Medicaid Recipients Agree to Pay $130,000 to Resolve False Claims Act Allegations of Health Care Benefit Fraud
Hattiesburg, Miss – Howard Randall Thomley, 60, of Hattiesburg, pled guilty yesterday before U.S. District Judge Keith Starrett to a Criminal Information charging him with health care fraud for his role in a $200 million scheme to defraud health care benefit programs, including TRICARE, announced U.S. Attorney Mike Hurst, Special Agent in Charge Christopher Freeze with the Federal Bureau of Investigation, Special Agent in Charge Thomas J. Holloman III of IRS Criminal Investigation’s Atlanta Field Office and Special Agent in Charge John F. Khin of the Defense Criminal Investigative Service’s Southeast Field Office.
Thomley will be sentenced by Judge Starrett on July 2, 2019 and faces a maximum penalty of 10 years in federal prison.
During his guilty plea, Thomley admitted that, from approximately August 2012 through January 2016, he conspired with others to carry out a scheme to defraud TRICARE, which is a federally funded health care benefit program that serves United States military personnel and their families.
Thomley owned and operated a company called Advantage Marketing Professionals, which marketed medications for Advantage Pharmacy, a compounding pharmacy in Hattiesburg. For each prescription submitted by Thomley, Advantage Marketing Professionals and Thomley would receive a percentage of the revenue that Advantage Pharmacy obtained from TRICARE.
Thomley and others associated with Advantage Marketing Professionals recruited beneficiaries of TRICARE and paid them a percentage of the revenue from each prescription – including refills – that they and their families accepted, in order to induce the beneficiaries to accept millions of dollars of expensive compounded medications that were not medically necessary. In order to obtain prescriptions, Thomley and his co-conspirators filled out pre-printed prescription forms with the beneficiaries’ names, and obtained prescriber signatures, knowing that the medical professional prescribing the medication had not examined the recruited beneficiaries. Sometimes, the prescribers had previously signed blank prescription forms, which were later filled in by Thomley or his co-conspirators.
Advantage Pharmacy, upon receiving prescriptions, filled the prescriptions, dispensed compounded medications, and submitted claims to TRICARE, received reimbursement, and disbursed a portion of those payments to Thomley.
TRICARE paid approximately $3.6 million in reimbursements for medications sent to the beneficiaries recruited by Thomley and his co-conspirators.
"This nefarious and complex health care fraud scheme was one of the largest in Mississippi's history, and possibly one of the largest in our nation's history," said Special Agent in Charge Freeze. "Billions of taxpayer dollars are lost to heath care fraud each year, and conspiracies against Tricare strip benefits directly from our military's brave men and women and their families. This guilty plea brings this case one step closer to justice and shows the unwavering commitment, of all of the partnering agencies, to uncover, investigate and prosecute dishonest and unethical physicians, health care providers and any others associated with America's health care system. The collective resources of law enforcement at all levels will continue to expose these types of corruption and will actively seek justice for those who participate in these schemes."
This case was investigated by the Federal Bureau of Investigation, Internal Revenue Service - Criminal Investigation, and the Defense Criminal Investigative Service, among other agencies. It is being prosecuted by DOJ Trial Attorneys Kate Payerle and Jared Hasten of the Criminal Division’s Fraud Section, Assistant U.S. Attorneys Mary Helen Wall of the Southern District of Mississippi and Sean Welsh of the Western District of Virginia, formerly of the Criminal Division’s Money Laundering and Asset Recovery Section (MLARS), with the support and assistance of Trial Attorney Amanda Wick of MLARS.
The Fraud Section leads the Medicare Fraud Strike Force, which is part of a joint initiative between the Department of Justice and HHS to focus their efforts to prevent and deter fraud and enforce current anti-fraud laws around the country. Since its inception in March 2007, the Medicare Fraud Strike Force, which maintains 14 strike forces operating in 23 districts, has charged nearly 4,000 defendants who have collectively billed the Medicare program for more than 14 billion.