Don’t Even Try It

212
Cropped shot of a doctor talking to a senior patient in a clinic

Tricare covers the cost of compounded drugs, which are a combination of two or more drugs prepared by a pharmacist for a patient’s individual needs. (Of course, the compounded medication needs to be medically necessary to qualify for Tricare coverage.) Jonah Miller, 48, of Shoreline, Wash., got around that requirement and bilked the health insurance program for military members, their dependents, and retirees of approximately $19.4 million through a South Florida compounding pharmacy fraud scheme. (Now that, my friends, is a huge chunk of change.)

Miller had a little help with carrying out his healthcare fraud scheme. (Where there’s one fraudster, you can be sure there are many more nearby waiting to get their fair share of the take.) He recruited Tricare beneficiaries to order expensive and medically unnecessary compound drugs from a Broward, Fla., pharmacy.

Miller also paid doctors to approve pre-printed prescriptions for excessive amounts of the compounded medication even though the beneficiaries did not require them. (Apparently, the pharmacy prepared the medications with the idea of maximizing profit with very little therapeutic value. Does that surprise you?)

Because of Miller’s illegal actions, Tricare sustained a loss of $19.4 million. He received more than $4.9 million from the Florida-based pharmacy for the referrals. (There was definitely a bit of back scratching going on there.)

Miller pleaded guilty to one count of conspiring to commit healthcare fraud. He was sentenced to 97 months, or a bit more than eight years in prison. The Court ordered Miller to pay restitution of approximately $19.4 million and a forfeiture judgment of approximately $4.9 million was also imposed. (The combination of jail time and restitution ought to put this criminal in his place and serve as a reminder to other unscrupulous individuals to not try this kind of scam, ever.) 

Today’s Fraud of the Day comes from a Department of Justice press release, “Washington Man Sentenced to 97 Months’ Imprisonment for His Role in Health Care Fraud Scheme Against Tricare,” on September 22, 2021.

Miami, Florida – A Washington man was sentenced yesterday to over eight years in federal prison for defrauding Tricare of approximately $19.4 million through a South Florida compounding pharmacy fraud scheme. Tricare is the health care benefit program for the United States Department of Defense.

Jonah Miller, 48, of Shoreline, Washington, pleaded guilty on July 15, to one count of conspiring to commit health care fraud. Miller recruited Tricare beneficiaries to order expensive, medically unnecessary compound drugs from a Broward pharmacy. In furtherance of the scheme, Miller paid doctors to approve pre-printed prescriptions for excessive amounts of the expensive drugs without regard to the beneficiaries’ actual medical needs. Investigation revealed that the drugs were formulated to maximize profit without legitimate therapeutic value. Miller’s fraudulent referrals caused an actual loss to the Tricare program of approximately $19.4 million. In exchange for the referrals, Miller personally received over $4.9 million from the pharmacy. In addition to the prison sentence, the Court imposed restitution in the amount of approximately $19.4 million and a forfeiture judgment of approximately $4.9 million.

 

 

SHARE
Previous articleJust Put It on My Tab
Next articleToo Much Information

Larry Benson, Senior Director of Strategic Alliances, LexisNexis Risk Solutions - Government

Larry Benson is responsible for developing strategic partnerships and solutions for the government vertical. His expertise focuses on how government programs are defrauded by criminal groups, and the approaches necessary to prevent them from succeeding.

Mr. Benson has 30 years of experience in sales and business development. Before joining LexisNexis® Risk Solutions, he spent 12 years founding and managing two software technology startups. During the 1990s he spent 10 years as a Regional Director helping to grow a New England-based technology company from 300 employees to 7,000. He started his career with Martin Marietta Aerospace working on laser guided weapons and day/night vision systems.

A sought-after speaker and accomplished writer, Mr. Benson is the principal author of “Fraud of the Day,” a website dedicated to educating government officials about how criminals are defrauding government programs. He has co-authored WTF? Where’s the Fraud? How to Unmask and Stop Identity Fraud’s Drain on Our Government, and Data Personified, How Fraud is Changing the Meaning of Identity.

Benson holds a Bachelor of Science in Physics from Albright College, and earned two graduate degrees – a Master of Business Administration from Florida Institute of Technology, and a Master of Science in Engineering from Lehigh University.