Sought TRICARE Beneficiaries to Receive Expensive Compounded Drugs

LITTLE ROCK-United States District Judge Brian S. Miller sentenced Bradley Fly, 36, of Germantown, Tenn., to 20 months in federal prison for violating the Anti-Kickback Statute. In July 2019, Fly pleaded guilty to offering two TRICARE beneficiaries’ money in exchange for signing up to receive expensive compounded drugs.

At sentencing, the United States introduced evidence that Fly bribed two people: his longtime friend (then a Marine reservist), plus an Army National Guardsman, whom Fly solicited while seated courtside at a Memphis Grizzlies game. Fly then facilitated prescriptions for both men and their wives, for which TRICARE paid over $500,000, earning himself over $180,000 in commission.

Judge Miller heard testimony from the Marine reservist and from a Special Agent with the U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG) that the prescriptions were part of a larger network of prescription generation, including recruiters whom Fly paid for TRICARE beneficiary information and a group of doctors whom Fly used to sign prescriptions without consulting patients.

“There is no room for kickbacks in the healthcare marketplace,” said Acting United States Attorney Jonathan D. Ross. “Serious penalties and prison await those, like Mr. Fly, who fail to abide by the law. This office and its partners at the FBI and HHS-OIG are committed to rooting out such criminal conduct.”

“Mr. Fly paid kickbacks generating fraudulent claims to line his pockets without concern for the health and welfare of the patients,” said Miranda L. Bennett, Special Agent in Charge of the HHS-OIG Dallas Region. “We will continue working with our law enforcement partners to pursue individuals defrauding federal health care programs.”

“By defrauding TRICARE, Mr. Fly disgracefully cheated U.S. Veterans, their families, and American taxpayers,” said FBI Little Rock Acting Special Agent in Charge Jason Van Goor. “We are grateful for our state and federal partners who help us both investigate these cases and protect the financial integrity of our nation’s health care systems.”

In addition to the 20-month prison sentence, Fly was sentenced to three years of supervised release. The investigation was conducted by HHS-OIG and the FBI and prosecuted by Assistant United States Attorney Alexander D. Morgan.

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VEACs brings direct access to VA and non-VA resources to your community

Nearly a thousand Veterans, their families, caregivers, and survivors attended a Veterans Experience Action Center (VEAC) in Montgomery, Ala., on Feb. 5, 2020. Those in attendance received direct access to VA’s benefits and services. The one-stop shop for Veterans brought together VA and community resources with one goal: to serve Veterans on the spot.

This was the second year the community held the action center. Seventy local organizations provided a host of services at the VEAC, including on the spot job interviews, flu inoculations, free haircuts, access to healthcare organizations, mental health services, and dozens of other local assistance programs. The vast outpouring and variety of support ensured that VEAC participants knew the community was there to support them.

Veterans Experience Action Centers are different than other outreach events because Veterans are able to file claims, ask questions, and apply to VA benefits and healthcare within minutes of showing up. In addition to the amazing community organizations and Veteran Service Organizations in attendance, more than 50 VA employees were also on site to process actions immediately. Even members of the the Air Force showed up, directing Veterans to booths and cooking hot dogs!

A Veteran in attendance said, “I came here for some information, and all I really wanted was this form just so I can know what to do… and I ended up filing my claim today!”

TVA again held the event at the Multiplex’ Cramton Bowl, this year with more than 70 booths. Some of the organizations included Vietnam Veterans of America, Veterans of Foreign Wars, Paralyzed Veterans of America, Disabled American Veterans, Walgreens, Humana Health, and many more.

Some Veteran find that VA processes can be overwhelming, or that the eligibility or rules and regulations are hard to understand. Instead of waiting for Veterans to come to VA, VA is getting into the community where Veterans reside. VA will also be setting up these events across the country. In fact, several VA leaders from Kentucky were in attendance to better prepare for their upcoming Veterans Experience Action Center in Lexington, Ky.

In action

One Veteran showed up just before the event wrapped up. She was in tears, sharing her struggles with transition to civilian life, PTSD and Military Sexual Trauma as a military retiree. She had recently submitted a compensation claim but did not understand her award letter. Veterans Benefits Administration employees explained to her what the claim’s decision meant, and then also shared that she was eligible for concurrent military and VA benefits.

For a list of future VA outreach events, including Veterans Experience Action Centers, visit: https://www.va.gov/outreach-and-events/events/

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Miami, Florida – A 29-year-old Georgia man who redirected the benefits of veterans and social security beneficiaries to accounts that his co-conspirators set up and controlled has been sentenced to 78 months in prison by a South Florida federal district judge. In addition, the man must pay more than $900,000 in restitution to his victims.

Defendant Ronaldo Green was a member of a conspiracy that obtained the personal information (including names, dates of birth and social security numbers) of disabled veterans and social security beneficiaries. The co-conspirators used this information to fraudulently open bank accounts and prepaid debit cards in the victims’ names. They also forged documents in the victims’ names that directed the U.S. Department of Veterans Affairs and the Social Security Administration to deposit benefit payments into those fraudulent accounts, instead of the victims’ legitimate bank accounts. Green and his co-conspirators withdrew the diverted money from ATMs and banks in South Florida and Georgia. They used it on personal expenses. Much of the money was ultimately funneled to architects of the scheme, located in Jamaica.

