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OC Pharmacist Convicted in $11 Million Fraud Scheme

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Los Angeles: Prosecutors revealed Wednesday that a licenced Orange County pharmacist would be sentenced in April for her role in a healthcare fraud scheme that bilked the US military’s healthcare plan out of more than $11 million.

According to the Department of Justice, Sandy Mai Trang Nguyen, 42, of Irvine, was convicted Tuesday in Los Angeles of 21 counts of healthcare fraud and one count of obstructing a federal audit.

Prosecutors said the fraud entailed filling over 1,000 phoney prescriptions for compounded drugs at the expense of the Tricare health care plan.

Compounded medications are tailor-made products that doctors may prescribe when the FDA-approved option does not match a patient’s health needs, according to prosecutors.

Nguyen was the lead pharmacist at the now-defunct Irvine Wellness Pharmacy, according to the DOJ. Nguyen and others under her supervision filed around 1,150 compounded prescriptions for pain, scarring, and headaches from late 2014 to May 2015, with Tricare funding reimbursements in the tens of thousands of dollars for each prescription.

Prosecutors said that the majority of the prescriptions were steered to the pharmacy by so-called marketers who were paid roughly 50% of the Tricare reimbursements.

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Prosecutors claim that beneficiaries were asked to disclose their Tricare insurance information for prescriptions they did not require and that the majority were never evaluated by a physician.

Prosecutors told jurors that Nguyen was aware that the prescriptions were issued by doctors who did not reside in the same state as the alleged recipients.

OC Pharmacist Convicted of Role in $11M Fraud Scheme - MyNewsLA.com

According to them, in some situations, many members of the same family received identical drugs. Prosecutors stated that in one example, a 13-year-old child in Chicago obtained the same prescription as an 86-year-old woman in Orange County, who turned out to be Nguyen’s grandmother.

Prosecutors claimed that the pharmacy billed beneficiaries for hundreds of dollars in mandatory co-payments, but they refused, claiming that they knew the prescriptions were completely covered by Tricare.

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According to the DOJ, the total co-payments due during the scheme surpassed $16,000, but the pharmacy never collected them.

Prosecutors allege that Nguyen also impeded a federal audit by supplying phoney, cut-and-pasted prescriptions in order to conceal Tricare’s attempt to legitimise millions of dollars paid for the same medications.

According to authorities, Tricare paid $11,098,756 on falsely submitted claims during Nguyen’s stint as pharmacist-in-charge.

The sentencing date has been set for April 3 by U.S. District Judge Otis D. Wright II. Nguyen faces up to ten years in federal prison for each count of healthcare fraud and up to five years in federal prison for the count of audit obstruction.

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