Fort Belvoir, Va. –
Operations Investigative Support Division (OIS) auditors recent supported the Defense Criminal Investigative Service (DCIS) Tulsa Resident Office and the Assistant U.S. Attorney on a TRICARE fraud case. Jimmie Mathews, Nathan Mathews and Amber Delger were sentenced for their roles in a conspiracy to commit health care fraud against TRICARE, the health care program that covers health benefits for members of the U.S. Armed Forces military personnel, retirees and their dependents. Jimmie and Nathan owned Stars & Stripes Therapy (Stars & Stripes) in 2020 and in 2016, Jimmie and Delger owned Emerald Therapy Services (Emerald Lane). Both companies were massage therapy providers and claimed to treat TRICARE beneficiaries, receiving payments from the Defense Health Agency for those services.
In 2018, the three defendants conspired together to submit false and fraudulent claims to TRICARE for services they did not complete. Documents alleged the defendants scheduled numerous appointments for TRICARE beneficiaries. If the beneficiary couldn’t make the appointment or stopped attending the appointments all together, the defendants would continue billing TRICARE as if the beneficiaries received care. Emerald Lane additionally billed TRICARE using the National Provider Identity number of numerous occupational therapists long after they stopped working for the business. In total, Emerald Lane and Stars & Stripes billed more than $7 million to TRICARE and received nearly $3 million in reimbursement.
Throughout the investigation, OIS auditors supported the investigation using claim data and evaluated outliers found in the data. The team provided an overview in in-person meetings and compared office closures and doctor availability dates to claimed service provided dates and analyzed bank statements.
Read the press release for more information.