pharmacist sentenced to nearly 6 years in prison for multi-million dollar compound drug scam that defrauded health care plans | USAO-CDCA

LOS ANGELES – An Orange County pharmacist has been sentenced to 70 months in federal prison for submitting more than $ 13 million in claims for prescriptions for medically unnecessary compound drugs, the Justice Department said today.

Thu Van Le, 42, aka “Tony Le”, of Placentia, was sentenced Monday by US District Judge R. Gary Klausner.

In addition to jail time, Judge Klausner ordered Le to pay $ 10,982,759 in restitution to Tricare, the U.S. military-run health care plan, and $ 768,488 in restitution to Amplan, the plan. health insurance for Amtrak employees.

Le, a pharmacist who owns TC Medical Pharmacy in Corona, pleaded guilty on July 12 to one count of healthcare fraud.

From March 2015 to December 2016, Le Pharmacy submitted over $ 13 million in claims to Tricare and AmPlan, against which Tricare paid $ 10,982,759 and AmPlan paid $ 768,488. Le, in turn, paid handsome bribes to so-called “marketers” of up to 50% of Tricare’s refunds.

Traders have used personal and insurance information to generate fraudulent prescriptions for compound drugs, court documents show. Traders who participated in the program solicited beneficiaries of the health plans through deceptive cold calls that promised free compound drugs. In some cases, beneficiaries were not contacted at all and simply received expensive drugs that they had not ordered.

Compound drugs are tailor-made products that doctors can prescribe when the Food and Drug Administration-approved alternative does not meet a patient’s health needs.

The has agreed to be bound by the Tricare and AmPlan rules for the reimbursement of claims for their beneficiaries. Tricare and AmPlan demanded that the drugs be medically necessary, that beneficiaries be examined by doctors and that Le’s pharmacy collect user fees. Prescriptions were meant to meet the unique needs of patients, but instead were formulated to maximize reimbursements and were prepared on an assembly line basis.

Defense Criminal Investigation Department, FBI, IRS Criminal Investigation, Amtrak Inspector General’s Office, Office of Personnel Management Inspector General’s Office, Department United States Labor – Employee Benefits Security Administration, Department of Health and Human Services, and California Department of Insurance investigated this matter.

Assistant U.S. Attorney Mark Aveis of the Major Fraud Section continued the case.

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