Tennessee Doctors Plead Guilty in $65 Million TRICARE Fraud

[nitpicker]

https://www.justice.gov/usao-sdca/pr/tennessee-doctors-plead-guilty-65-million-tricare-fraud

Department of Justice
U.S. Attorney’s Office
Southern District of California

FOR IMMEDIATE RELEASE
Wednesday, April 11, 2018

Tennessee Doctors Plead Guilty in $65 Million TRICARE Fraud

Assistant U. S. Attorneys Benjamin J. Katz and Mark W. Pletcher [phone] and [phone]

NEWS RELEASE SUMMARY – April 11, 2018

SAN DIEGO – Two doctors, Carl Lindblad and Susan Vergot, pleaded guilty in federal court today, admitting that they participated in a health care fraud scheme that bilked TRICARE – the health care program that covers United States service members – out of more than $65 million by prescribing thousands of exorbitantly expensive compounded medications to patients that they never saw or examined. Drs. Lindblad and Vergot entered their guilty pleas before U.S. Magistrate Judge Mitchell D. Dembin. Both pleaded guilty to conspiracy to commit health care fraud. Their sentencings are scheduled for June 29, 2018 before U.S. District Court Judge Janis L. Sammartino.

Compounded medications are specialty medications mixed by a pharmacist to meet the specific medical needs of an individual patient. Although compounded drugs are not approved by the Food and Drug Administration (FDA), they are properly prescribed when a physician determines that an FDA-approved medication does not meet the health needs of a particular patient, such as if a patient requires a particular dosage or application or is allergic to a dye or other ingredient.

According to the guilty pleas, a team of individuals worked to recruit and pay Marines, primarily from the San Diego area, and their dependents – all TRICARE beneficiaries – to obtain compounded medications that would be paid for by TRICARE. This information was sent to Choice MD, the Tennessee medical clinic that employed Drs. Lindblad and Vergot. Drs. Lindblad and Vergot then wrote prescriptions for the TRICARE beneficiaries, despite never examining the patients in person. Once signed by the doctors, these prescriptions were not given to the beneficiaries, but sent directly to particular pharmacies controlled by co-conspirators, which filled the prescriptions and billed TRICARE at exorbitant prices.
(snip)

Between December 2014 and May 9, 2015 – the day that TRICARE stopped reimbursing for compounded medications – Drs. Lindblad and Vergot authorized 4,442 total prescriptions. Over this time, their co-conspirators billed TRICARE $65,679,512 for these prescriptions.
(snip)

[Sherman A1]

1. I hope they gets to spend the rest of their lives

Repaying ever dine plus interest.