An Orange County pharmacist has been sentenced to nearly six years in federal prison for submitting more than $13 million in claims for medically unnecessary compounded medication prescriptions, the U.S. Department of Justice announced Tuesday.
Thu Van “Tony” Le, 42, of Placentia, was sentenced Monday by U.S. District Judge R. Gary Klausner, who ordered Le to pay over $10.9 million in restitution to TRICARE, the U.S. military’s managed health care plan, and $768,488 in restitution to Amplan, Amtrak’s employee health care plan, according to the DOJ.
Le, a pharmacist who owned TC Medical Pharmacy in Corona, pleaded guilty in Los Angeles federal court in July to one count of health care fraud.
From March 2015 to December 2016, Le’s pharmacy submitted more than $13 million in total claims to TRICARE and AmPlan, against which the military plan paid $10,982,759 and AmPlan paid $768,488. Le, in turn, paid so-called “marketers” handsome kickbacks of up to 50% of the TRICARE reimbursements.
The marketers used personal and insurance information to generate fraudulent prescriptions for compounded medications, according to court documents. Marketers who participated in the scheme solicited beneficiaries of the health plans through misleading cold calls that promised free compounded medications. In some cases, beneficiaries were not contacted at all and simply received expensive medications that they did not order.
Compounded drugs are tailor-made products doctors may prescribe when the Food and Drug Administration-approved alternative does not meet the health needs of a patient. Le agreed to be bound by TRICARE and AmPlan rules for reimbursement of claims for their beneficiaries.
TRICARE and AmPlan required that medications be medically necessary, that beneficiaries be examined by physicians, and that Le’s pharmacy collect co-payments. The prescriptions were supposed to be for unique patient needs, but they instead were formulated to maximize reimbursements and were prepared on an assembly-line basis.