TRICARE Fleeced Again But There Are Differences


For ten years (1998 – 2004) a company that went under the name of Health Visions Corporation (VHC) fleeced TRICARE. The claimed amount lost was $100 million. We know from DODIG reports that TRICARE knew they were being fleeced but continued to ignore it even after the DODIG bashed them for their failures.

When TRICARE finally did react they did so with a vengeance against beneficiaries, blaming them for many of their ills and claiming that they were responsible. At the time comments such as “They [beneficiaries] deserve whatever they get.”, “Military retirees are not satisfied with living the good life in the Philippines so spend their time defrauding TRICARE.”, “If they [beneficiaries] didn’t use HVC then there wouldn’t have been any fraud.” and on and on. With this attitude is there any wonder that beneficiaries in the Philippines have suffered with draconian and arbitrary policies that were implemented to harm them or implemented through ignorance of the local health care industry practices and policies. Were there decisions colored because they harbored this loathing for a group of beneficiaries they saw as the root of their problems and the reason for the negative DODIG reports against them? Based on comments we received from some TRICARE employees at the time one could easily draw that conclusion. At the very least it was obvious to some that they had dehumanized beneficiaries in the Philippines by their comments and attitude which made it easy to disregard their concerns and the harm that came to them.

Fast forward to 2015, a full ten years later and what do we see in the headlines? Compound drugs fleece TRICARE, create deep budget hole.

But this time there are major differences in how TRICARE reacts.

  1. Instead of fraud in the Philippines we find it is in the United States and referred to as “inappropriate and potentially fraudulent activity”.
  2. Instead of $100 million lost over ten years we find $1.7 billion lost and it only took nine months and that doesn’t include the loses from the previous fiscal year.
  3. The loss is of such magnitude that TRICARE claims they will not be able to pay legitimate medical claims for the last part of the fiscal year unless Congress comes up with additional money or allows the Pentagon to reprogram money from other areas.
  4. New policies were put in place to reduce this “inappropriate and potentially fraudulent activity”.

To put this into prospective the cost to the taxpayer per year was $10 million for the HVC fraud which was shut down and prosecuted and beneficiaries accused of various fraudulent acts and draconian measures implemented that has cost effected beneficiaries millions of dollars in lost reimbursements. And HVC was no longer paid for future claims and an executive of the company was tried and prosecuted for fraud.

The cost to the taxpayer for this current “inappropriate and potentially fraudulent activity” comes to $2.27 billion per year. Yet not a word from TRICARE about closing down the offending companies or blaming TRICARE beneficiaries in the United States of fraudulent activity or claims that TRICARE wouldn’t be in this situation if beneficiaries had simply not used this provider. Nor do we see draconian measures that will cause these beneficiaries to not be reimbursed for future legitimate claims.

The differences are glaringly obvious.

If you want to find out the real story behind DHA’s focused attack on TRICARE beneficiaries in the Philippines instead of their spin and propaganda, read TRICARE: Betrayal in the Philippines, Is This the Future of TRICARE Overseas? It is available at the link and most online book sales outlets such as iBooks, Barnes & Noble, Amazon and others.

Never forget the Defense Health Agency and International SOS always have your back when it comes to high quality and easy access to care; just ask them!

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About TRICARE Overseas Philippines

We are U.S. Military retirees working to insure we obtain the medical benefit promised in spite of the Defense Health Agency.
This entry was posted in Closed Network, CMAC Table, Defense Health Agency (DHA), Demonstration, International SOS, Tricare Management Activity (TMA), Tricare Overseas Program Philippines. Bookmark the permalink.

21 Responses to TRICARE Fleeced Again But There Are Differences

  1. Ken says:

    I give up, I’m moving back to the U.S. in January 2016 where my medical care will cost Tricare a lot more money than it does in the Philippines. It’s a huge problem getting reimbursed here even when you use doctors on their list.

