Leave Gramma Out Of It

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Cropped shot of a medical professional filling out paperwork

Who funds Tricare, a much-needed health insurance program provided to active duty and retired military personnel and their family members? We do. Tricare is federal program provided by Medicare, therefore funded by the US taxpayer. And pharmacist Sandy Mai Trang Nguyen stole $11 million from it.

Compounded drugs are tailor-made products doctors may prescribe when the Food and Drug Administration-approved alternative does not meet the health needs of a patient. Nguyen was the pharmacist-in-charge of Irvine Wellness Pharmacy when she developed her scheme to fulfill fraudulent orders for compound drug prescriptions. Starting in late 2014, Nguyen and others under her supervision filled about 1,150 compounded fraudulent prescriptions for pain, scarring and migraines, reimbursed by Tricare. That is a high yielding fraud with each prescription cost averaging about $9,500 each.

According to prosecutors, Nguyen blatantly disregarded Medicare rules for prescriptions including accepting prescriptions that were written by doctors who didn’t live in the same state as the supposed beneficiaries. The bulk of the prescriptions were directed to the pharmacy by so-called marketers (a fraudster’s BFF) who received kickbacks of nearly 50% of the Tricare reimbursements.

Nguyen also solicited patients who did not need medication to provide their Tricare insurance information for her scheme. Nguyen must have assumed no one was going to look at the prescription details. In multiple cases, members of the same families, received the same medications, even within her own family. For instance, a 13-year-old boy in Chicago received the same prescription as an 86-year-old woman in Orange County who turned out to be Nguyen’s grandmother. Frauding Gramma goes too far!

Someone did start to question Nguyen. When she learned she was facing a federal audit, Nguyen cut-and-pasted prescriptions to cover-up her fraud, to no avail. Nguyen was found guilty on November 22, 2022.

Sentencing for Nguyen is April 3, 2023.  Great job by the California Department of Insurance with this investigation.

Today’s Fraud of the Day is based on an article “OC pharmacist convicted in $11M fraud scheme” published by CBS City News on November 23, 2022

A licensed Orange County pharmacist faces sentencing in April for her role in a health care fraud scheme that authorities said bilked the U.S. military’s health care plan out of more than $11 million, prosecutors announced today.

Sandy Mai Trang Nguyen, 42, of Irvine, was convicted Tuesday in Los Angeles of 21 counts of health care fraud, and one count of obstruction of a federal audit, according to the Department of Justice. Prosecutors said the scheme involved the filling of more than 1,000 bogus prescriptions for compounded medications at the expense of the Tricare health care plan.

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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.