Defense Health Care: Oversight of the TRICARE Civilian Provider Network Should Be Improved
GENERAL ACCOUNTING OFFICE WASHINGTON DC WASHINGTON DC United States
Testifying before Congress in 2002,military beneficiary groups described problems accessing care from TRICAREs civilian medical providers. Providers also testified on their dissatisfaction with the TRICARE program, specifying low reimbursement rates and administrative burdens. The Bob Stump National Defense Authorization Act of 2003 required GAO to review the oversight of the TRICARE network of civilian providers. Specifically, GAO describes how the Department of Defense DOD oversees the adequacy of the civilian provider network, evaluates DODs oversight of the civilian provider network, and describes the factors that have been reported to contribute to network inadequacy. GAO analyzed TRICARE Primethe managed care component of TRICARE. To describe and evaluate DODs oversight, GAO reviewed and analyzed information from reports on network adequacy and interviewed DOD and contractor officials in 5 of 11 TRICARE regions. GAO recommends that DOD improve its oversight of the civilian provider network by ensuring sufficient information is reported and by exploring options for evaluating beneficiary complaints and improving provider survey data. DOD concurred with the recommendations.