRICARE beneficiaries in the Philippines for all their past and current failures with fraud. They like to tell Congress that 77% of all beneficiaries in the Philippines are on “prepayment review” with the implication that the vast majority of us are suspected of defrauding TMA and the taxpayer; we have TMA letters to Senators stating this. This claim becomes problematic and fall apart when one considers that almost 77% of retirees recently indicated in our survey that they don’t even file claims due to the extreme difficulty in complying with the numerous technical requirements. Even if we assume our survey was off and only 25% don’t file claims the assertion that 77% are on “prepayment review” is still obviously an exaggeration by TMA intended to dissuade Congress from listening to any of the “defrauding” retirees in the Philippines as that would mean that every beneficiary that files claims is suspected of fraud. Put another way, out of 11,000 beneficiaries in the Philippines, TMA implies 8,470 retirees, widows, wives and children are suspected of defrauding them.
TMA admonishes beneficiaries who sign blank claim forms and strongly advises that beneficiaries never sign a blank claim form because it is an open invitation to defraud and TMA has claimed this behavior has assisted in fraud in the Philippines. It also provides them with ammunition to claim we assist in fraud.
Recently a new “claim form” has come to light. It appears to be one developed by International SOS (ISOS) for use by overseas providers but it has no form number or date and is generally referred to as the “CDW” by them; the form heading says TRICARE OVERSEAS PROGRAM CLAIM DEVELOPMENT WORKSHEET. Although it says “worksheet” apparently it is really a claim form and based on information contained in the Guide for Completing the Claim Development Worksheet this is confirmed.
It has come to our attention, through personal experience and input from others, that providers are demanding that beneficiaries sign these forms even when the care portion is blank and further demanding that they sign the form when the provider is an “Institutional” provider. There are two kinds of approved providers in the Demo. Institutional providers are hospitals and non-institutional providers are physicians. The form indicates that a patient signature is only required when the provider is “Non-Institutional” or a physician. See the Claim Development Worksheet link above. Further the Guide for Completing the Claim Development Worksheet, see link above, specifically states, Patient Signature is only required for Non‐Institutional Providers (individual providers or clinics). Institutional Providers are required to have a permanent hospital record containing a signed release of medical information on behalf of the beneficiary. Institutional providers are required to have your signature on file using yet another un-numbered or dated form, ‘Signature on File’ Authorization Letter.
The “CDW” form further states that your signature certifies the correctness of the claim. So if you sign a blank form you have just certified the correctness of whatever the provider decides to submit as care provided and the amount billed which may or may not be what actually happened. The advantage to the Signature on File process is you are not certifying to the authenticity of the claim information.
Recent experience by multiple beneficiaries has been that hospitals and physicians are demanding that they sign the blank form. We queried Global 24 and after multiple requests for information we were finally told;
1) In regards to your visit to AUFMC and the request to sign the CDW form, you do not have to sign the form when visiting an institutional provider, in order for the claim to be processed.
2) When visiting an Individual provider you can request that they fill in the entire claim form before then signing or you can ask them to contact you to return and sign the form once they have completed the form.
We further suggest you ask to see the document they intend to attach to this “CDW” form which lists the specific care provided and associated charges and initial it as proof you saw it.
We advise this because recently we were asked to advise a retiree on what to do after receiving a letter from Wisconsin Physician Services (WPS). The letter was asking for clarification of information included on a “CDW” and attached itemized bill for care he had received from a hospital, Institutional, provider. First he signed the blank form. Because he did not file the claim, he had no idea how to respond to the request for additional information. Further he found that the attached itemized bill included care not received on the date indicated and the amount listed under “Amount paid by beneficiary” was not correct either.
In the first place he should not have signed a blank form and without seeing the attached itemized bill. Secondly WPS should not be asking him to explain or clarify what the provider submitted and we advised him that he should respond to WPS to send their questions to the provider. By signing the blank from this retiree in essence certified a claim that was at least partially fraudulent wither deliberately or by accident and gives TMA the ability to claim he participated in the fraud.
The points to take away from this are;
1) Never sign a blank claim form or any document where you are certifying to the correctness of information you have not seen.
2) Demand to also see the itemized bill the provider intends to submit with the claim and initial the bill in one corner to prove you saw it if it is questioned in the future.
3) Never sign the claim form when the care is provided by a hospital and demand they follow instructions and complete a “Signature on File” document instead as this relieves you from any responsibility as to the correctness or authenticity of the claim.
If the Demo providers object tell them to call Global 24 so they can be properly trained. If they still refuse to comply or if Global 24 fails to address the issue please report the incident to us at firstname.lastname@example.org