    In addition, I had to paid 45,000 pesos out of my pocket for Mohs Cancer surgery, There is only one doctor at Makati Med who does it and she is not Tricare Approved or Certified. I got the appropriate waiver and sent it in, but still could not get reimbursed. So I quit!!

    Liked by 1 person

    • We can’t blame you and your experience only reinforces the points made in the article. We are treated much differently here. Essentially if you live in the Philippines as a TRICARE beneficiary you are treated as a criminal but move to another country or the U.S.A. and you are then considered an honorable retired military member. The attitude and actions of DHA and their contractor demonstrate this daily.

      Liked by 1 person

    • Gary F. Ossinger says:

      Ken
      I also pay up front while living in the ( Samar/Tacloban.) area, Medical is a major problem here. Not to mention a mechanic or dentist, Just finding a Dr who believes in Preventive Medicine is a problem, I have been fighting these medical contractors in the U.S. and P.I. for many years and while they are to blame certainly for the graft and corruption it is our own people in the U.S. who have no idea about the culture they are dealing with. Am presently in Cebu ( due to medical requirements) and there are many 1st class hospitals in Cebu. Everything from sanitation to 1st class Drs who may be trained out of country. You are right about costs, have had 2 open heart surgeries with in 12 months both done in the U.S. Nearly $1,000,000. Cost here ( the surgery is available) is about 20% of the cost in the U.S. Both problems were discovered by accident during routine check ups in the States. So really am living on borrowed time. Am pushing 80 hard. I guess my point is the trade off. I like the Provence and would not live up north in Luzon. Been there, done that. Any way you look at it there is a trade off.
      older than dirt

      Liked by 1 person

      • Ken says:

        Gary, even if you had the surgery here with Tricare Certified doctors and hospitals, Tricare would lower the approved amount substantially below the billed amount, and then pay only 70% of their approved amount. So if you get reimbursed 50% of the billed amount you will be fortunate.

        Liked by 1 person

      • Robert Sherman says:

        I Use Baypoint Hospital and medical center in Olongapo at sbma and the Doctor fee is 3 Times what my doctor Charges But I have to use Tricare approve Doctors and Labs at least they fill out forms

        Liked by 1 person

      • Those massive fee increases for Tricare patients were encouraged/directed by International SOS and defended by the Defense Health Agency, stating increases of 2 to 4 times local rates for all other patients is normal for Tricare. Of course in the past the Defense Health Agency spent years crying that they were being defrauded by the very same providers when they did the same thing to include International SOS with Prime Remote claims.

        Liked by 1 person

    • james allen says:

      Ken I agree with you 100% I met a wonderful woman through a great friend back home in America and I am going to make this my new home now because she is a great Christian woman and hard worker. We will get married soon in 2016. It really is a crying shame being served in military and retired from service. Retired in 2000 and when I was home I used the VA clinic back home but if needed any sort of surgery I would have to drive 2 hours. And to wait several weeks to be seen or months and once there more waiting game.
      Only twice I went to civilian hospital for emergency and one was by ambulance and the ambulance alone for a 4 mile ride was well over $1000 not to mention the outrageous charges the fees were for the service. And would get a bill in the mail from hospital not even 2 to 3 weeks later showing what tricare..covered and what my portion due to hospital was.
      By reading these remarks on here is very sad and a great concern….there is good and bad all over in this world and just because of a few bad apples it shouldn’t ruin the whole batch. My doctor is the owner/surgeon and is clearly on list of Tricare. I was so surprised on the cost of help and furthermore my doctor took me off a pill that our VA system put me on twice a day and for my acid and said that could lead to stomach cancer if keep taking of twice a day he almost fell off his chair when he asked me how long have I been on them? And I said around 7 years. … . ……..It’s Very Sad when I am fortunate to have such a great doctor and been going on now 7 months and tricare..hasn’t paid yet…for the ones reading this..how would this stand for you if you were treating people or at your work and your employer would not pay well over half a year?
      Furthermore I’ve had headaches when I was home off and on an of course pills was the way VA fixed problem….they gave me an MRI here and discovered lack of blood flow going to the brain and the result almost very sure it was from chlostioma. Spelling incorrect but you get my point so now I am on embol…..
      I am 55 now and am going to be a daddy end of march…1st..in my life…if I was a younger man I would take her back to America with me…but the process is so long is So long up to 5 years for her and she don’t want to leave her family. I finally found my happiness people are so very kind to.
      Tricare should be thankful that I’m not using civilian help back home where we all know it’s outrageous what there billing is and because they are the ones sticking it to All insurances.
      I wasn’t a high ranking person when I got out and not able to pay in full always and even when we do I see it will be a lengthy time either way.
      It’s just not fare for any veteran who has served to go through such inconvenience because of whatever happened in whatever case here. I have proper documentation of all results and pictures and still….
      All I ask is speaking for vets like myself here please take care of us and the doctor who ..like my doctor giving me great medical treatment. ..thanks to all reading and again please don’t let certain places or doctors or whatever the case maybe ruin it for great doctors like myself.

