The General Counsel operates under the direction, authority, and control of the
Department of Defense (DoD) Legal Services Agency (DLSA) and is assigned to the
Executive Director, TRICARE Management Activity (TMA), to provide all legal services
to be performed within and involving TMA and its mission to manage TRICARE, administer
and manage the Defense Health Program (DHP) appropriations, support the Uniformed
Services in the management and administration of the TRICARE Program, and administer
the Civilian Health and Medical Program of the Uniformed Services (CHAMPUS). The
General Counsel is also responsible for managing the TRICARE Appeals and Hearings
system and has been designated as the debt collection official responsible for managing
all aspects of the TRICARE debt collection program.
The Office of General Counsel consists of two divisions; the General Law Division
with offices in Aurora, Colorado and Falls Church, Virginia; and the Appeals, Hearings
and Claims Collection Division with an office in Aurora, Colorado. In general, the
following functions are performed:
General Law:
The General Law Division is responsible for the following areas:
- Administrative Law.
Provides legal advice and counsel to the Executive Director and staff on questions
of law and administrative policy involved in the operation of TMA and the performance
of its mission.
- Litigation.
Legal representation of TMA and TRICARE litigation interests.
- Contract Law.
Legal support for the TRICARE Acquisition Process.
- Representation.
Represents TMA/DoD in all legal matters and administrative proceedings involving
TRICARE. Maintains a direct liaison with the General Counsel of the Department of
Defense and counsel for other Federal, State, and local agencies.
- Ethics.
Administer the DoD ethics program for TMA as the DoD Deputy Designated Ethics Official
(DAEO).
- Fraud. Reviews cases of suspected fraud, makes appropriate referrals for
investigation, monitors case investigation and prosecution, and initiates final
case disposition.
Appeals, Hearings and Claims Collection:
The Appeals, Hearings and Claims Collection Division is responsible for the following
areas:
- Formal Review Process.
Reviews and determines legal sufficiency of adverse contractor decisions on beneficiary
claims. Issues decisions based on medical review, application of law and regulation,
or other agency review.
- Hearing Process.
Represents TMA/DoD in all hearings before an independent hearing officer.
- Recoupment Process: Administer the recoupment process which involves numerous
actions required to collect outstanding beneficiary and provider debts as mandated
by the Federal Claims Collection Act (FCCA) and the Federal Medical Care Recovery
Act.
Organization Chart
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