Medicaid Recipients Agree to Pay $130,000 to Resolve False Claims Act Allegations of Health Care Benefit Fraud
Gulfport – A Monroe, Louisiana man pleaded guilty today to engaging in a multi-million dollar conspiracy to pay illegal health care kickbacks and conspiracy to defraud the United States, announced Acting U.S. Attorney Darren J. LaMarca, Acting Special Agent in Charge Paul Brown with the Federal Bureau of Investigation in Mississippi, and Special Agent in Charge Cynthia A. Bruce of the DoD OIG, Defense Criminal Investigative Service (DCIS) Southeast Field Office.
According to court documents, Thomas “Tommy” Wilburn Shoemaker, 57, admitted that he participated in a scheme to defraud TRICARE and other health care benefit programs by acting as a marketer for World Health Industries, Inc. (“WHI”), a pharmacy specializing in the production of compounded medications. Shoemaker acknowledged that he allowed WHI to use his TRICARE insurance to adjust prescription formulas to ensure the highest reimbursement without regard to efficacy, and he recruited doctors to procure prescriptions for high margin compounded medications. Furthermore, as a marketer, Shoemaker admitted to obtaining numerous fraudulent prescriptions using personal information of military acquaintances. Through his company, he received over $300,000 in commissions for the prescriptions that were reimbursed by TRICARE, and in total, he received at least $672,538.19 in proceeds that were derived directly from the fraud scheme.
Shoemaker is scheduled to be sentenced on November 30, 2021, and faces a maximum penalty of 5 years in prison. A federal district judge will determine any sentence after considering the U.S. Sentencing Guidelines and other statutory factors.
The Federal Bureau of Investigation and the Defense Criminal Investigative Service are investigating the case.
Trial Attorneys Emily Cohen and Alejandra Arias of the DOJ Criminal Division’s Money Laundering and Asset Recovery Section and Assistant U.S. Attorney Kathlyn Van Buskirk of the Southern District of Mississippi are prosecuting the case with assistance from Sara Porter and Dustin Davis from the DOJ Criminal Division’s Fraud Section.