Audit of TRICARE Ambulance Transportation Reimbursements

Submitting OIG:

Department of Defense OIG

Date Issued:

Wednesday, August 17, 2022

Agency Reviewed / Investigated:

Department of Defense

Submitting OIG-Specific Report Number:

DODIG-2022-122

Component, if applicable:

Defense Health Agency (DHA)

Location(s):

Agency-Wide

Type of Report:

Audit

Questioned Costs:

$118,850,000

Funds for Better Use:

Number of Recommendations:

View Document:

Attachment	Size
DODIG-2022-122.pdf	2.95 MB

Related Open Recommendations

Recommendation Number	Recommendation Status	Significant Recommendation
D-2022-0122-D000AX-0001-0001.b	Open	No
Rec. 1.b: The DoD OIG recommended that the Director of the Defense Health Agency review the 69 unsupported TRICARE East, TRICARE West, and TRICARE for Life claims to determine whether they were properly paid to the ambulance transport providers and recoup the payments that were not proper.
D-2022-0122-D000AX-0001-0002.b	Open	No
Rec. 2.b: The DoD OIG recommended that the Director of the Defense Health Agency require the TRICARE Overseas contractor to educate ambulance providers in the TRICARE Overseas region about the importance of submitting supporting documentation with claims and implement review procedures to monitor compliance.
D-2022-0122-D000AX-0001-0003.a	Open	No
Rec. 3.a: The DoD OIG recommended that the Director of the Defense Health Agency, in coordination with the TRICARE contractors and external third-party auditors, ensure samples for quarterly, annual, and external claim audits include ground ambulance transport claims. Specifically, review claim forms and supporting documentation to ensure the level of service billed matches the level of service or transport mode furnished and noted in the supporting documentation; ensure claims meet the TRICARE and Medicare definitions of medical necessity; and ensure claims meet TRICARE Reimbursement and Medicare Claims Processing Manual point-of-pickup ZIP code requirements.
D-2022-0122-D000AX-0001-0003.b	Open	No
Rec. 3.b: The DoD OIG recommended that the Director of the Defense Health Agency review the 11 improperly paid claims and recoup the overpayments made to the ambulance providers, while also using payment recovery audits, as defined in Office of Management and Budget guidance, to identify and recover other overpayments to ambulance providers outside of our sample.

Department of Defense OIG

Department of Defense

The Department of Defense Office of Inspector General was established in 1982. The mission of the DoD OIG, as established by the Inspector General Act of 1978, as amended, (5 U.S.C. Appendix); and implemented by DoD Directive 5106.01, "Inspector General of the Department of Defense," is to serve as an independent and objective office in DoD to:

a) conduct, supervise, monitor, and initiate audits, evaluations, and investigations relating to programs and operations of the Department of Defense,

b) provide leadership and coordination and recommend policies for activities designed to promote economy, efficiency, and effectiveness in the administration of, and to prevent and detect fraud and abuse in, such programs and operations,

c) provide a means for keeping the Secretary of Defense and the Congress fully and currently informed about problems and deficiencies relating to the administration of such programs and operations and the necessity for and progress of corrective action

http://www.dodig.mil

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Audit of TRICARE Ambulance Transportation Reimbursements

Related Open Recommendations