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Ten defendants charged in $100 Million TRICARE fraud scheme

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TRICARE Health Program, TRICARE Pharmacy Program, Program Integrity, Program Integrity

DALLAS — Special agents with the Federal Bureau of Investigation and the Defense Criminal Investigative Service (DCIS) arrested nine defendants this week in connection with their roles in a $100 million health care fraud conspiracy perpetrated against TRICARE, the health insurance program for members of the military and their families. A tenth defendant surrendered to the FBI. The defendants, including doctors, pharmacy owners, and marketers were charged in a 35-count superseding indictment returned last week in Dallas and unsealed this afternoon, announced U.S. Attorney John Parker of the Northern District of Texas.

"Exhaustive investigative work by FBI and DCIS special agents and investigators not only led to today’s arrests, but to the identification and seizure of millions in assets that these defendants derived from their participation in this massive scheme that caused the TRICARE health insurance program -- designed for our military personnel, veterans and their families -- to suffer more than $100 million in actual losses," said Parker.

"Today’s arrests helped to alleviate the burden on the American taxpayers from an organized group determined to commit fraud within the healthcare industry, principally, the TRICARE system," said Acting Special Agent in Charge Michael A. Costanzi of FBI Dallas. "This joint effort by the Dallas FBI and DCIS is one of many successful law enforcement partnerships forged to dismantle healthcare fraud groups."

"The indictments and arrests in this investigation highlight another step forward by DCIS and its law enforcement partners to protect the integrity of the Department of Defense (DoD) health care program known as TRICARE," said Special Agent in Charge Janice M. Flores, of the DCIS Southwest Field Office. "Fraud and abuse by pharmacies and medical providers that bill for compounded prescriptions and/or medications is a significant threat to the DoD health care system. With DoD’s limited resources and budgets, DCIS must continue to aggressively investigate fraud, waste and abuse to preserve and recover precious taxpayer dollars for our most vulnerable programs."

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Memorandum to Establish 2017 TRICARE Reserve Select and TRICARE Retired Reserve Rates

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Calendar Year 2017 premium rates are established for TRICARE Reserve Select and TRICARE Retired Reserve as specified in the attachment. Please provide widest dissemination. This information can be found at www.tricare.mil/trs and www.tricare.mil/trr.

DHA IPM 16-001 - MHS Drug Take Back (DTB)

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Describes procedures for MHS organizations to offer beneficiaries the option of returning their controlled and non-controlled prescriptions and over-the-counter medications for disposal through a DTB program.

Memorandum to Establish 2016 Rates for TRICARE Young Adult Premiums

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TRICARE Young Adult (TYA) premium rates are established annually on a calendar year (CY) basis in accordance with Title 10, United States Code, Section 1110b and Title 32, Code of Federal Regulations, Part 199.26.

ASD HA Memorandum 14-022 Policy Memorandum to Establish 2015 Premium Rates for the TRICARE Young Adult Program

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TRICARE Young Adult (TYA) premium rates are established annually on a calendar year (CY) basis in accordance with Title 10, United States Code, Section 111Ob and Title 32, Code of Federal Regulations, Part 199.26. TYA monthly premiums for CY 2015 shall be the rates listed in this document.

Establishing TRICARE Reserve Select and TRICARE Retired Reserve Rates for 2015 Calendar Year

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ASD (HA) Memorandum 14-015 - Establishing TRICARE Reserve Select and TRICARE Retired Reserve Rates for 2015 Calendar Year. This memorandum establishes the Calendar Year 2015 premium rates for TRICARE Reserve Select and TRICARE Retired Reserve as specified in the attachment. This information can be found at www.TRICARE.mil/trs and www.TRICARE.mil/trr.

Military Health System Prescription Transfer Procedures

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Effective immediately, all Department of Defense (DoD) military treatment facility (MTF) outpatient phannacics will accept patient requests for prescription transfers from another MTF and from retail phannacies. When another phannacy requests prescription transfer infonnation on behalf ofa patient, DoD MTF outpatient phannacies will respond to the inquirer in a timely maru1er.

Procedures on Responsibility of Dispensing Prescriptions at MTF Pharmacies 14-004

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This memorandum clarifies procedures relating to Health Affairs Policy 04-032, "TRICARE Pharmacy Benefit Program Formulary Management," dated December 22, 2004, which remains in effect. Specifically, this memorandum is addressed to all military treatment facility (MTF) providers and pharmacies. It revalidates the requirement for MTFs to provide medications prescribed by MTF providers and restates procedures for obtaining 3rd tier (Nonformulary) and compounded medications for patients treated at MTFs.

DoD Instruction 5505.12

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This Instruction implements policy, assigns responsibilities, and prescribes procedures under References (a) and (b) for preventing, detecting, reporting, and evaluating suspected fraud by contracted civilian healthcare providers at all DoD MTFs. This Anti-Fraud Program is part of the DoD management control program prescribed by References (c), (d), and DoD Instruction 5010.40 (Reference (e)).

  • Identification #: 5505.12
  • Date: 10/3/2013
  • Type: Instructions
  • Topics: Program Integrity

Guidelines for Suspension and Reinstatement of TRICARE Reserve Select Coverage 12-009

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This memorandum clarifies the procedures under title 32 of the Code of Federal Regulations, section 199.24(d)(3) for suspending TRICARE Reserve Select (TRS) coverage for up to 12 months and, upon request from a TRS member/survivor request, lifting the suspension, which will reinstate coverage with no break.

Notification of 2013 Monthly Premium Rates for TRICARE Reserve Select and TRICARE Retired Reserve 12-008

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Calendar Year 2013 premium rates are established for TRICARE Reserve Select and TRICARE Retired Reserve as specified in the memorandum.

Policy Memorandum to Establish 2013 Premium Rates for the TRICARE Young Adult Program 3116-12

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Calendar Year 2013 premium rates established for the TRICARE Young Adult program as specified in the memorandum.

Enrollment of Active Duty Service Members in Terminal Leave Status

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This memorandum describes the enrollment policy for Active Duty Service members (ADSMs) in terminal leave status. It restates our policy and provides further guidance on how ADSMs can access health care services while on terminal leave.

Clear and Legible Report Process 02-2011

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The purpose of this Policy Memorandum is to document unifonn business rules for managing the Clear and Legible Report (CLR) process and incorporate these business rules as standard operating procedures at all Referral Management Centers (RMC).

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