All throughout the United States of America, there is a great respect for our military. You’d be hard pressed to find an American who isn’t supportive and appreciative of the incomparable sacrifices made by the men and women who defend our country. Perhaps, this is why, of the many stories about health care fraud covered by the Allegiant Experts Blog, the story covered in today’s blog is especially disappointing.

As reported by City News Service by way of the San Diego Union Tribune this week, a San Diego-based nurse practitioner has pleaded guilty in federal court to her charges stemming from a kickback scheme involving San Diego County Marines. This past Tuesday, 52 year-old Candace Michelle Craven entered her guilty plea, admitting that she conducted bogus “telemedicine” evaluations that resulted in expensive prescriptions paid for by TRICARE.

What is TRICARE?

TRICARE is a health care program of the United States Department of Defense Military Health System. Formerly known as CHAMPUS (Civilian Health and Medical Program of the Uniformed Services), it provides civilian health benefits for U.S. Armed Forces military personnel, military retirees and their dependents.

Craven is one of seven different defendants who were all charged in a scheme that bilked TRICARE out of more than $65 million. Along with her team, Craven would recruit and pay Marines, mostly from the San Diego area, to obtain specialty medications that would be paid for TRICARE.

How was the scheme conducted?

At the time the scheme was being pulled off, Craven worked for Choice MD, which is a Tennessee-based medical clinic. Her role was to speak with TRICARE beneficiaries by phone and recommend that they were prescribed specific medications even though she never examined them in person.

The prescriptions were then signed by Choice MD doctors and sent directly to pharmacies that were controlled by Craven’s co-conspirators. They would then fill the orders and bill TRICARE at highly inflated prices. In total, Craven and her team of fraudsters signed 4,442 prescriptions and billed TRICARE over $65.6 million for them.

Who else was charged in this scheme?

Josh Morgan of San Diego was a member of the team. The former Marine pleaded guilty in April for his role in the scheme. It was his job to recruit TRICARE beneficiaries to fraudulently obtain drugs. Doctors Carl Lindblad and Suzy Vergot also pleaded guilty for their participation in the fraud plot.

Choice MD owners, Ashley and Jimmy Collins, were indicted in March for their alleged participation in the health care fraud scheme. Their case is currently pending. Craven now faces a maximum punishment of ten years in prison and several fines. Her sentencing is scheduled for February 8, 2019.

How was the team caught?

The charging of this San Diego team of fraudsters was part of the national takedown that took place this past June. The charging over 600 people across the United States was the result of a nationwide health care fraud investigation that uncovered over $2 million in fraudulent billings.

“The investigation focused on schemes to bill Medicare, Medicaid and other public and private insurance providers for treatments that were medically unnecessary and often were not provided to the patient at all,” explains the City News Service report.

Are you a lawyer currently trying a health care fraud case?

Please don’t hesitate to contact Allegiant Experts to find out how our clinical expertise may help you. Call us at 407-217-5831 or email us at info@allegiantexperts.com.