Tricare takes big hits from stateside fraudsters

Federal prosecutors in Los Angeles have unveiled what amounts to a $161 million looting of the Medicare and Tricare health insurance systems.

Tricare is the primary health insurance for many U.S. expats, who are military retirees or dependents.

The Tricare managed care program was the primary victim of schemes involving  pharmacies, said the U.S. Attorney’s Office in Los Angeles, California. “Over the course of just a few years, Tricare paid hundreds of millions of dollars for medications dispensed to patients across the nation, typically creams that supposedly would treat minor pain, scars, erectile dysfunction or general wellness,” said the prosecutorial office.

Five cases announced Wednesday relate to pharmacies and allege losses of more than $100 million, most of which was paid by Tricare over the course of just a few months, the announcement said.

The cases filed in federal court in Los Angeles and Santa Ana are part of a nationwide sweep announced in Washington by Attorney General Loretta Lynch, who said criminal and civil charges have been filed against 301 individuals who participated in health care fraud schemes involving approximately $900 million in false billings.

The California cases were filed by lawyers with the Justice Department’s Medicare Fraud Strike Force.

In one case, John Garbino, a marketer who resides in Dana Point, California, was charged with receiving illegal kickbacks after referring prescriptions to pharmacies that filled the prescriptions and billed Tricare, said the U.S. Attorney summary, which added:

One Palmdale, California, pharmacy received more than $46 million from Tricare in only six months. Another pharmacy in Corona, California, received nearly $6 million over the same six-months. Garbino allegedly received illegal kickbacks of as much as 65 percent for referring prescriptions to the pharmacies.

In another scheme, the Florida-based operator of a telemedicine Web site was charged with health care fraud for allegedly misusing the identity and medical credentials of a physician to submit prescriptions to a pharmacy, said the U.S. Attorney’s Office. The criminal complaint in this case alleges that two local pharmacies received more than $6.5 million in payments from Tricare in 2015, it added.

In Washington, the U.S. Attorney General’s Office said that criminal and civil charges have been filed against 301 individuals, including 61 doctors, nurses and other licensed medical professionals, for their alleged participation in health care fraud schemes. The Washington announcement did not reference Tricare. In California there were 22 arrests.

Military retirees here have had a love-hate relationship with Tricare. The most problems that have been disclosed to A.M. Costa Rica over the years involve reimbursements for medical procedures done at Costa Rica hospitals. Some hospitals have required payments from U.S. veterans because payment from Tricare were long in coming. Veterans usually prefer that hospitals and physicians bill Tricare directly.

Tricare insurance is considered by many veterans here as a benefit earned by years of military service.

Medicare, another U.S. federal medical program, does not cover older Americans overseas. But the attorney general’s announcement outlined medical frauds in many states. Defendants participated in schemes to submit claims to Medicare and Medicaid, another federal program, for treatments that were medically unnecessary and often never provided. In addition, individuals were recruited to lend their names to the various frauds.

Since January 2009, the Justice Department’s Civil Division, along with U.S. Attorney’s Offices around the country, recovered more than $18.3 billion in cases involving fraud against federal health care programs, said the Attorney General’s Office.

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