The Breastfeeding Shop and Its Owner Agree to Pay $1 Million to Resolve Allegations of False Claims for Reimbursement for Breast Pumps and Related Equipment for TRICARE Beneficiaries

PHILADELPHIA – United States Attorney David Metcalf announced that the United States has entered a settlement agreement with Scottie Girl, LLC, d/b/a The Breastfeeding Shop, in Emmaus, Pennsylvania, and its owner Patricia Gatter to resolve allegations that The Breastfeeding Shop submitted false claims for reimbursement for breast pumps and related equipment for TRICARE beneficiaries. The Breastfeeding Shop and Ms. Gatter will collectively pay the United States $1 million to resolve the allegations.

TRICARE, managed by the Defense Health Agency, is the health care program for U.S. military service members, retirees and their families worldwide. In 2015, the TRICARE program rolled out a new benefit of breast pumps and related equipment for nursing mothers.

The United States alleged that during the early years of the new benefit, The Breastfeeding Shop billed the TRICARE program hundreds of dollars more per breast pump than it charged to the Pennsylvania Medicaid Program, thereby utilizing a prohibited dual fee schedule. The United States also alleged that The Breastfeeding Shop engaged in prohibited “unbundling,” meaning The Breastfeeding Shop would take breast pump accessories that are pre-packaged and included in the standard breast pump kit and then bill TRICARE separately for each item as a replacement part.

“Durable medical equipment suppliers play a vital role in providing safe and effective medical products to patients in need, and especially to our brave service members and their families,” said U.S. Attorney Metcalf. “As alleged, The Breastfeeding Shop and Gatter prioritized their own financial interests through a billing scheme that was to the detriment of the government. This conduct will not be tolerated by my office.”

“Today’s settlement is a direct result of the relationship we have with our partners at the Department of Defense Office of Inspector General’s Audit component and the Department of Justice,” stated Christopher M. Silvestro, Acting Special Agent in Charge of the Defense Criminal Investigative Service Northeast Field Office, the law enforcement arm of the Department of Defense’s (DoD) Office of Inspector General. He further stated, “Fraud involving TRICARE, the healthcare system for military members and their families, is something we take seriously and will investigate fully.”

“Protecting the integrity of the TRICARE program and ensuring responsible stewardship of taxpayer dollars are top priorities for the Defense Health Agency. This settlement sends a clear message that we will not tolerate practices that exploit the program and inflate costs at the expense of our service members, veterans, and their families. Access to essential medical equipment, like breast pumps, is vital for the health and well-being of new mothers and infants within our TRICARE community. We thank the U.S. Attorney’s Office and the Defense Criminal Investigative Service for their continuing dedication to the pursuit of justice,” stated Dr. Glen Diehl, Acting Deputy Director of the Defense Health Agency.

Assistant United States Attorney Judith Amorosa and former Auditor Dawn Wiggins handled the case for the Eastern District of Pennsylvania. The matter was investigated by the Defense Criminal Investigative Services of the U.S. Department of Defense.

The claims resolved by the settlement are allegations only; there has been no determination of liability.