Posted on 07/10/2020 5:39:11 PM PDT by ransomnote
A Mississippi businessman pleaded guilty Thursday for his role in a multi-million dollar scheme to defraud TRICARE, the health care benefit program serving U.S. military, veterans, and their respective family members, as well as private health care benefit programs, by paying kickbacks to practitioners and distributors for the prescribing and referring of fraudulent prescriptions for not medically necessary compounded medications that were ultimately dispensed by his pharmacies, as well as for his role in a scheme to launder the proceeds of the fraud scheme.
Acting Assistant Attorney General Brian C. Rabbitt of the Justice Department’s Criminal Division, U.S. Attorney Mike Hurst of the Southern District of Mississippi, Special Agent in Charge Michelle Sutphin of the FBI’s Jackson Field Office, Acting Special Agent in Charge Andrew M. Thornton of IRS Criminal Investigation’s (IRS-CI) New Orleans Field Office, Special Agent in Charge Cynthia Bruce of the Defense Criminal Investigative Service’s (DCIS) Southeast Field Office, and Interim Director Steven Maxwell of the Mississippi Bureau of Narcotics (MBN), made the announcement.
Wade Ashley Walters, 53, of Hattiesburg, Mississippi, a co-owner of numerous compounding pharmacies and pharmaceutical distributors, pleaded guilty to one count of conspiracy to commit health care fraud and conspiracy to commit money laundering before U.S. District Judge Keith Starrett of the Southern District of Mississippi. Defendant was remanded into custody following the plea hearing. Sentencing has been scheduled for Oct. 28, 2020, before Judge Starrett.
As part of his guilty plea, Walters admitted that, between 2012 and 2016, he orchestrated a scheme to defraud TRICARE and other health care benefit programs by distributing compounded medications that were not medically necessary. As part of the scheme, Walters among other things, adjusted prescription formulas to ensure the highest reimbursement without regard to efficacy; solicited recruiters to procure prescriptions for high-margin compounded medications and paid those recruiters commissions based on the percentage of the reimbursements paid by pharmacy benefit managers and health care benefit programs, including commissions on claims reimbursed by TRICARE; solicited (and at times paying kickbacks to) practitioners to authorize prescriptions for high-margin compounded medications; routinely and systematically waived and/or reduced copayments to be paid by beneficiaries and members, including utilizing a purported copayment assistance program to falsely make it appears as if the pharmacies were collecting copayments. Walters and his numerous co-conspirators effectuated a scheme to defraud health care benefit programs, including the TRICARE program, in the amount of $287,659,569, with losses to a government health care program exceeding $20,000,000. Walters obtained over $40,000,000 in proceeds derived directly or indirectly from the fraud.
Walters also admitted that he and others laundered the proceeds by engaging in monetary transactions in amounts of over $10,000 in proceeds from the fraud scheme, including transactions relating to his participation in a sham intellectual property scheme.
The FBI, IRS-CI, DCIS, FBI, and MBN investigated the case with assistance from the U.S. Postal Service Office of Inspector General (OIG), Office of Personnel Management OIG and the Mississippi Attorney General's Office. Trial Attorneys Dustin M. Davis, Sara E. Porter, and Katherine E. Payerle of the Criminal Division’s Fraud Section, Trial Attorney Stephanie Williamson of the Criminal Division’s Money Laundering and Asset Recovery Section, and Assistant United States Attorney Kathlyn R. Van Buskirk of the Southern District of Mississippi are prosecuting the case.
The year 2020 marks the 150th anniversary of the Department of Justice. Learn more about the history of our agency at www.Justice.gov/Celebrating150Years.
Not tricare!
Say what you will about China, but they do know something about how to deal with healthcare fraud.
2007: Zheng Xiaoyu, former Director of the State Food and Drug Administration
http://freerepublic.com/focus/f-bloggers/3863627/posts
Of course, they do commit their fair share of medical fraud and worse that their leaders get away with.
A crazy neighbor came to my door at 6:00 a.m. to tell me I’d be killed if I didn’t move. Gave me a $1500 bottle of Provigil, told me to take it to a particular compounding pharmacy at exactly noon and ask for Sam. I happened to know where the DEA office is in our town to report fraud. That particular drug was not on DEA dangerous list, so they couldn’t take it. Police came and took it.
What is it with compounding pharmacies?
I’ve used a compounding pharmacy for nearly 20 years...they are very reputable
Anytime payment is guaranteed for a service you can bet there are fraudulent operators. For meds...certain Ointments or novel suspensions are falsely prescribed by docs or p.a.s in on the deal. Rx makes very expensive stuff...dispenses it...gets paid...and splits some the profits with the collaborators. I have heard in some cases, people get fraud prescriptions for bronchodilator inhalants...rx gets paid...buys the inhaler back from patient...at a lower price than reimbursement...then sells it to drug users to open up their bronchioles so they get a faster and deeper rush from their inhaled drugs. So rx gets paid twice...and spends a bit. Big profit. Total corruption. Taxpayers pay. Fraudsters should get a prison sentence that ends on their 78th birthday.
I am lovin’ all these federal busts you’re reporting on.
I pay hard cash for my compounded meds and I doubt the biz is involved in stuff you described...too much risk of reputation.
But, I can see how smaller compounders might play games
I get a compounded cream for HRT and for years I have had to pay out of pocket for it because Tricare will not cover items from a compounding pharmacy. They would cover three separate medications at a much higher cost that did not work so well but not the cream.
So something is being left out here.
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