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Defense Health Agency

"On October 1, 2013, the Department of Defense established the Defense Health Agency (DHA) to manage the activities of the Military Health System. These activities include those previously managed by TRICARE Management Activity (TMA), which was disestablished on the same date. During the next several months, all TMA websites will change to reflect the new DHA. We appreciate your patience during this transition."

TRICARE Management Activity Office of the General Counsel

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:

  1. 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.
  2. Litigation. Legal representation of TMA and TRICARE litigation interests.
  3. Contract Law. Legal support for the TRICARE Acquisition Process.
  4. 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.
  5. Ethics. Administer the DoD ethics program for TMA as the DoD Deputy Designated Ethics Official (DAEO).
  6. 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:

  1. 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.
  2. Hearing Process. Represents TMA/DoD in all hearings before an independent hearing officer.
  3. 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