Yet another scammer thought he would get away with his crimes. In a recent case, a thief was convicted for his part in a large compounded prescription drug ring, with kickbacks and bribes that included money, dinners and hunting trips.
The Anti-Kickback Statute (AKS) bans offering bribes for medical care or drugs that aren’t medically necessary for patients. This applies to prescriptions that will be paid by TRICARE and Medicare (or any government program), and it was the physicians of those patients who were targeted and encouraged to use a certain pharmacy.
Theft had apparently been going on for many years, likely beginning in 2012. Over the years, the thieves submitted over $54 million in false claims. Of that, TRICARE had paid out over $42 million in claims for those drugs. The compounded drugs in question had been rigged to be the most expensive possible to get back the most money in payment from TRICARE, and included drugs and pain/scar creams. The scammers would use “test billing” on fake claims to learn which claims would be paid the best.
TRICARE is the benefit program that provides coverage for retirees, spouses and families, active duty and others. In this case, the thieves submitted fake claims in over 30 states and a few foreign countries (which is likely why the scammer turned over his passport).
The original indictment was dated 2020 and included a whole alphabet of government agencies, including the FBI, Health and Human Services, Department of Defense, Department of Justice and the VA Office of Inspector General.
Meanwhile, several others were charged in the crimes, which included soliciting or receiving health care kickbacks and offering to pay kickbacks. Additionally, they used “blanket letters of authorization” as permission to modify the prescriptions of the drugs to get the most profit.
A big thumbs-up to the Health Care Fraud Strike Force Program that spearheaded the investigation. Since 2007, they’ve gone after thousands of thieves that have billed more than $24 billion in fake claims.
(c) 2023 King Features Synd., Inc.