      Like

  2. Gary F. Ossinger says:

    If Locals in the Philippine Gov’t are involved so are bribes. Have watched this for over 25 years in P.I. Probably only Indonesia has a more corrupt gov’t than the Philippines. I mean at every level right down to Brgy level. It is built into the culture. There is much truth in a Philippinos worst enemy is a Filipino. In order to obtain reasonable benefits ( by western standards) a Filipino has to be employed by the Gov’t. After a few years the Gov’t system and peer pressure with in the system, forces changes in the idealistic attitudes of the young to conform to the ” System “. A first class example is the PNP, Philippine National Police. It is very slowly changing but, not nearly enough. Thoses of us who choose to retire here and live in rural communities see this on a daily basis. Our environment is quite different than Olongapo or Angeles.City. People fail to realize that there are some 79 Proviences and maybe 82 dialects in P.I. That every different geographical area is different in their habits, culture, dialect and behavior. My experience has been that the only things all Filipinos have in common is the Catholic religion ( which is practiced differently in different areas ) and the English language which in the Philippine Constitution is the 2nd National language. One of my most interesting experiences was Attending Silliman University in Dumagueti 1999 / 2000 doing a Masters in Philippine Social Anthropology. Very useful wish I had been able to finish the program but had to return to Samar to attend the farm.

    i

    Liked by 2 people

  3. Shannon says:

    My family and I will be returning back to the U.S.. My father who is medically retired and is married to my mother a Philippine national moved here to try and make a better life and my mother wanted to be near her family. Tricare has let my family down and it has just about ruined my parents financially with my fathers medical bills. My father who is a very proud Southerner, American and man says that for the first time in his life he has to quit something and run away with his tail tucked between his legs. So sometime in 2016, more than likely April we will return home to Arkansas. It tears at my heart to see my father dealing with his injuries and struggling to make a life for my mother, myself and my siblings only to be treated so poorly by Tricare. To see my parents have to sell the hotel they worked so hard to build just to keep up his latest rounds of surgeries is an image I will not soon forget.

    Liked by 2 people

  4. Mike V. says:

    My wife and I lived in Angeles for a very long time. Unlike so many others we never accepted the “free turkey” that the crooks at Cybercare gave away during the holidays and never cheated or gamed the system. We knew dependent wives connived with doctors to fake illnesses and split the TRICARE payment, with or without the veteran’s knowledge. We refused to deal with the doctors who billed TRICARE $400 or more for $50 worth of medications every month. Our sin was one of omission….failing to alert the proper authorities…minding our own business. And now all retired families in the Philippines are paying the price for that “free” health care they abused.

