A Mississippi man described as the “mastermind of the largest health care fraud scheme” in that state’s history has been sentenced to 18 years in prison and ordered to pay nearly $350 million in connection to his role in a scheme to defraud Tricare, Justice officials said.
Wade Ashley Walters, 54, of Hattiesburg, Miss., who earlier pleaded guilty to one count of conspiracy to commit health care fraud and one count of conspiracy to commit money laundering, was sentenced Jan. 15 in federal court in Mississippi, according to an announcement from the Justice Department. He is co-owner of numerous pharmaceutical distributors and compounding pharmacies — companies that make individualized medications for people.
He was ordered to pay nearly $288 million in restitution, and to pay an additional $57 million to forfeit his personal profit from the scheme, officials stated.
The sentencing “is another mile marker on the long road to justice for victims, our veterans, our military, and all American taxpayers, as the mastermind of the largest health care fraud scheme in Mississippi history has been held to answer for his crimes,” said Mike Hurst, U.S. Attorney for the Southern District of Mississippi, in the Justice Department announcement.
Since 2007, federal officials have been engaged in a coordinated, large-scale investigation of health care fraud. Some involve schemes to submit claims to Medicare, Medicaid and Tricare for treatments that weren’t medically necessary, and sometimes never provided. Some schemes resulted in convincing Tricare beneficiaries to fill prescriptions for pain creams, ointments and other topical medicines they didn’t necessarily need, resulting from illegal kickback schemes.
Between 2012 and 2016, Walters ran a scheme to defraud Tricare and other health care benefits programs by distributing compounded medications that weren’t medically necessary, officials stated.
According to Justice officials, Walters and his co-conspirators:
*adjusted prescription formulas to ensure the highest reimbursement without regard to effectiveness; and solicited recruiters to get prescriptions for high-margin compounded medications,
*paid those recruiters commissions based on the percentage of reimbursements paid, including claims reimbursed by Tricare, and set up a system to make it appear that the pharmacies were collecting copayments, while waiving or reducing copayments paid by beneficiaries.
*solicited medical practitioners to authorize prescriptions for high-profit compounded medications, and sometimes paid kickbacks to those practitioners.
The investigation into this specific scheme began in the FBI’s Jackson, Miss., field office. Among the federal agencies that investigated are the Defense Criminal Investigative Service’s southeast field office, the Internal Revenue Service’s Atlanta field office, and the Mississippi Bureau of Narcotics.
The Justice Department Criminal Division’s Fraud Section leads the Health Care Fraud Strike Force, formed in 2007. That has resulted in charging more than 4,200 defendants who have collectively billed Medicare for about $19 billion, according to Justice officials.
In May, 2015, a Tricare policy change required screening of all ingredients in the compounded prescriptions and rejecting any that contained non-FDA approved ingredients. These prescriptions were increasingly costly to the Defense Health Agency, which spent nearly $1 billion on compounded prescriptions in the first four months of 2015 alone.