Transitional outpatient payments (TOPS) – When the OPPS (outpatient prospective payment) was implemented, every provider was eligible to receive an additional payment adjustment (transitional corridor payment) if the payments it received for covered OPD services under the OPPS were less than the payments it would have received for the same services under the prior reasonable cost-based system. Transitional corridor payments are temporary payments for most providers to ease their transition from the prior reasonable cost-based payment system to the OPPS system. Cancer hospitals and children’s hospitals, however, receive the transitional corridor payments on a permanent basis. See Outpatient PPS False Claim in this Glossary.
TRICARE Fraud – formerly known as CHAMPUS, TRICARE is a program of the Department of Defense that helps pay for covered civilian health care obtained by military beneficiaries, including retirees, their dependents, and dependents of active-duty personnel. 10 U.S.C. §§ 1079, 1086; 32 C.F.R. Part 199. TRICARE contracts with fiscal intermediaries and managed care contractors to review and pay claims, including claims submitted for prescription drugs. Fraud patterns are the same as in medicare fraud and other healthcare fraud. The Defense Criminal Investigative Service (DCIS) investigates TRICARE fraud.