In a shocking revelation, a Tennessee couple, Jimmy and Ashley Collins, have pleaded guilty to orchestrating a fraudulent healthcare scheme that defrauded TRICARE, a healthcare program for United States service members, out of a staggering $65 million. The couple worked with a network of individuals to recruit TRICARE beneficiaries who would sign up to receive unnecessary and expensive compounded medications. The scheme involved doctors and medical professionals at a Tennessee medical clinic owned by the Collinses, who wrote prescriptions without conducting proper medical evaluations. These prescriptions were then sent to a pharmacy in Utah, which received massive reimbursements from TRICARE. The Collinses profited from kickbacks paid by the pharmacy, amounting to millions of dollars. The couple is the final piece of the puzzle to plead guilty, joining other individuals involved in the conspiracy. This case serves as a reminder of the critical need to hold fraudsters accountable and protect taxpayer-funded healthcare programs intended to support members of our armed forces.
Summary of the Case
The fraud scheme
In this case, the defendants, Jimmy and Ashley Collins, pleaded guilty to participating in a health care fraud scheme that defrauded TRICARE, a health care program for United States service members, out of more than $65 million. The scheme involved recruiting TRICARE beneficiaries to receive expensive compounded medications that they did not actually need.
The role of the Collinses
The Collinses worked with others to recruit TRICARE beneficiaries who were willing to sign up for unnecessary medications. They owned and operated Choice MD, a medical clinic in Tennessee, where doctors and medical professionals employed by the Collinses wrote prescriptions for these beneficiaries without conducting proper medical reviews or examinations.
Involvement of medical professionals and pharmacy
Doctors and medical professionals at Choice MD, including Dr. Susan Vergot, Dr. Carl Lindblad, and nurse practitioner Candace Craven, wrote prescriptions for TRICARE beneficiaries without conducting in-person medical reviews. These prescriptions were then sent to The Medicine Shoppe, a pharmacy in Utah, which filled the prescriptions and received massive reimbursement from TRICARE.
Kickbacks and payments
The Medicine Shoppe paid kickbacks to the Collinses based on a percentage of the TRICARE reimbursement for the prescriptions referred by the Collinses’ recruiter network. The Collinses, in turn, paid kickbacks to the recruiters working in their network.
Seized property and assets
The United States has seized property and assets obtained by the Collinses and others involved in the scheme. This includes an 82-foot yacht, luxury vehicles, a multimillion-dollar annuity, farm equipment, tractor-trailer trucks, and real estate.
Guilty pleas by other defendants
Other individuals involved in the scheme, including doctors, nurse practitioners, the corporate owner of the pharmacy, and patient recruiters, have pleaded guilty for their roles in the conspiracy to commit health care fraud.
Losses to TRICARE
Between December 2014 and May 9, 2015, the doctors at Choice MD authorized 4,442 prescriptions and billed TRICARE $65,679,512. This scheme resulted in significant losses to the taxpayer-funded health care program.
Accountability for the defendants
The Collinses are the last members of the conspiracy to plead guilty. They are scheduled to be sentenced on October 27, 2023. The legal consequences and sentences for the defendants involved in the scheme will hold them accountable for their crimes.
Introduction to TRICARE
TRICARE is a health care program that provides coverage for active duty service members, retirees, and their families. It aims to ensure that those who serve in the United States military have access to quality health care services.
Purpose of TRICARE
The main purpose of TRICARE is to provide comprehensive health care coverage to service members and their eligible family members. It covers a wide range of medical services, including doctor visits, hospital stays, prescription medications, and preventive care.
Coverage for service members
TRICARE provides coverage for active duty service members, including members of the Army, Navy, Air Force, Marine Corps, Coast Guard, and National Guard/Reserve. It also extends coverage to their eligible family members and retirees.
Healthcare fraud in the US
Healthcare fraud is a significant issue in the United States, costing the government and taxpayers billions of dollars each year. Fraudulent schemes, like the one in this case, contribute to the increasing costs of healthcare and can compromise the integrity of health care programs.
Importance of tackling healthcare fraud
Tackling healthcare fraud is crucial to protect the integrity and sustainability of health care programs like TRICARE. By holding perpetrators accountable and implementing robust systems and measures to prevent fraud, the government can safeguard taxpayer funds and ensure that healthcare resources are directed towards those who genuinely need them.
Details of the Fraud Scheme
Recruiting TRICARE beneficiaries
The fraud scheme involved recruiting TRICARE beneficiaries who were willing to sign up to receive expensive compounded medications. These beneficiaries were targeted to participate in the scheme even though they did not require these medications.
Choice MD Clinic
Choice MD clinic, owned and operated by the Collinses, played a central role in the fraud scheme. The clinic served as a platform for writing unnecessary prescriptions and submitting them for reimbursement from TRICARE.
