LOS ANGELES – A former Orange County pharmacist faces sentencing Monday for her role in a health care fraud scheme that authorities say bilked the U.S. military’s health care plan out of more than $11 million.
Sandy Mai Trang Nguyen, 43, of Irvine, was convicted in November in Los Angeles of 21 counts of health care fraud, and one count of obstruction of a federal audit.
She faces up to 10 years in federal prison for each health care fraud count, and up to five years for the obstruction count, according to the U.S. Attorney’s Office.
The scheme involved the filling of more than 1,000 bogus prescriptions for compounded medications at the expense of the Tricare health care plan.
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.
Nguyen was the lead pharmacist at the now-defunct Irvine Wellness Pharmacy. From late 2014 to May 2015, Nguyen and others under her supervision filled about 1,150 compounded prescriptions for pain, scarring and migraines, with Tricare funding reimbursements of tens of thousands of dollars per prescription, evidence shows.
Prosecutors said the bulk of the prescriptions were directed to the pharmacy by so-called marketers who received kickbacks of nearly 50% of the Tricare reimbursements.
According to prosecutors, beneficiaries were solicited to provide their Tricare insurance information for medications they did not need, and most were never examined by a physician.
The jury in Los Angeles federal court heard that Nguyen knew the prescriptions were written by doctors who didn’t live in the same state as the supposed beneficiaries. In some cases multiple members of the same families received the same medications. In one case, a 13-year-old boy in Chicago received the same prescription as an 86-year-old woman in Orange County who turned out to be Nguyen’s grandmother, prosecutors said.
The pharmacy billed beneficiaries for hundreds of dollars in required co-payments, but they balked at the payments, saying they understood the medications were fully covered by Tricare. The total co-payments due during the scheme exceeded $16,000, but the pharmacy never collected them.
Nguyen obstructed a federal audit by providing bogus, cut-and-pasted prescriptions to cover-up Tricare’s effort to validate millions of dollars paid for the same prescriptions, the jury found.
During Nguyen’s tenure as pharmacist, Tricare paid $11,098,756 on the fraudulently submitted claims, according to evidence presented at trial.