Austin Man Admits Role in $4.8 Million TRICARE Fraud Conspiracy
DALLAS, Texas — Jody Sheffield, 44, of Austin, Texas, pleaded guilty today, before U.S. District Judge Sidney A. Fitzwater, to one count of conspiracy to commit health care fraud stemming from a scheme to defraud TRICARE through the submission of unnecessary toxicology and DNA cancer screening tests. The announcement was made today by Criminal Chief Chad Meacham of the Northern District of Texas.
Sheffield faces a maximum penalty of not more than five years in federal prison, a $250,000 fine, and may be ordered to pay restitution. Sheffield will remain on bond pending sentencing, which is scheduled for May 18, 2017.
According to the plea agreement factual resume filed in the case, , Sheffield was the operations manager for ADAR Group, LLC (ADAR Group), an outpatient toxicology testing facility. Erik Bugen owned and operated ADAR Group. Britt Hawrylak and Matthew Hawrylak were marketers for Xpress Laboratories, Inc. (Xpress Laboratories) and Progen Lab Systems, LLC (Progen Labs), and financiers of ADAR Group.
Starting in May 2015 and continuing through May 2016, ADAR Group collected urine and saliva samples from TRICARE, a healthcare program of the United States Department of Defense (DoD) Military Health System that provided coverage for DoD beneficiaries world-wide, including active duty service members, National Guard and Reserve members, retirees, their dependents, and survivors. The samples were sent to Xpress Laboratories and Progen Labs and billed to TRICARE and private insurance for unnecessary toxicology and DNA cancer screening tests.
Sheffield and Bugen induced TRICARE beneficiaries to provide urine and saliva samples with $50.00 Wal-Mart gift cards. Sheffield and his codefendants disguised the kickback payments as a food assistance program for low income soldiers. They also paid monthly fees to doctors to sign test forms. Ultimately, Bugen obtained signature stamps from the doctors and Sheffield and other ADAR Group employees stamped the testing order forms. Beneficiaries did not see these doctors prior to obtaining the testing, did not receive test results, and did not know the purpose of their samples.
As a result of the scheme, TRICARE was billed approximately $36 million for tests that were not needed, not legitimately prescribed, and which were the product of kickbacks. For these claims, TRICARE paid approximately $4.8 million.
The Defense Criminal Investigative Service, Veteran’s Affairs- Office of Inspector General, and Federal Bureau of Investigation, are investigating. Assistant U.S. Attorney Adrienne Frazior is prosecuting.
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