Defense Health Care: Improvements Needed to Reduce Vulnerability to Fraud and Abuse
HEHS-99-142
Published: Jul 30, 1999. Publicly Released: Jul 30, 1999.
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Highlights
Pursuant to a legislative requirement, GAO reviewed the Department of Defense's (DOD) health care system, focusing on: (1) DOD's estimates of the extent of health care fraud and abuse; (2) DOD's efforts to reduce health care fraud and abuse in civilian settings; and (3) initiatives and incentives that could improve DOD's antifraud efforts.
Recommendations
Recommendations for Executive Action
| Agency Affected | Recommendation | Status |
|---|---|---|
| Department of Defense | To reduce TRICARE's vulnerability to fraud and abuse, the Secretary of Defense should direct the Assistant Secretary of Defense (Health Affairs) to expedite implementation of TRICARE Management Activity's revised antifraud requirements, including the requirements that contractors develop a corporate antifraud strategy, utilize new antifraud software, and develop an antifraud training program. |
Closed – Implemented
The DOD/TMA point of contact stated that TMA has visited each managed care contractor to ensure that this recommendation has been implemented. Specifically, each contractor has installed antifraud (artificial intelligence) software. TMA, with the help of the local Assistant U.S. Attorney's Office and DCIS, has provided on-site antifraud training. Regarding contractors developing a corporate antifraud training program, they are now all in compliance (two previous deficiency notices have been lifted). Additionally, the contractors are required to issue an annual corporate antifraud strategy via their web site or by letter of assurance. GAO's point of contact stated that all contractors have complied with this requirement.
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| Department of Defense | To reduce TRICARE's vulnerability to fraud and abuse, the Secretary of Defense should direct the Assistant Secretary of Defense (Health Affairs) to modify contracts to establish specific results-oriented goals and performance measures for contractors. |
Closed – Implemented
In its comments, DOD stated that, while establishing specific results-oriented goals and performance measurements for contractors is desirable, it was not aware of any methodology that would allow DOD to establish such goals without also creating perverse incentives. While DOD did not agree to adopt this recommendation, it stated it will continue to look for a way to increase appropriate efforts by its contractors to reduce fraud and abuse.
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| Department of Defense | To reduce TRICARE's vulnerability to fraud and abuse, the Secretary of Defense should direct the Assistant Secretary of Defense (Health Affairs) to include in DOD's military health system strategic plan how DOD will combat health care fraud and abuse and an assessment of DOD's performance in combating such activity. |
Closed – Implemented
In commenting on a draft to this report, the Assistant Secretary for Health Affairs stated that DOD completely concurred with the recommendation and noted that DOD has included a section on how it plans to combat fraud and abuse in the TRICARE Management Activity (TMA) strategic plan.
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Topics
Contract oversightDepartment of Defense contractorsFraudHealth care programsInternal controlsManaged health careProgram abusesHealth care fraudFraud and abuseDefense health care