Thirteen defendants plead guilty in Texas court to $126 million prescription scheme

Thirteen defendants, primarily individuals working in the health care industry, have pleaded guilty in federal court to a multi-state, $126 million scheme to defraud the federal government.

The defendants – including three pharmacy owners, three doctors, two pharmacists and three patient recruiters – pleaded guilty Wednesday in the U.S. District Court for the Southern District of Texas to defrauded the Labor Department's Office of Workers' Compensation Programs and TRICARE, the health-care program for U.S. service members and their families.

The scheme involved submitting fraudulent claims to the programs for drugs and other prescriptions that had been written for injured federal workers and members of the armed forces.

Patient recruiters and doctors were paid kickbacks for prescribing drugs that were selected by the pharmacy owners because of the amount of reimbursement they would receive per prescription – and not predicated in most cases on patient need. In many cases, the drugs were then mailed to patients despite no request, want or need on the patients' behalf for them, according to the Justice Department.

"The health care fraud and kickback scheme executed by these defendants manipulated federal health care programs for personal gain without regard for patient need or medical necessity," said Kenneth Polite Jr., an assistant attorney general under the agency's criminal division. 

Each of the defendants is scheduled to be charged in February 2022 and face maximum sentences of five to 20 years in prison.