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What are the penalties for Tricare Fraud?

Texas Tricare Fraud Attorneys - Oberheiden & McMurrey, LLP


Dr. Nick Oberheiden, Esq.
Healthcare Fraud Defense Attorneys

Tricare Fraud implies the submission of false or fraudulent claim to a governmental healthcare program. The government considers approximately $ 50 billion of claims per year suspicious and subject to federal fraud investigations. Given the amounts at stake, it is no surprise that sooner or later successful providers and business owners may find themselves in the middle of a government investigation. If that’s the case, immediate attention and a strategic defense plan from experienced attorneys are required.

Tricare Fraud Explained

Similar to the better known Medicare and Department of Labor government programs, Tricare Fraud refers to the submission of false or fictitious claims to a federal governmental healthcare program. Currently, there is a trend to prosecute owners and business executives of pharmacies and compound pharmacies for alleged Tricare Fraud. Like Medicare, Tricare beneficiaries are among the healthcare program of the United States Department of Defense Military Health System. As such, Tricare investigations fall within the jurisdiction of the Department of Defense.

What Are the Penalties?

Tricare Fraud is investigated by the Department of Defense (DOD), the Office of Inspector General (OIG), the Department for Health and Human Services (HHS), the Department of Justice (DOJ), the Federal Bureau of Investigation (FBI), and other federal law enforcement agencies. Frequently, the Drug Enforcement Administration (DEA) joins in on TRICARE fraud investigations, most certainly in the context of compound pharmacies. Tricare Fraud can be investigated and prosecuted in one of two ways:

  • Criminal Charges:

Investigations may lead to criminal charges of responsible individuals. In that case, the government brings a federal healthcare fraud case before a U.S. District Court and indicts responsible individuals to seek incarceration and imprisonment. Criminal healthcare fraud cases are very unique as they require the defense attorney to understand both, healthcare law and federal criminal procedure.

  • Civil Liability:

Investigations may end with civil liability. In such a case, targets may become responsible for recoupment requests, non-payment of future claims, civil fines of up to $ 11,000 per false claim, exclusion from federal healthcare programs, treble damages, and fees payable to the attorneys of the U.S. government. Civil liabilities are mostly imposed on companies, but can extend to responsible individuals (CEO, CFO etc.) within a company.

It is important to note that liability does not require a specific intent to violate the law; in fact, the government does not even need to prove actual knowledge of the wrongfulness of the transaction.

Who Are the Targets?

Tricare Fraud allegations are on the rise and they are serious. Healthcare fraud statutes apply to any individual or business that directly or indirectly contracts with and is paid for services by the United States government. Particularly exposed are providers in the following areas:

  • Compound Pharmacies
  • Pharmacies
  • Toxicology Laboratories
  • Hospitals
  • Physician Owned Entities
  • Physicians, Nurses, Staff
  • Medical Device Companies (“DME”)

Who Will Handle My Case?

If you are under Tricare investigation, you need attorneys that understand the complex nuances of healthcare law as well as know how to get a case dismissed in a federal proceeding. The attorneys of Oberheiden, P.C. represent individual and corporate clients in Tricare Fraud investigations. Oberheiden, P.C. has a long track record in avoiding criminal and civil liability for our clients. All cases are personally handled by former healthcare prosecutors from the Department of Justice, who bring first hand knowledge to the table, and Dr. Nick Oberheiden, a highly sought after healthcare fraud defense attorney with experience from handling Tricare and healthcare fraud cases across the country.

To find out more about TRICARE Fraud, you should contact one of the experienced attorneys of Oberheiden, P.C.. We will provide you a detailed and reliable case assessment.

Oberheiden, P.C.
National Criminal Defense
Former Federal Prosecutors and Experienced Defense Attorneys
(214) 469-9009

This information has been prepared for informational purposes only and does not constitute legal advice. Reading of this information does not create an attorney-client relationship. Prior results do not guarantee similar future outcomes. Oberheiden, P.C. is a Texas LLP with headquarters in Dallas. Mr. Oberheiden limits his practice to federal law.

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