The government charges individuals involved in fraudulently billing for unneeded health care products and services.
Thomas “Tommy” Wilburn Shoemaker, 57, of Rayville, Louisiana, was sentenced this month to 30 months behind bars for his involvement in a government health care scheme to defraud TRICARE as well as private insurers by “paying kickbacks to distributors for the referral of medically unnecessary prescriptions,” according to the Department of Justice (DOJ). TRICARE is a health care program specifically tailored to the Department of Defense Military Health System and also provides civilian health care benefits for armed forces family members, military retirees, and their dependents. Shoemaker’s scheme led to more than $180 million in fraudulent charges to the insurance companies, the government contended.
Shoemaker “acted as a marketer for pharmacies within the network alongside co-conspirators Mitchell ‘Chad’ Barrett and David Jason Rutland,” engaging in the government health care scheme. The DOJ believes that over the course of five years, they were able to gain at least $182.5 million in funds billed to the Medicare and TRICARE programs, as well as other providers.
Shoemaker himself is involved with the military and has TRICARE insurance, so he was able to work with pharmacies 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,” according to the DOJ’s release. He also collected unnecessary prescriptions for others using the contact information of military personnel.
Shoemaker initially entered a guilty plea in August of this year to the DOJ’s filed charges of “conspiracy to defraud the United States and solicit, receive, offer, and pay illegal kickbacks.” He will not only serve the prison time that was ordered in sentencing but will “pay restitution and forfeit all assets traced to his ill-gotten gains,” according to the DOJ.
Meanwhile, Thomas Farese of Delray Beach, Florida, and Domenic J. Gatto Jr. of Palm Beach Gardens, Florida, were also charged late last month by the DOJ for their alleged roles in a $25 million dollar scheme to defraud Medicare, TRICARE, and the Civilian Health and Medical Program of the Department of Veteran’s Affairs CHAMPVA, which provides health care benefits program for VA dependents. The spouse or child of a veteran who is permanently disabled qualifies for CHAMPVA, as does the surviving spouse or child of a veteran who died from a disability and the surviving spouse or child of a veteran who was at the time of death rated disability from service.
The two men, along with other co-conspirators, received kickbacks s in exchange for physician’s prescriptions for of orthotic braces that were ordered without showing medical necessity. Farese and the others had financial incentives in the companies from whom they ordered and they specifically “brokered a kickback relationship whereby [they] received an illegal kickback each time the suppliers distributed the medical equipment,” the government said. Gatto and the others “laundered the proceeds…through several layers of bank accounts under their control.”
The government has indicated time and again that it will crackdown on anyone who tried to defraud its programs and unveil all instances in which kickbacks are received. It will prosecute anyone who it finds to be responsible for orchestrating fraudulent activities.