At The Criminal Defense Firm, we have been at the forefront of defending physicians, distributors, marketers, compound pharmacies, and pharmacy executives in Tricare fraud investigations. We also regularly work with our clients to develop Tricare compliance programs, in order to avoid these investigations altogether. We work with healthcare providers and pharmacies across the United States, and are proud to have become the go-to law firm for Tricare-related investigations.
The Risks of Tricare Referrals
The Office of the Inspector General (OIG), the Department of Defense (DOD), the Federal Bureau of Investigation (FBI), and other federal agencies are currently taking a closer look at compound pharmacies, toxicology groups, and other healthcare service providers whose businesses involve Tricare referrals. Specifically, these agencies are investigating whether referral relationships between physicians and pharmacies violate the federal anti-kickback statute, the False Claims Act, and various other federal laws. When the Department of Justice (DOJ) brings charges based, on the findings of these investigations, in addition to allegations of fraud, the referring physicians, marketers, and pharmacies often face criminal conspiracy charges for participating in “schemes” to unlawfully benefit from Tricare referrals.
Understanding Tricare Fraud
Tricare fraud can be charged as either a civil or criminal offense. In most cases that we have seen, the government alleges that several individuals conspired to defraud the U.S. government by billing for medically unnecessary compound lotions, and then unlawfully sharing the revenues with referring providers and business executives.
The penalties for Tricare fraud can be severe:
Civil Liability
In a civil case, the government can seek civil fines of up to $ 11,000 per false claim, plus recoupment requests, treble damages, fees, and exclusion from future participation in federal healthcare programs. These monetary penalties are typically imposed on companies, but in rare cases can extend to responsible individuals (including the company’s CEO, CFO, COO, and board members) as well.
It is important to note that liability does not require a specific intent to violate the law. In fact, the government does not even need to prove actual knowledge of the wrongfulness of the transaction in order to pursue a civil case.
Criminal Charges
In more extreme cases, the government may open a criminal investigation that leads to charging responsible individuals with healthcare fraud pursuant to 18 U.S.C. 1347. Under this statute, an individual who knowingly and willfully executes or attempts to execute a scheme to defraud a government program can be fined and imprisoned for up to 10 years.
Our Track Record (Excerpts)
Our healthcare fraud defense lawyers have extensive experience in Tricare fraud investigations. Our lawyers experience includes, but is not limited to:
- Defense of a healthcare provider against Tricare Fraud allegations by the Department of Defense and the Department of Justice
Result: No civil or criminal liability, case dismissed.
- Defense of a healthcare provider against Tricare Fraud allegations by the Office of Inspector General
Result: No civil or criminal liability, case dismissed./li>
- Defense of a healthcare provider against Tricare Fraud allegations by the U.S. Attorney’s Office and the Department of Defense
Result: No civil or criminal liability, case dismissed.
- Defense of a healthcare provider against Tricare Fraud allegations by the Department of Defense and the U.S. Attorney’s Office
Result: No civil or criminal liability, case dismissed.
- Defense of a healthcare provider against Tricare Fraud allegations by the Department of Defense and the U.S. Attorney’s Office
Result: No civil or criminal liability, case dismissed.
The attorneys of The Criminal Defense Firm are among the most-demanded healthcare fraud defense attorneys in the nation. Our attorney’s many years of experience as federal and state prosecutors involved in healthcare fraud cases, combined with our proven results in defending healthcare fraud allegations, have made The Criminal Defense Firm one of the preeminent law firms for healthcare providers and business executives.
Speak with a Tricare Fraud Defense Lawyer at The Criminal Defense Firm
If you believe that you may be under investigation for Tricare fraud, you should contact The Criminal Defense Firm immediately for a free and confidential case assessment. Call 866-603-4540 or contact us online to speak with one of our attorneys directly about your case.
Brian Kuester offers his extensive experience to counsel companies and individuals under civil or criminal government investigation. When resolution requires litigation, clients choose Mr. Kuester’s proven court and litigation experience.