Inspector General audit reveals TRICARE program left Va. beneficiaries paying more than necessary

RICHMOND, Va. (WRIC) -- An audit report reveals that the health insurance program for military service members and their families, TRICARE, put beneficiaries at risk due to a lack of internal controls.

According to an audit conducted by the Department of Justice, TRICARE put beneficiaries at risk of paying much higher costs, according to reports by the Inspector General after it reviewed financial records across both TRICARE's East and West regions, which include all 50 U.S. states.

The reviewed financial records were from November 2022 to February 2025 and found that nationwide, their policy did not require a regulated rate among states for the service equipment device "Intermittent Limb Compression Devices."

According to the report, the Defense Health Agency (DHA) allowed a rental rate for certain items, such as intermittent limb compression sleeves, to exceed the purchase rate (non-renal) for new compression devices in seven states, including Virginia.

The DHA allowed the state prevailing rates for rental intermittent limb compression sleeves devices to range from $150 in Mississippi to $12,000 in Connecticut. These rental rates exceed purchase amounts by 533% and $6,005 nationwide.

Limb compression sleeves

For limb compression sleeves, Virginia is charging a monthly rental rate of $4,680 and a purchase rate of $3,450 which is a 35.7% difference than the average.

The DHA also allowed for state prevailing rates for "miscellaneous prosthetic implants" with prosthetic items including arm and leg prosthetics and cochlear devices.

These prosthetic items ranged state to state, anywhere from $412 in New York to $3,300 in Georgia -- which is 101% higher than the national average rate of $1,645 and 701% higher than the lowest rate of $412.

Rental sleep apnea mouthguard

As for the rental sleep apnea mouthguard rentals costs, the lowest was $207 in South Dakota, and the highest was $5,000 in South Carolina. Virginia is the second highest at $595.

The TRICARE East Region contractor placed a rental value of $5,000 on the sleep apnea mouthguards in South Carolina. However, the contractor of the mouthguard only placed a purchase value of $2,500 in South Carolina--this is half the amount TRICARE is charging for rentals alone.

Implantable anchors and screws

Implantable anchors and screws -- bone-to-bone or soft tissue-to-bone implants -- are an additional benefit that is offered to beneficiaries under TRICARE. According to the audit, the DHA allowed for state prevailing rates for these items as well. These prices ranged from $795 in Maine to $6,096 in New Jersey.

New Jersey's rate is 217% higher than the national rate of $1,925, and 667% higher than the lowest rate of $795 in Maine.

In Virginia, the state prevailing rates for prosthetic implants remain at the average of $1,075.

In 2020, Virginia ranked third out of 50 states for having the highest military personnel in the nation.

With TRICARE's state-regulated pricing issue, this could make it increasingly more difficult for active duty members and veterans to access their benefits.

The DHA's state prevailing rates far exceed rates similarly developed by organizations such as FAIR Health, according to the audit. Fair Health is a non-profit organization based in New York.

The non-profit also analyzes the health care costs of 48 billion private health care claim records and 45 billion Medicare claim records for 10,000 services in all areas of the U.S., dating as far back as 2002.