The TRICARE Management Activity (TMA) has created a separate but unequal medical benefit for military retirees and their families living in the Philippines. As we know the Supreme Court ruled in a landmark case, Brown v. Board of Education, that separate is inherently unequal. Military retirees living in the Philippines know, their "separate" TRICARE plan is also inherently unequal.
Beneficiaries living anywhere else in the world can use any local country provider and expect to be reimbursed for the cost of the care.
The Philippines is one of only two foreign countries where a Maximum Allowed Charge Table (CMAC) is used. Claims filed using local standard global bills are routinely partially denied because it is claimed they exceed the CMAC. Any veteran filing the same claim for the same amount or more anywhere else in the world has their claims paid in full as do active duty military and their dependents who live in the Philippines.
In 2005 TMA, the DODIG, DCIS and the U.S. Attorney General in Madison WI jointly developed a number of incremental changes that were designed to reduce fraud in the Philippines. Over the next three years TMA implemented the more draconian of these measures. Most of these changes greatly reduced access to care for veterans and greatly increased their cost share. However five years after they agreed to also implement a Preferred Provider Organization in the Philippines where military retirees would simply see providers or be admitted to hospitals and pay their copay, they failed to act and now refuse to discuss the PPO that they agreed to implement. Implementation of a PPO would eliminate all of the current access to care issues, eliminate the need for beneficiaries to file claims, go a long way in eliminating fraud and save the taxpayer millions of dollars a year.
Separate but equal was a legal doctrine in United States Constitutional law that justified systems of segregation. Under this doctrine, services, facilities and public accommodations were allowed to be separated by race; on the condition that the quality of each group's public facilities were (supposedly) to remain equal.
In this case, separate but equal represents what the TRICARE Management Activity (TMA) has done to military retirees and their families living in the Philippines. As we know the Supreme Court ruled that "separate but equal" was in fact not equal in a landmark case, Brown v. Board of Education by ruling that separate is inherently unequal.
As veterans (military retirees) living in the Philippines know their "separate" TRICARE plan is also inherently unequal. However TMA refuses to discuss these issues with affected veterans saying that the separate but equal policies are necessary to preclude fraud when in fact TMA is responsible for much of the fraud through their past actions, lack of action and policies, some of which are briefly outlined below.
Historically TMA has ignored reported fraud in the Philippines until forced to take action by the DODIG and Congress but then instituted draconian policies that not only failed to stop fraud but limited access to care for military retirees.
They instituted a secret process to certify providers. The sole stated purpose of this process is to insure that only legitimate providers are used. In practice the process causes hundreds of claims to be denied each year because of the "process" and not because the provider was not legitimate or committing fraud. Veterans lose thousands of dollars a year because of this process.
Because of the Philippine unique maximum allowed charge table (CMAC) that expects local global bills to be converted to U.S. billing practices with itemized charges, veterans have to know U.S. billing standards, medical terminology and medical coding to convert their local bills to meet these requirements. Because most veterans are not trained to do this they will lose additional thousands in denied claims that exceed the allowed charges that otherwise would be paid.
No other veteran in the world is subjected to these measures that create a separate and unequal medical benefit. Unlike anywhere else in the world not even Active Duty and their families in the Philippines are subjected to the limited plan, just military retirees and their families.
One measure TMA agreed to institute in the Philippines to reduce fraud and return access to normal levels was a Preferred Provider Organization (PPO), but after five years it is the one measure they failed to implement. This single measure would all but eliminated fraud, save five million dollars a year or more, eliminate the need for the other measures and create a benefit that is equal in practice to the one offered in the U.S. and around the world to every other veteran.
TRICARE beneficiaries in the Philippines represent the second largest overseas population and the largest in any country without a U.S. military base or TRICARE office. These veterans and their families should have the same benefit as everyone else enjoys.
We request that TMA and Congress correct these glaring deficiencies by implementing the promised and agreed to PPO in the shortest time possible to limit any additional hardship and suffering of these veterans and their families.