A Mississippi pharmacist and a Louisiana marketer pleaded guilty in federal court for their roles in a multi-million-dollar scheme to defraud TRICARE and private insurance companies.
A release from the US Attorney’s office said the two were responsible for around $180 million in fraudulent billings, including more than $50 million paid by federal health care programs.
According to court documents, Mitchell “Chad” Barrett, 54, now of Gulf Breeze, Florida, participated in a scheme to defraud TRICARE and other health care benefit programs by distributing medically unnecessary compounded medications. Barrett is licensed as a pharmacist in Mississippi and was a co-owner of various compounding pharmacies. As part of this scheme, Barrett adjusted prescription formulas to ensure the highest reimbursement without regard to efficacy. He solicited recruiters to procure prescriptions for high margin compounded medications and paid those recruiters commissions based on the percentage of reimbursements paid by pharmacy benefit managers and health care benefit programs, including commissions on claims reimbursed by TRICARE. He further routinely and systematically waived and/or reduced copayments to be paid by beneficiaries and members, and utilized a purported copayment assistance program to falsely make it appear as if his pharmacy and its affiliate compounding pharmacies had been collecting copayments.
According to court documents, Thomas “Tommy” Wilburn Shoemaker, 57, of Rayville, Louisiana, participated in the scheme by acting as a marketer for Barrett’s pharmacies. Shoemaker allowed the pharmacies to use his TRICARE insurance to adjust prescription formulas to ensure the highest reimbursement without regard to efficacy, and he recruited doctors to procure prescriptions for high margin compounded medications. Shoemaker also obtained numerous fraudulent prescriptions using personal information of military acquaintances.
Barrett pleaded guilty to conspiracy to engage in monetary transactions in criminally derived property. He faces a maximum penalty of 10 years in prison.
Shoemaker pleaded guilty to conspiracy to defraud the United States and solicit, receive, offer, and pay illegal kickbacks, and faces a maximum penalty of five years in prison.
A federal district court judge will determine any sentence after considering the U.S. Sentencing Guidelines and other statutory factors. Shoemaker and Barrett must also pay restitution and forfeit all assets that can be traced to the criminal activity.