Former pharmacy manager pleads guilty to $88 million health care fraud conspiracy targeting military health care programs – CBS Tampa

MIAMI, Fla. (CW44 News At 10) – A Palm Beach County, Florida man has pleaded guilty to his role in a multi-million dollar conspiracy to defraud Tricare and CHAMPVA through a fraud scheme compound pharmaceutical from South Florida.

As part of his guilty plea, Matthew Smith, 58, admitted his role in fraudulently billing Tricare and CHAMPVA for expensive and medically unnecessary compound drugs from a Broward pharmacy. Tricare and CHAMPVA are the health care programs of the United States Department of Defense and Department of Veterans Affairs. As part of the scheme, Smith – then executive vice president of pharmacy – and his co-conspirators paid around $40 million in bribes to patients, patient recruiters and doctors in exchange for their order. pain creams, scar creams and expensive vitamins without regard. to the actual medical needs of the beneficiaries. Drugs have been formulated to maximize profit without legitimate therapeutic value. Reimbursement rates sometimes reached $15,000 for a month’s supply. Additionally, the pharmacy failed to charge beneficiaries for mandatory co-payments, which the co-conspirators hid. The fraudulent billings caused a loss to the programs of approximately $88 million.

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Smith pleaded guilty to one count of conspiracy to commit health care fraud. Sentencing is scheduled for April 5 at 3:00 p.m. in Miami before U.S. District Judge Roy K. Altman. Smith faces up to 10 years in federal prison.

US Attorney Juan Antonio Gonzalez of the Southern District of Florida; Special Agent in Charge Cynthia A. Bruce, Department of Defense Inspector General’s Defense Criminal Investigative Service (DCIS), Southeast Field Office; Special Agent in Charge David Spilker, Veterans Affairs, Office of the Inspector General (VA-OIG), Southeast Field Office; Special Agent in Charge George L. Piro of the FBI Miami; and Special Agent in Charge Justin C. Fielder of the Miami Field Office of the FDA’s Office of Criminal Investigations made the announcement.

“Fraudsters steal exorbitant amounts of money from our government health programs through prescription drug fraud schemes,” said U.S. Attorney Gonzalez. “Those who use kickbacks and fraudulent billing activity to defraud vital public programs will be held accountable.”

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“The escalation of pharmaceutical fraud has defrauded the Defense Health Agency of more than a billion dollars and exploited not only the military, but all citizens,” said DCIS Special Agent in Charge Bruce. “I thank the U.S. Attorney’s Office and our team of investigators for their tireless efforts to unravel this network of crimes, trace the assets, and hold these individuals accountable.”

“The defendant has pleaded guilty to his heinous conduct in the fraud of several federal health care programs intended to benefit deserving veterans and their families,” said Special Agent in Charge David Spilker of the Southern Field Office. -is the Inspector General of the Department of Veterans Affairs. “The VA OIG is committed to continuing to work with our law enforcement partners to ensure the integrity of VA health care and benefits programs.”

“Illegal kickbacks have undermined the integrity of the Tricare health benefits program by placing profits ahead of patient well-being,” said George L. Piro, FBI Miami Special Agent in Charge. “The investigators who unraveled this scam are to be commended for their diligence and commitment. The FBI and our partners will continue to pursue those who pay bribes and fraudulently charge for unnecessary medical services.

“Criminals whose schemes result in medically unnecessary prescription drugs being sent to consumers could put public health at risk,” said Special Agent in Charge Justin C. Fielder, of the Miami Field Office of the Bureau of Criminal Investigations. the FDA. “We will continue to prosecute and bring to justice those who put profits above public health.”

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The DCIS, VA-OIG, FBI and FDA investigated the matter.

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