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Suspect TRICARE insurance fraud in North or South Carolina?

TRICARE fraud is a disrespectful act of greed affecting all taxpayers. If you think you’ve seen it, even if you were involved, you can blow the whistle – and potentially receive a life changing reward.

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How to Recognize and Report TRICARE Fraud in North and South Carolina

TRICARE insurance fraud hurts military families and undermines the integrity of the healthcare system, increasing healthcare costs and taxes while keeping vital care from people who need it. Fortunately, the federal False Claims Act (FCA) provides a powerful mechanism for whistleblowers to expose TRICARE fraud and potentially receive significant financial rewards.

TRICARE insurance fraud can occur in various forms, often involving providers, beneficiaries, or contractors. If you suspect TRICARE fraud, a whistleblower attorney can discuss your situation with you confidentially and help you decide on the next best steps for you.

Even if you were involved or you’re unsure if you’re seeing TRICARE insurance fraud, contact us online or call 1-888-292-8852 any time for a free, confidential discussion. We can guide and help protect you.

What are common examples of TRICARE fraud and abuse?

Here are some common examples of TRICARE fraud:

Billing for services not provided

  • Billing TRICARE for medical services or procedures that were never performed
  • Billing TRICARE multiple times for the same service
  • Charging for more expensive procedures than those performed

Improper coding

Unnecessary services

  • Prescribing unnecessary tests, treatments, or procedures to inflate bills
  • Exaggerating or fabricating diagnoses to justify costly treatments or services that aren’t needed

Kickbacks and referral schemes

  • Paying or receiving illegal payments in exchange for patient referrals or for prescribing specific medications, treatments, or equipment
  • Doctors referring patients to facilities or services in which they have a financial interest

Prescription drug fraud

  • Pharmacies billing TRICARE for drugs not dispensed or for expensive brand-name drugs when cheaper generics were provided

False claims by beneficiaries

  • Individuals who are not eligible for TRICARE claiming benefits anyway
  • Beneficiaries falsifying information to receive higher levels of care or benefits

Medical identity theft

  • Stealing or using someone’s TRICARE information to fraudulently receive medical services, prescriptions, or equipment

Durable medical equipment (DME) fraud

  • Billing TRICARE for expensive DME (such as wheelchairs or prosthetics) that is unnecessary, never delivered, or delivered at inflated prices
  • Telemarketers may contact TRICARE beneficiaries, offer free or low-cost DME, and then bill TRICARE for unnecessary or overpriced equipment

TRICARE is meant to help military families

TRICARE is a healthcare program managed by the U.S. Department of Defense (DoD) that provides health benefits to active-duty military personnel, retirees, and their families. Unlike other government aid programs like Medicaid and Medicare, TRICARE specifically serves the military community.

TRICARE typically features lower out-of-pocket costs for beneficiaries, especially active-duty service members. Fraudsters drive these costs up drastically, but when you stand up against healthcare fraud like TRICARE fraud and other theft from the government, you can play a vital role in protecting resources meant for vulnerable people, holding fraudsters accountable, and helping ensure our tax dollars go where they should.

What to do if you suspect TRICARE fraud

If you suspect TRICARE insurance fraud, there are steps you can take to bravely report it, help protect yourself, and potentially receive a reward:

  1. Avoid internal reporting: Internal reporting can sometimes lead to destruction of evidence before you have a chance to pursue a whistleblower claim
  2. Know your retaliation protections: The False Claims Act includes provisions to protect whistleblowers from retaliation by their employer, and we know how to protect you
  3. Contact an experienced whistleblower attorney: Reach out to a whistleblower attorney who is experienced with TRICARE fraud cases and can advise you on the next best steps for you

The potential financial rewards for being a whistleblower

Whistleblowers who pursue claims under the FCA may be entitled to a portion of the government’s recovery as a reward in a successful case. This could be up to 30% of the total amount recovered by the government. The exact potential percentage depends on factors such as the level of contribution by the whistleblower and whether the government chooses to intervene in the case.

Healthcare fraud, like TRICARE fraud cases, can result in large settlements, often in the millions of dollars. This means your potential whistleblower reward could amount to a life-changing amount of money in a successful case. For example:

  • Whistleblowers received a total reward of nearly $3.8 million as part of a $20 million judgement against Acadia Healthcare Company, Inc. for submitting false claims to TRICARE and other government health programs3
  • A whistleblower received $2.7 million as part of a $27 million judgment against Precision Toxicology for billing TRICARE and other government health programs for unnecessary testing over nearly a decade3

Do you suspect TRICARE fraud against the government? Contact us online or call 1-888-292-8852 today for answers, help, and a confidential chat with a professional.

What protections do whistleblowers have under the FCA?

You may be concerned about coming forward with allegations of TRICARE fraud. It’s understandable to be cautious, but you should know that the FCA provides several protections for whistleblowers.

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Remedies for retaliation

If you experience retaliation, the FCA allows you to sue for remedies including:

  • Job reinstatement
  • Double back pay
  • Compensation for damages

Confidentiality

Your identity will remain under seal while the government investigates your claim. Your identity may eventually be revealed if the case goes to court, but a whistleblower attorney on your side can significantly reduce your odds of facing retaliation.

How a whistleblower attorney can help

There are several ways a whistleblower attorney can help you with your TRICARE insurance fraud whistleblower case, including:

  • Assessing the strength of your TRICARE fraud case based on extensive experience
  • Assisting you in filing your whistleblower lawsuit
  • Safeguarding your rights and using the FCA’s protections to help protect you from retaliation
  • Potentially moving forward with your case even if the government declines, which can result in a greater reward for you in a successful case
  • Advocating for the maximum reward to which you may be entitled in a successful case

Why choose Carolina Whistleblower Attorneys

Our team of accomplished attorneys is led by Bill Nettles, the former U.S. Attorney who helped make South Carolina one of the top four states for whistleblower recoveries during his tenure.1,4

We are dedicated to exposing fraud against the government and supporting those who courageously report TRICARE insurance fraud. Our success stories demonstrate our passion for seeking justice on your behalf.1

We operate on a contingency fee basis, meaning we cover all case expenses, and you won’t pay a penny unless we get a reward for you. Guaranteed.2 And with our You-First Policy, your needs are always our top priority.

If you suspect TRICARE fraud, we encourage you to have a confidential conversation with us. We’re here to answer your questions and help you explore your options. The consultation is free, with no obligation. Contact us online or call 1-888-292-8852 today!

See what else our clients say

Awards we’ve won

For standards of inclusion for awards listed, visit bestlawyers.com, thenationaltriallawyers.org, superlawyers.com, farrin.com/business-nc-power-list, and millondollaradvocates.com. National Trial Lawyers Top 100 designation is for 2025. Regarding the Million Dollar Advocates Forum, we do not represent that similar results will be achieved in your case. Each case is different and must be evaluated separately. Firm award is for the Law Offices of James Scott Farrin. Attorney awards are for attorneys with the Law Offices of James Scott Farrin.

Contact the Carolina
Whistleblower Attorneys

If you’re wondering if it’s a good idea to speak with a whistleblower lawyer about what you know, let us set the record straight.

  • Corporate ethics hotlines can be risky and may lead to termination. If you’ve already done this, call us immediately.
  • Your coworkers could be aware of the fraud – or complicit in it – and you should not talk to them about it.
  • The first claim to be filed under the False Claims Act can proceed – if you’re not first, you’re at a serious disadvantage and may get nothing (another reason not to speak to your coworkers about it).
  • A confidential discussion costs you a few minutes, but could save you time, stress, and money.

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