Couple in U.S. Swindle $65 Million in TRICARE Fraud Scheme

In a shocking turn of events, Jimmy and Ashley Collins, a seemingly unassuming married couple hailing from Birchwood, Tennessee have confessed in a federal court to orchestrating a colossal healthcare fraud scheme that drained more than $65 million from TRICARE, the vital healthcare program designed to cover United States service members, according to the United States Attorney's Office in the Southern District of California. The revelation has sent shockwaves through the nation as the couple's actions strike at the heart of a program intended to support military personnel and their families, reports Hoodline.

The elaborate deception

Operating in cahoots with accomplices, the Collinses actively preyed on TRICARE beneficiaries, enticing them to sign up for expensive compounded medications they didn't actually require. This elaborate ruse involved promising monthly payments in exchange for participation in a purported medical evaluation. Alas, the evaluation never transpired and instead, the fraudsters capitalized on their victims' vulnerability for personal gain.

Under the pretense of medical treatment, the unsuspecting beneficiaries' information was funneled to Choice MD, a medical clinic co-owned and operated by the Collinses. Medical professionals employed by the couple at Choice MD including Dr. Susan Vergot, Dr. Carl Lindblad, and nurse practitioner, Candace Craven proceeded to write prescriptions for these individuals without conducting legitimate medical reviews or examinations. "The scheme alleged in this case resulted in massive losses to a taxpayer-funded healthcare program meant to help members and veterans of our armed forces," declared U.S. Attorney Randy Grossman. "With these guilty pleas, we are holding these defendants accountable for their crimes."

Between December 2014 and May 9, 2015, the doctors under the Collinses employed at Choice MD issued a staggering 4,442 prescriptions, resulting in a jaw-dropping total of $65,679,512 in fraudulent claims submitted to TRICARE. Such a deceitful operation put immense strain on the program, depriving genuinely needy service members of vital medical resources.

The kickback system, seized assets, and accountability

The Collinses didn't stop at exploiting TRICARE; they devised a kickback system to compound their ill-gotten gains further. The owners of The Medicine Shoppe, a pharmacy in Bountiful, Utah, responsible for filling the deceitful prescriptions, paid substantial kickbacks to the Collinses based on a percentage of the TRICARE reimbursements. In turn, the Collinses distributed kickbacks to their network of recruiters, including defendants Josh Morgan, Kyle Adams and Daniel Castro, among others.

Federal investigators and agencies worked tirelessly to apprehend all those involved in the fraudulent scheme. As a result, the United States successfully seized numerous assets purchased with ill-gotten proceeds, including an 82-foot yacht, luxury vehicles, valuable farm equipment, and various Tennessee real estate holdings.

Ensuring justice and safeguarding TRICARE

The road to justice has been a long one with several individuals involved in the conspiracy having already pleaded guilty, including doctors, medical professionals, pharmacy owners, and recruiters. The guilty pleas of the Collinses signify that the last pieces of the puzzle have fallen into place with all members of the conspiracy being held accountable for their roles in this grand deception.

The sentencing of Jimmy and Ashley Collins, scheduled for October 27, 2023, before U.S. District Judge Janis L. Sammartino will determine the full extent of their penalties. The outcome will serve as a stark warning to anyone contemplating defrauding TRICARE or any other healthcare program designed to assist those who serve and protect the nation.

In the face of this egregious betrayal of trust, the Department of Defense, the Defense Criminal Investigative Service, the Naval Criminal Investigative Service, and the Federal Bureau of Investigation have remained steadfast in their commitment to protect TRICARE and safeguard the welfare of military personnel and their families. The successful prosecution of this landmark case reaffirms the collective resolve to uphold the integrity of TRICARE, ensuring that the nation's brave servicemen and women receive the healthcare resources they genuinely deserve.