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News | March 30, 2023

Pharmacist Found Guilty of 22 Felonies Totaling $11 Million in Tricare Fraud

By DCAA Staff Writer

DCAA Supervisory Auditors Mark Saunders, Fei Lincoln, and Technical Specialist Elba Piligrino assisted in a case involving healthcare fraud. Sentencing for this case is scheduled for April 2023.

An Orange County, California pharmacist was found guilty of 22 criminal charges for a health care fraud scheme in which bogus prescriptions for medications were filled, costing Tricare more than $11 million. The pharmacist filled approximately 1,150 fraudulent prescriptions for pain, scarring and migraines for reimbursement by Tricare. Nearly all of these prescriptions were sent to the pharmacy by marketers or telemedicine businesses who solicited Tricare beneficiaries and received kickbacks of upwards of 50 percent of Tricare reimbursements. The pharmacist faces a statutory maximum of 10 years in Federal prison for each of the 21 health care fraud counts and 5 years for an audit obstruction count

DCAA’s auditors supported law enforcement partners by reviewing prescription records, Tricare disbursements, and other accounting records and developing damage models demonstrating the impact of the fraud.

Read the Department of Justice press release.