April 24, 2015 --
The Defense Health Agency, Office of Program Integrity has received a significant number of concerns from TRICARE beneficiaries regarding unsolicited attempts by “Call Centers” to encourage them to provide personal identifying information and health information so that they can allegedly provide prescribed cream medications to the TRICARE beneficiary.
TRICARE and its contractors never call and ask for personal identifying information or health information. Beneficiaries should be wary of unsolicited attempts by any entity asking them for personal or health information, either by phone or in person.
The Call Center will normally cold call and say, "I am a representative calling from XYZ, we are calling to tell you about a benefit TRICARE will cover for you for a prescription pain cream you are eligible for. Do you have any of the following medical issues (list of issues) or pain? If so, TRICARE wants to get you taken care of, all we need are your doctor’s name and your TRICARE information and we will contact your doctor and get these medications or supplies out to you immediately and submit a claim. "
DHA PI strongly advises you not to give any information to these types of unsolicited requests for your personal health information and personal identifying information. Often these Call Centers have identified what limited information they have through “google” searches or through individuals who have approached you independently and obtained information directly from you.
Should a beneficiary receive a phone call for this information don’t provide any information. Immediately submit a Fraudline report to the Pharmacy Benefits contractor ESI. Beneficiaries can report the issue to Express Scripts Inc. — Express Scripts Fraud Tip Hotline: 866-759-6139; email: TRICAREfraudtip@express-scripts.com.
ESI can also flag your profile and reject attempts to bill for these medications. If a beneficiary does receive unsolicited medication in the mail, that individual can refuse delivery.
Additionally, TRICARE has revised and published the following on our webpage at www.health.mil:
TRICARE Revises Compound Drug Coverage
Starting May 1, 2015, Express Scripts, the TRICARE pharmacy contractor, will screen all ingredients in compound drug claims to ensure they are safe and effective, and covered by TRICARE. This screening process is like the one TRICARE already uses for other prescription drugs, but it will now apply to the ingredients in compound drugs. For more specific details, click on the link below: