Articles Posted in Tricare fraud

IMG_0355-300x201Michael Burton, of Decatur, Georgia, was sentenced to 96 months in federal prison for his participation in a scheme that defrauded TRICARE and other insurers a combined $6.5 million. According to the Department of Justice, Burton plead guilty to charges of conspiracy to commit health care fraud, conspiracy to commit money laundering, and money laundering.

From 2014 to 2015, Burton and his team of conspirators defrauded TRICARE and other private insurance companies through the submission of fraudulent claims for prescriptions including scar creams, pain creams, and wellness capsules. Sales representatives were recruited to obtain personal and insurance coverage information from individuals in exchange for commission payments. Co-defendant, Brad Hodgson, would then use the information to prescribe the compounded drugs without a necessary medical purpose. These individuals were not the patients of Hodgson, and he was not licensed to write prescriptions.

Once the prescriptions were forged, fraudulent claims for the reimbursement of these drugs were submitted to TRICARE and other insurers. These claims totaled $6.5 million, with Burton’s participation in the scheme profiting him a total of $1.4 million in the form of commission payments.