    Liked by 2 people

    • Mike, Don’t feel guilty about your ‘omission’. It is well documented in DODIG reports that many retirees did report this activity and did so for years but the TRICARE Management Activity chose to ignore the reports or take any action except to pay the claims without question. It was only about ten years later and after multiple negative DODIG reports and prodding by congress did they take action. And that action was to implement draconian measures the punish beneficiaries because they blamed beneficiaries for making them look bad. That’s not to say that some beneficiaries were not involved in fraud but most were not. Also it should be understood the total and complete lack of understanding of the local health care industry and lack of any reasonable controls on claim payments opened the door to easy fraud.

      Liked by 2 people

  5. wgraue says:

    Nobody, and specifically our elected officials and fraud watchdogs admit the conditions which exist here, including the abuse by US officials practiced openly. Apparently without fear, whistle blowers are persicuted and downgraded, lavish meals are charged on. government credit cards, so is personal transportation including personal vehicle fuel. A bribe in the right place gets a diplomatic member of the embassy staff extra unauthrized housing, and various illegal deeds reported to the embassy are ignored with impunity. All this along with various skimming practices continue, even bought from outgoing civil servants ton incoming replacements. It is called in embassy vernacular “clientelle charge.”. As veterans at the mercy of this incorporated thievery, we pay for the graft and corruption perpetuated against us with no end in sight.

    Liked by 1 person

    • james allen says:

      I was treated by a tricare..approved doctor and has found things that the VA missed my treatment was done 6 months ago…approved till now my doctor has not been paid after I paid my 10% which is required by tricare…I am a retired navy veteran and how would anyone feel if they don’t get paid past 6 months?…if somehow or someone who ever disrupted the system…why should that effect those veterans getting great treatment and less expensive than any other country especially U.S.

      Like

      • Ken says:

        I started asking doctors at Makati Med if they were getting reimbursed by Tricare. Most were not without a lot of followup. My ENT doctor says he no longer bills Tricare because he doesn’t get paid. He simply has the Vet pay the normal fee and file for reimbursement.

        In my move to the U.S. coming up, at least I will have Medicare with a Tricare supplement. In the Philippines, I’m lucky to get reimbursed 50% of the total bill, if anything, with medicare and tricare supplement my bill is covered almost 100% and that is the reason I will be moving back to the U.S.

        Like

      • We are finding more and more retirees who are deciding to return to the states, primarily because of the lack of a reasonable TRICARE option in the Philippines. We have also talked to retirees that contemplated moving to the Philippines but changed their minds after finding out how the TRICARE system really works in practice in the Philippines.

        Like

  6. Mike V. says:

    Why hasn’t some ambulance-chasing (literally) lawyers group initiated a class-action lawsuit against the Wisconsin Physicians Service (WPS) for denying retirees their congressionally authorized entitlement to “quality health care?” (The brochure’s words, not mine).

    Like

  7. JFrank says:

    you have no clue what’s truly going on when it comes to fraud.

    Like

  8. Mariciel says:

    Visit Lorma Medical Center in San Fernando City, La Union. They cater Tricare for life and standard including their dependents.

    Like

    • Mike V. says:

      I just had major surgery at the new The Medical City-Clark. Its a beautiful facility, not an
      over-crowded anti-foreigner dump like AUF, and the operation was an outstanding success.

      THE BILL, HOWEVER….was almost as much as a stateside hospital would charge with huge markups, both in materials and doctors’ fees. I gladly paid my deductible and 25%….and TRICARE assures me that, even if the hospital doesn’t get paid all it billed by TRICARE. I am not liable for anymore payments. Unfortunately, that probably means they will eventually stop accepting TRICARE patients like other hospitals in the Angeles City area have already done.

      Like

      • You are exactly correct. There are at least two issues. The first is the CMAC is not designed for the Philippines but a reflection of a small percentage of the US billing system which is not the same as the Philippines. Second the hospital has little idea how to convert their Philippine designed bill that meets local requirements into a US designed bill that meets TRICARE’s standards. Bottom line the hospital will take a hit and after enough of these they will get tired and tell TRICARE to take a hike just as the other hospital in Angeles did a long time ago.

        Like

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