Our DHA OGC legal professionals include:
- Attorneys
- Paralegals
- Investigators
- Administrative personnel
We provide legal counsel in a wide range of matters including:
- Direct care and legal support to military medical and dental treatment facilities
- TRICARE and private sector care
- Labor and employment law
- Administrative Law and Congressional correspondence
- Medical research and development
- Operations and Combat Support Agency functions
- Litigation
- Information Law (e.g. FOIA, HIPAA)
- Ethics
- Government contracting
- Claims
- Business Integrity and Fraud
OGC Branches
DHA OGC branches report to the DHA General Counsel through a principal deputy general counsel, two deputy general counsels, and branch chiefs. These include:
- Administrative Law Branch
- Direct Care Legal Support Branch
- TRICARE Branch
- Litigation Branch
- Labor and Employment Law Branch
- Ethics Branch
- Medical Research and Development Branch
- Contract Law/Information Technology/Program Management Support Branch
- Contract Law/Military Medical Treatment Facility Support Branch
- Claims Branch
Affirmative Claims Division
The Claims Division administers the program across three main lines of effort:
Medical Services Account, Third Party Collections, and Medical Affirmative Claims. Together, these programs recover the cost of health care services provided through the Defense Health Program, making Claims a revenue-generating mission that helps strengthen and sustain military health care delivery.
Medical Services Account
Bills and collects for care provided at MTFs for eligible non-active-duty patient categories, using annually approved ASA/Outpatient rates and eligibility.
Third Party Collections
Recovers the cost of care for covered beneficiaries from other health insurance/third-party payers under 10 U.S.C. § 1095. Funds support care delivery at the treating MTF.
Medical Affirmative Claims
Recovers the cost of care when a third party causes injury/illness, pursuing applicable insurance under the Federal Medical Care Recovery Act and/or The Third-Party Payer Act.
Appeals, Hearings, and Claims Collections Division
The Appeals, Hearings, and Claims Collections Division is responsible for the following:
Subpoenas
The Office of General Counsel accepts subpoenas and requests for medical claim records. However, OGC is not able to accept subpoenas from state courts because these courts do not have jurisdiction over the federal government.
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.
Recoupment Process
The office represents the DHA/DOD in all hearings before an independent hearing officer. We also administer the recoupment process which involves numerous actions required to collect outstanding beneficiary and provider debts as mandated by the Federal Claims Collection Act.
