A Mississippi-based nurse practitioner and physician have been charged in separate, but similar schemes to defraud Tricare.
Nurse practitioner Susan Perry, 58, faces 13 charges, including one count of conspiracy to commit healthcare fraud and wire fraud, one count of distributing a controlled substance and four counts of soliciting and receiving healthcare kickbacks, according to her indictment (PDF).
The Department of Justice alleges that Perry defrauded Tricare by prescribing medically unnecessary medications, including ketamines, which are a controlled substance. The prescriptions were made to patients that Perry had not actually treated, according to DOJ.
All told, Tricare reimbursed the pharmacy for more than $3.3 million in the fradulent prescriptions made by Perry, according to DOJ. Perry also received $50,000 in kickbacks from the pharmacy, federal authorities said.
Albert Diaz, M.D., 78, was hit with a 16-count indictment (PDF) for a similar scheme, according to DOJ. Diaz's charges include four counts of wire fraud, four counts of distributing a controlled substance and five counts of falsifying records in a federal investigation.
Diaz defrauded Tricare for more than $2.3 million in fraudulent prescriptions, according to DOJ. He also allegedly submitted falsified patient records to a Tricare audit to make it seem as though he was prescribing the medications to patients he had examined.
Medicaid fraud news
In another case of fraud, Cesar Tavera, 53, the head of a nonprofit mental health provider, was sentenced to 70 months in prison for his role in defrauding Medicaid and embezzling more than $1.5 million, DOJ announced.
He was also ordered to pay $2.5 million in restitution.
Tavera was the executive director of Nueva Vida Behavioral Health Center of New Jersey, a nonprofit provider that worked with Camden's Hispanic community. Tavera employed several unlicensed therapists to treat Medicaid recipients, and then billed Medicaid as if qualified therapists had worked with those patients, according to DOJ.
Tavera also billed Medicaid for therapies that never occurred and regularly embezzled from Nueva Vida's accounts, according to DOJ. He plead guilty to the charges in May.