Prescriptions without medical review
Doctors at Choice MD, including Dr. Susan Vergot, Dr. Carl Lindblad, and nurse practitioner Candace Craven, wrote prescriptions for TRICARE beneficiaries without conducting proper medical reviews or examinations. This allowed the scheme to generate a high volume of fraudulent prescriptions.
The Medicine Shoppe pharmacy
The prescriptions written by the doctors at Choice MD were sent directly to The Medicine Shoppe, a pharmacy in Utah. The pharmacy filled these prescriptions and received significant reimbursement from TRICARE.
Prescription authorization and billing
Choice MD authorized a total of 4,442 prescriptions between December 2014 and May 9, 2015. These prescriptions were then billed to TRICARE, resulting in a total billing amount of $65,679,512 for the unnecessary medications.
Involvement of Medical Professionals
Doctors at Choice MD
Doctors employed by the Collinses at Choice MD, such as Dr. Susan Vergot and Dr. Carl Lindblad, played a crucial role in writing the unnecessary prescriptions for TRICARE beneficiaries. They did not conduct proper medical reviews or examinations, disregarding the health needs of the beneficiaries.
Nurse practitioner’s role
Nurse practitioner Candace Craven, employed by the Collinses at Choice MD, was also involved in the fraudulent scheme. Craven played a role in writing prescriptions without conducting medical reviews, contributing to the submission of fraudulent claims to TRICARE.
Kickbacks and Payments
Kickbacks paid to the Collinses
The Collinses received kickbacks from The Medicine Shoppe based on a percentage of the TRICARE reimbursement for the prescriptions referred by their recruiter network. These kickbacks totaled at least $45.7 million dollars.
Kickbacks paid to recruiters
The Collinses, in turn, paid kickbacks to recruiters working in their network, including defendants Josh Morgan, Kyle Adams, and Daniel Castro. These kickbacks were intended to incentivize the recruiters to continue identifying TRICARE beneficiaries to participate in the fraud scheme.
Seized Property and Assets
Property obtained with scheme proceeds
As a result of the fraud scheme, the United States has seized property and assets that were obtained by the Collinses and others involved. This includes an 82-foot yacht, luxury vehicles, a multimillion-dollar annuity, farm equipment, tractor-trailer trucks, and real estate.
List of seized items
The seized items obtained with the proceeds of the scheme include an 82-foot yacht, multiple luxury vehicles, two Aston-Martins, a multimillion-dollar investment annuity, dozens of pieces of farm equipment and tractor-trailer trucks, and three pieces of real estate located in Tennessee.
Guilty Pleas by Other Defendants
Involvement of additional defendants
Other individuals involved in the fraud scheme, including doctors, nurse practitioners, the corporate owner of The Medicine Shoppe, and patient recruiters, have pleaded guilty for their roles in the conspiracy to commit health care fraud.
Their guilty pleas and roles in the fraud
These individuals have acknowledged their involvement in the fraud scheme and have accepted responsibility for their actions. Their guilty pleas reflect their admission of guilt for participating in the conspiracy to defraud TRICARE.
Losses to TRICARE
Financial impact of the fraud scheme
The fraudulent scheme resulted in significant losses to TRICARE, the taxpayer-funded health care program. The unnecessary prescriptions authorized by the doctors at Choice MD and filled by The Medicine Shoppe amounted to a total reimbursement billing of $65,679,512.
Reimbursement amount billed by Choice MD doctors
Between December 2014 and May 9, 2015, the doctors at Choice MD authorized 4,442 prescriptions and billed TRICARE for these prescriptions. The massive volume of fraudulent prescriptions contributed to the substantial losses incurred by TRICARE.
Accountability for the Defendants
Legal consequences and sentences
The defendants involved in the fraud scheme will face legal consequences for their actions. Guilty pleas, like those made by the Collinses and others, demonstrate their acceptance of responsibility and will assist in holding them accountable for their crimes.
Scheduled sentencing for Jimmy and Ashley Collins
Jimmy and Ashley Collins, the main defendants in the case, are scheduled to be sentenced on October 27, 2023. The sentencing will play a crucial role in determining the appropriate punishments and restitution amounts for the defendants.
Impact and consequences of the TRICARE fraud scheme
The TRICARE fraud scheme, spearheaded by the Collinses and their co-conspirators, resulted in significant financial losses to a taxpayer-funded health care program that is intended to support members and veterans of the armed forces. The scheme exploited the system and diverted resources away from those who genuinely needed them.
Efforts to prevent future healthcare fraud
Cases like this highlight the importance of proactive efforts to prevent and detect healthcare fraud. By implementing robust systems, conducting thorough investigations, and prosecuting offenders, the government can deter individuals from engaging in fraudulent schemes and safeguard taxpayer funds.
Importance of holding perpetrators accountable
Holding perpetrators accountable for their actions is crucial in maintaining the integrity and effectiveness of health care programs like TRICARE. The guilty pleas in this case demonstrate that individuals involved in fraudulent activities will face legal consequences for their crimes, ensuring that justice is served.