TRICARE beneficiaries being targeted by call centers

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FALLS CHURCH, Va. — The Defense Health Agency, Office of Program Integrity (DHA-PI) has received a significant number of concerns from our TRICARE beneficiaries regarding unsolicited contact from call centers encouraging them to provide personally identifiable and health information.

According to sources, 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. “

TRICARE and its contractors will never call and ask for personally identifiable or health information. Beneficiaries should be wary of unsolicited attempts by any entity asking for this information, either by phone or in person.

DHA-PI strongly advises you to not give any information to these types of unsolicited requests. Often, these call centers have identified what limited information they have through internet searches or through individuals who have approached beneficiaries independently and obtained this information directly.

Should you receive a similar phone call, do not provide any information to the caller. Immediately following the call, submit a report to our pharmacy benefits contractor, Express Scripts Inc., by calling the Express Scripts Fraud Tip Hotline at 866-759-6139, or by sending an email to TRICAREfraudtip@express-scripts.com.

ESI can flag your profile and reject attempts to bill for these medications. If you do receive unsolicited medication in the mail, you can refuse delivery. Additionally, after May 1, ESI will screen all ingredients in compound drug claims to ensure they are safe, 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.