Don’t Even Try It

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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.

 

 

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Larry Benson
Larry Benson is currently the Director of Strategic Alliances for Revenue Discovery and Recovery at LexisNexis Risk Solutions. In this role, Benson is responsible for developing partnerships for the tax and revenue and child support enforcement verticals. He focuses on embedded companies that have a need for third-party analytics to enhance their current offerings.