Turbulent Skies Ahead

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Calculator and stethoscope on paperwork

Tricare is a healthcare insurance program offered to members of the U.S. military, their families, and retirees across all seven branches of the armed forces. It’s egregious that a former Air Force officer was recently sentenced for her role in defrauding Tricare out of billions of dollars. She was involved in a nationwide conspiracy to take advantage of the extensive reimbursements Tricare offers for prescriptions. (I’m guessing turbulent skies are ahead for this Air Force officer.)

Maj. Romeatrius Moss gave pre-printed prescription pads to service members at the medical clinic on base while stationed at Vance Air Force Base in Oklahoma. She encouraged them to ask their doctors about compounded prescription, which are personalized prescriptions crafted for patients who don’t react well to the ingredients in the standard form of a medication. (Personally, I wouldn’t react well to discovering that I did NOT need medicine from a nurse that is actually a fraudster.)

Moss knew that in most cases, compounded medications were medically unnecessary, but she was part of the larger scheme to defraud Tricare by billing for the most expensive forms of the medications. She sent patients with the pre-printed prescriptions to civilian pharmacies to have them filled. (Moss was paid a part of the Tricare reimbursement the pharmacies received for every referral she made to them.)

This healthcare fraud scheme was part of a larger nationwide effort orchestrated by pharmaceutical marketing group CMGRX, which began marketing compounded medications to Tricare knowing their healthcare programs would reimburse for these more expensive prescriptions. (No wonder pharmaceutical companies get the reputation for being dishonest or predatory.)

Tricare reimburses healthcare providers anywhere from $400 to $10,000 per compounded prescription. ($10,000? Wow, that is shocking!) This includes coverage for compounded pain and scar creams, ointments, and erectile dysfunction drugs. CMGRX recruited more than 2,300 service members, or family members of service members, from across the country to order their compounded pain and scar creams.

Military personnel involved in the healthcare fraud scheme would receive a kickback from CMGRX in the form of $250 per prescription. The marketing group fraudulently labelled this as a payment for participating in a medical study or a charitable donation from their fictitious charity “Freedom from Pain Foundation.” (The only donations they were interested in making were to their own bank accounts.)

More than $124 million in pharmacy claims were fraudulently filed with Tricare due to this scheme. Moss was one of the highest-ranking service members involved in the conspiracy. (It’s important to know that she earned her nursing doctorate from the University of Alabama-Birmingham and later founded the foundation Black Nurses Rock to support African American nurses. Too bad her expertise was not used to help her fellow servicemembers.)

More than 100 people have been convicted for their roles in this healthcare fraud scheme and the Justice Department has recovered roughly $300 million. (This was a well-orchestrated scheme involving military personnel across multiple states and ranks.)  Moss pleaded guilty to accepting kickbacks as part of a plea agreement. She was sentenced to two years in prison and three years of supervised release.

Moss was ordered to pay $622,459 in restitution. She must also give up her $750,000 house in Enid, Oklahoma, a 2016 Porsche Cayenne, and a 2000 Fleetwood Pace Arrow recreational vehicle. (Was losing her career, home, and reputation worth the money she was promised? I think not.)  

Tricare fraud and suspected fraud should be reported to the Defense Health Agency through their web complaint form.

Today’s Fraud of the Day comes from an article, “Former Air Force Major Sentenced to Two Years in Prison for Tricare Fraud,” published in Military.com on August 11, 2020.

A former Air Force officer has been sentenced to two years behind bars for her role in a nationwide scheme to defraud the military’s health program, Tricare, of billions of dollars.

Maj. Romeatrius Moss, 40, pleaded guilty Oct. 15, 2019, to accepting kickbacks for referring patients at Vance Air Force Base, Oklahoma, to civilian pharmacies that specialized in compounded medications; she faced up to five years in prison.

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Larry Benson
Larry Benson is currently the Director of Strategic Alliances for Revenue Discovery and Recovery at LexisNexis Risk Solutions. In this role, Benson is responsible for developing partnerships for the tax and revenue and child support enforcement verticals. He focuses on embedded companies that have a need for third-party analytics to enhance their current offerings.