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A massive billing glitch in Tricare's East region, managed by Humana, on Thursday slammed about 25,000 beneficiaries with premium charges 100 times more than they owe monthly for their coverage.
Editor's note: This article by Jim Absher originally appeared on Military.com, a leading source of news for the military and veteran community.
Prescription drug costs for Tricare users are set to rise Jan. 1, some by as much as 42%.
Effective Jan. 1, 2020, a 90-day supply of generic drugs received through the program's Express Scripts mail-order pharmacy will increase from $7 to $10. Co-pays on brand-name drugs received through the mail will go from $24 to $29; the price rises from $53 to $60 for non-formulary drugs.
Editor's note: This article by Patricia Kime originally appeared on Military.com, a leading source of news for the military and veteran community.
For those who saw a loophole, it was easy money.
In 2013, a handful of pharmacy companies that make compounded medications — personalized dosages or formulas normally crafted for patients who can't tolerate certain ingredients — discovered they could make treatments such as pain and scar creams, wound ointments and erectile dysfunction drugs, and market them to patients enrolled in Tricare.
Then, they could bill the government a hefty sum, between $400 and $10,000 per prescription, making enough to cover the cost of beneficiaries' co-payments, provide kickbacks to participating physicians and middlemen, and generously pad their own pockets.
When the Defense Health Agency's losses caused by these specious prescriptions topped nearly $1.5 billion in the first half of 2015, the Pentagon moved to restrict its coverage of all compounded medications.
And the Justice Department began pursuing the unscrupulous pharmacists, doctors, marketers and salesmen involved, including military troops who saw the largest case of medical fraud in the Pentagon's history as a chance to make cash on the side.
If you are a reservist, young adult or transitioning service member enrolled in Tricare or a transition health insurance plan, you will probably soon be paying more for your health insurance. And an enrollment change could impact how much some users must pay up front.
Tricare just released the 2020 rates for the Tricare Reserve Select (TRS) and Tricare Retired Reserve (TRR) programs, as well as for the Tricare Young Adult and Continued Health Care Benefit Programs. Like almost everything else, the prices will mainly be increasing.
Ex-pharmacist gets 2 years, $7 million bill for role in scheme to bilk Tricare out of more than $100 million
A former pharmacist from Irving has been sentenced to two years in federal prison for his role in a health-care kickback scheme that scammed the military's insurance program out of more than $100 million, court records show.
Ravi Morisetty, 44, is one of 13 defendants, including doctors and marketers, in the Trilogy Pharmacy case, and he is the first to be sentenced. He pleaded guilty last year to his role in the fraud.
The pharmacy's two owners, Jeffrey Fuller and Andrew Baumiller, also have pleaded guilty in the case and are awaiting sentencing.
A former Marine helped recruit service members for a scheme to bilk the Department of Defense for cash by purchasing tubes of scar cream that did nothing to treat scars for insane prices, according to a remarkable investigation by the Nashville Tennessean.