Insurance Fraud Scheme of Epic Proportion

TRICARE is the health care program that covers United States military service members. The insurance fraud, the equivalent of a high stakes “bank robbery,” swindled the U.S. Government program out of more than $65 million. The scheme involved prescribing thousands of extraordinarily expensive compound medications to military patients. Interestingly, none of the patients were neither seen, nor examined.

“Compounded medications are specialty medications mixed by a pharmacist to meet the specific medical needs of an individual patient. Although compounded drugs are not approved by the Food and Drug Administration (FDA), they are properly prescribed when a physician determines that an FDA-approved medication does not meet the health needs of a particular patient, such as if a patient requires a particular dosage or application or is allergic to a dye or other ingredient”

Insurance Fraud Ecosystem

The fraud scheme involved a team of individuals that focused on recruiting and exploiting U.S. Marines (and their dependents), mainly from the San Diego, CA area. All of the individuals recruited were TRICARE beneficiaries. The team’s goal was to convince the beneficiaries that they required compounded medications. After doing so, the information was forwarded to Choice MD, a medical clinic in Tennessee, where Drs. Lindblad and Vergot practiced medicine. Despite never examining the patients in person, Drs. Lindblad and Vergot proceeded to write bogus prescriptions for the TRICARE beneficiaries.