Agencies Expose $200 Million Health Fraud Involving Tricare

By Massimo Vernicesole / Shutterstock.com

In another victory for the 12-year-old multi-agency Medicare Fraud Strike Force, a Mississippi woman pleaded guilty for her part in a $200 million criminal scheme to defraud major federal health care programs, including the military’s Tricare.

Hope Thomley, 52, appearing on Wednesday in District Court for the Southern District of Mississippi, accepted guilt on one count of conspiracy to commit health care fraud and one count of conspiracy to commit money laundering and tax evasion, according to a release from the Justice Department.

The plea avoids a trial on a 26-count indictment from May 2018 that was set to go to trial next month. Thomley is one of 10 accused in the case.

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“Hope Thomley and her co-conspirators stole millions of dollars from a federal health care program that serves our nation’s brave military personnel and their families,” said Assistant Attorney General Brian Benczkowski, who worked with agents from the FBI and criminal investigators from the Defense Department and the Internal Revenue Service  “The Department of Justice and our law enforcement partners will continue to target unscrupulous medical professionals, business owners, and pharmacies that steal from our nation’s vital health care programs.”

Thomley’s “efforts to conceal the source of her ill-gotten gains and evade taxes were the precise reason why IRS-CI’s involvement was so essential to unraveling the criminal conspiracies involved in this case,” added IRS-CI Special Agent in Charge Thomas Holloman III. “IRS special agents are uniquely equipped to decipher this type of criminal activity, and levy the appropriate charges to address the criminal conduct.”

Defense Criminal Investigative Service Special Agent in Charge John Khin said, “The egregious corruption uncovered in this complex and expansive fraud scheme wasted and diverted millions of dollars in limited taxpayer funds that should have been spent on critical medical care for our military members and their families.”

Thomley admitted her role in the scheme to market medications known as compounded medications, which ordinarily are medications that are specially combined or formulated to meet the individual needs of patients, Justice said.  She owned and operated the exclusive marketing agency for Advantage Pharmacy of Hattiesburg, Miss., which obtained prescriptions and applied for reimbursement from health care benefit programs. Her company, Justice said, received nearly half of the reimbursements that Advantage Pharmacy obtained from the compounded medications. 

“In order to further increase her profit, Thomley admittedly obtained prescribers’ signatures on blank prescription forms, and then filled out those forms with the names of her children and TRICARE beneficiaries that she and her husband recruited from the community to receive these medications,” Justice said. In all, she avoided paying some $6.6 million in income taxes, she admitted.

The government seized more than $15 million in cash and other assets from Thomley, money that will be forfeited. She is scheduled to be sentenced by Judge Keith Starrett on July 2.

Since its inception in March 2007, the Medicare Fraud Strike Force, which maintains 14 strike forces operating in 23 districts, has charged nearly 4,000 defendants who have collectively billed Medicare for more than $14 billion, Justice said.

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