Back to Top Skip to main content

25 arrested for fraud related to TRICARE and compound drugs

Official TRICARE logo Official TRICARE Logo

Recommended Content:

Program Integrity

Twenty-five people were arrested in June, accused of committing fraud against TRICARE, the health plan for 9.4 million military service members, retirees, their families and survivors. The arrests were associated with $47 million in fraudulent compound drug claims paid by TRICARE in recent years. 

The arrests were part of a major health care fraud prosecution announced in June by the U.S. Department of Justice (DOJ), U.S. Department of Health and Human Services, the Defense Criminal Investigative Service and other agencies. 

TRICARE officials have praised DOJ, DCIS and other agencies for their relentless pursuit of those accused of perpetrating fraud. 

“Such widespread and blatant fraud threatens the integrity of the TRICARE benefit,” said Mr. John Marchlowska, chief of the DHA Program Integrity Division. “Our beneficiaries have a right to know that the medications we cover are safe and effective, and that we are spending money wisely. This announcement shows that our enforcement actions are effective. To date, TRICARE has recovered approximately $235 million related to compound drugs, and we will continue pursuing cases like this.” 

The arrests relating to fraud against TRICARE included four doctors, one physician’s assistant, four pharmacists and sixteen people involved in selling or marketing compound products to TRICARE beneficiaries. The complaints allege various types of wrongdoing, including kickback schemes, the writing of prescriptions without a doctor/patient relationship, and misuse of patients’ personal health data. 

The investigations stem from dozens of complaints filed by TRICARE beneficiaries who noticed suspicious charges from compound pharmacists. The DHA Pharmacy Operation Division and the DHA Program Integrity Office also reported suspicious cases to DCIS for further investigation.

TRICARE experienced a massive surge in the claims for unnecessary and costly compound drugs in 2014 and the first half of 2015. In 2004, TRICARE spent a total of $5 million for compound drugs. In 2014, that number increased to $514 million, and spiked to over $1 billion in just the first four months of 2015. Compound drugs accounted for only 0.5% of the volume of drugs provided by TRICARE, but made up more than 20% of the cost. Many compound products were of dubious or no clinical value, and some may have been dangerous. 

In May 2015, the Defense Health Agency (DHA) took action to implement an ingredient screen to make sure that all TRICARE covered compound drugs are safe, clinically necessary and cost effective. Since then, TRICARE’s monthly cost for compound drugs has stabilized under $10 million, close to the level in 2008. The DHA has realized more than $1 billion in cost avoidance since implementing the screening. 

If you think you are the victim of TRICARE related fraud, you can report it to the Defense Health Agency. You can also report cases where you think someone is trying to defraud TRICARE. For example, if your TRICARE explanation of benefits shows a bill for something you didn’t get, tell your TRICARE Regional Contractor.

You also may be interested in...

2016 Annual Fraud and Abuse Report

Report
4/28/2017

2016 Annual Fraud and Abuse Report capturing all the activities of the Program Integrity Office to thwart fraud, waste and abuse.

Recommended Content:

Program Integrity | Reporting Fraud or Abuse

Ten defendants charged in $100 Million TRICARE fraud scheme

Article
10/17/2016
Official TRICARE logo

Special agents with the Federal Bureau of Investigation and the Defense Criminal Investigative Service arrested nine defendants this week in connection with their roles in a $100 million health care fraud conspiracy perpetrated against TRICARE

Recommended Content:

TRICARE Health Program | TRICARE Pharmacy Program | Program Integrity

2015 Annual Fraud and Abuse Report

Report
4/20/2016

2015 Annual Fraud and Abuse Report capturing all the activities of the Program Integrity Office to thwart fraud, waste and abuse.

Recommended Content:

Program Integrity | Reporting Fraud or Abuse

TRICARE Beneficiaries Being Targeted by Call Centers and Others For Unsolicited Medical Prescriptions

Publication
4/10/2015

The Defense Health Agency, Office of Program Integrity (DHA-PI) has received a significant number of concerns from our TRICARE beneficiaries regarding unsolicited attempts by “Call Centers” to encourage them to provide personal identifying information and health information so that they can allegedly provide prescribed cream medications to the TRICARE ...

Recommended Content:

Program Integrity | Fraud Alerts

Anthem Blue Cross Blue Shield Data Breach

Publication
2/11/2015

Anthem Blue Cross Blue Shield states they were the target of a very sophisticated external cyber-attack. Anthem advises that once the attack was discovered, they immediately made every effort to close the security vulnerability.

Recommended Content:

Program Integrity | Fraud Alerts

Anti-Fraud Program and Audit Standardization Template

Publication
1/12/2015

Military treatment facilities must standardize their implementation of an Anti-Fraud Program to ensure uniformity across the Military Health System (MHS). This template provides guidance for implementing an MTF anti-fraud program.

Recommended Content:

Program Integrity

2014 Annual Fraud and Abuse Report

Report
12/31/2014

2014 Annual Fraud and Abuse Report capturing all the activities of the Program Integrity Office to thwart fraud, waste and abuse.

Recommended Content:

Program Integrity | Reporting Fraud or Abuse

DoDI 5505.12: Anti-Fraud Program at Military Treatment Facilities (MTFs)

Policy

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 #: DoD Instruction Number 5505.12
  • Date: 10/3/2013
  • Type: Instructions
  • Topics: Program Integrity

TRICARE Lottery Sweepstakes Scam

Publication
6/8/2012

TRICARE Program Integrity has become aware of a Lottery Sweepstakes Scam in which fraudulent checks bearing the TRICARE name are being utilized.

Recommended Content:

Fraud Alerts | Program Integrity

Unofficial TRICARE Websites

Publication
3/3/2010

Provides information related to privately hosted web sites that "appear" official, but ARE NOT operated by TRICARE or its contractors

Recommended Content:

Program Integrity | Fraud Alerts

Arrest of Earl B. Bradley

Publication
1/14/2010

Press release issued by the Attorney General for the State of Delaware concerning the arrest of Earl B. Bradley, M.D.

Recommended Content:

Program Integrity | Fraud Alerts

Express Scripts Reports New Threats Tied to Data Security Breach

Publication
11/11/2008

ESI, TRICARE's pharmacy contractor, reports Extortion Threat to Expose Personal Information of Members

Recommended Content:

Program Integrity | Fraud Alerts

TRICARE Patients Treated at Endoscopy Center of Southern Nevada

Publication
3/7/2008

The Southern Nevada Health District announced it is notifying approximately 40,000 patients of a local medical clinic about potential exposure to hepatitis C following an investigation of several acute cases of the illness.

Recommended Content:

Program Integrity | Fraud Alerts

Robert Stokes and Quality of Care

Publication
12/12/2007

Kent County, Michigan Health Department news release related to the Robert Stokes indictment and quality of care concerns

Recommended Content:

Program Integrity | Fraud Alerts

TRICARE's Program Integrity Office Battles Fraud

Publication
10/29/2007

Article from the TMA Public Affairs Offfice containing important information for beneficiaries about reporting fraud

Recommended Content:

Program Integrity | Fraud Alerts
<< < 1 2 3 4 5  ... > >> 
Showing results 1 - 15 Page 1 of 10

DHA Address: 7700 Arlington Boulevard | Suite 5101 | Falls Church, VA | 22042-5101

Some documents are presented in Portable Document Format (PDF). A PDF reader is required for viewing: Download a PDF Reader or learn more about PDFs.