Defense Health Care:

Management Attention Needed to Make TRICARE More Effective and User-Friendly

T-HEHS-99-81: Published: Mar 11, 1999. Publicly Released: Mar 11, 1999.

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Pursuant to a congressional request, GAO discussed the Department of Defense's (DOD) implementation of TRICARE, focusing on the extent to which: (1) beneficiaries enrolled in TRICARE are getting timely access to health care; (2) claims for medical services are paid in a timely and accurate manner; (3) DOD and its contractors are identifying and mitigating fraud and abuse in TRICARE; and (4) DOD's pharmacy programs are cost-effective and consistently serve the needs of all beneficiaries.

GAO noted that: (1) DOD is not meeting its standards for scheduling beneficiary appointments, even for active-duty members; (2) also, even though contractors are meeting TRICARE claims processing timeliness standards, millions of claims are paid late, and claims processing continues to burden beneficiaries, civilian providers, and TRICARE contractors and managers; (3) additionally, although DOD has efforts under way to combat health care fraud, these efforts have not yet been effective, and additional opportunities exist to save hundreds of millions of dollars; (4) to cost-effectively meet beneficiaries' needs for prescription drugs, a top-to-bottom redesign of the pharmacy programs of DOD and its contractors is needed; (5) GAO has offered a number of recommendations regarding timely access to appointments and the pharmacy programs, which GAO believes, and DOD agrees, should help address these issues; and (6) whether these operational difficulties will continue depends largely on the extent to which TRICARE management increases its attention and actions to fully resolve these problems.

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