Amtrak OIG-supported investigation leads to prison time, $11.7 million in restitution, including more than $768,000 to Amtrak, for California pharmacist’s health care fraud scheme

 |  Investigations Press Release

For Immediate Release:

October 7, 2021

 

LOS ANGELES – An Orange County Pharmacist on Tuesday was sentenced to nearly six years in prison and was ordered to pay more than $10 million in restitution to Tricare, the U.S. military’s health care plan, and more than $768,000 to Amtrak’s employee health care benefit plan for submitting millions of dollars in fraudulent claims for unnecessary prescriptions.

 

Thu Van Le, 42, a.k.a. “Tony Le,” of Placentia, was sentenced Monday to 70 months in federal prison and order to pay $10,982,759 in restitution to Tricare and $768,488 to Amtrak’s health care benefit plans. Le pleaded guilty to one count of health care fraud in July 2021.

 

According to court documents, Le’s pharmacy submitted more than $13 million in fraudulent claims for unnecessary compounded medications to Tricare and Amtrak’s health care benefit plans. Le paid kickbacks of up to 50 percent of the insurance reimbursements to so-called “marketers” who used personal and insurance information to generate the fraudulent prescriptions. 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. According to a press release form the U.S. Attorney’s Office, Central District of California, 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.

 

In addition to Amtrak OIG, the case was investigated by the Defense Criminal Investigative Service; FBI; IRS Criminal Investigation; the Office of Personnel Management OIG; the U.S. Department of Labor, Employee Benefits Security Administration; the Department of Health and Human Services; and the California Department of Insurance.

 

Reports of fraud, waste, or abuse; criminal or unethical acts affecting Amtrak’s property or operations; or mismanagement in Amtrak programs or operations can be made 24 hours a day, seven days a week via the Amtrak OIG Hotline at 1-800-468-5469 or online at https://amtrakoig.gov/report-fraud-waste-abuse. More information is available in the U.S. Attorney’s Office press release: https://direc.to/hoBr.

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