From 2012 to 2017, members of the conspiracy attempted to redirect over $1.8 million in benefits from more than 100 disabled veterans and social security beneficiaries. Although several of the attempts failed, the defendants’ actually stole more than $1 million. The victims have been reimbursed for their losses.

Green’s co-defendants, Omar Bailey and Jamare Mason, were sentenced during prior hearings. Bailey received 24 months’ imprisonment. Mason received 78 months’ imprisonment and was ordered to pay over $1 million in restitution. U.S. District Judge James Cohn, who sits in Ft. Lauderdale, imposed the sentences.

Juan Antonio Gonzalez, U.S. Attorney for the Southern District of Florida; David Spilker, Special Agent in Charge, Department of Veterans Affairs, Office of Inspector General’s (VA-OIG) Southeast Field Office; and Rodregas Owens, Special Agent in Charge, Social Security Administration, Office of the Inspector General (SSA-OIG), made the announcement.

U.S. Attorney Juan Antonio Gonzalez commended the investigative efforts of the Transnational Elder Fraud Strike Force, including partners from VA-OIG, SSA-OIG, United States Postal Inspection Service, and Homeland Security Investigations.

The case was prosecuted by Assistant U.S. Attorneys Lois Foster-Steers and Sajjad Matin.

Combatting elder abuse and financial fraud targeted at seniors is a key priority of the Department of Justice. The mission of the Department’s Elder Justice Initiative is to support and coordinate the Department’s enforcement and programmatic efforts to combat elder abuse, neglect and financial fraud and scams that target our nation’s seniors. To learn more visit https://www.justice.gov/elderjustice. The public is encouraged to report suspected elder victimization and fraud by visiting https://www.justice.gov/elderjustice/roadmap or calling the victim connect hotline at 1-855-484-2846.

Related court documents and information may be found on the website of the District Court for the Southern District of Florida at www.flsd.uscourts.gov or at http://pacer.flsd.uscourts.gov, under case number 19-cr-60313.

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David Pruett was “hobbling around” for several years upon being discharged from the U.S. Navy in the late 1990s, before learning he could get some help for his injuries through the Veterans Administration.

Now it’s his job to help Veterans navigate that same system to ensure they get the help they deserve.

Effective last week, the longtime Rifle resident and real estate appraiser is the new appointed agent whose job it is to steer Garfield County Veterans to the various services that are available to them.

It was the former longtime Veterans Services Officer for the county, Joe Carpenter, who helped Pruett work through the process to get the help he needed.

“Today, there are a lot of young Veterans who’ve served in the last 20 years who may need those services, but aren’t really sure how to go about it,” Pruett said. “As I learned, it’s not just an old guys’ thing. Some Veterans need that assistance the day they get out.”

County commissioners last week appointed Pruett, a Navy Veteran and Rifle High School graduate, to be the new Veterans services officer (VSO) for Garfield County. He replaces outgoing VSO Lisa Reed-Scott, who had been at the post since January 2019. She resigned last month to pursue other career avenues.

Pruett, 49, was active duty as a member of the prestigious Navy SEALs (Navy Special Warfare) for almost five years after graduating from Mesa State College in Grand Junction (now Colorado Mesa University) in 1994 with a degree in criminal justice.

Injuries ended his military career prematurely, but he continued in the volunteer spirit after returning to Rifle, as a firefighter for the Rifle Fire Protection District, and with the Sunlight Mountain Resort Ski Patrol and the Garfield County Sheriff’s Office Search and Rescue.

“I’m excited to have the chance to work with Veterans here in Garfield County,” Pruett told county commissioners upon his appointment. “I’m very familiar with paperwork, working as an appraiser, and I have the paper cuts to show for it.”

Growing up in Rifle

Pruett was born in Denver, but his parents, Mike and Irene Pruett, moved to Rifle when he was young. He has two siblings, sister Kimberly, who lives in Grand Junction, and brother Mark from Denver.

While attending Mesa, he met his wife, Annick Pruett, who is well-known in the Rifle area as community relations director for Grand River Health. David Pruett took over the family appraising business after working with his mother for several years. He and Annick have two grown children, daughter Makenna and son Dalton.

“David is a former student of mine and former student body president of Rifle High School, so this makes me very happy,” County Commissioner Mike Samson, a longtime former RHS teacher, said of Pruett’s appointment to the VSO position.

Pruett said he had always wanted to go into special operations, and the opportunity presented itself after he graduated from Mesa State.

“I always liked the military, and special operations was something I had considered,” he said. “I looked at the Army Green Berets, but at that time the fastest way to get into special operations was in the Navy.”

The stretch of time during which he served did not involve any major conflicts, though he was part of various operations in North Africa and the Middle East where the SEALs were tasked with stopping ships that were breaking embargoes.

“I was going to make it a career, but injuries I sustained in training pushed me out,” Pruett said.

Back home in western Colorado, when not working, Pruett said he still enjoys his weekends in the outdoors as much as possible.

“When I left the service, they asked me why I wanted to come back here … ‘there’s nothing there,'” he recalled.

“I told them that, if I’m at home on a weekend, it’s either because I’m sick or it’s a bad weekend,” Pruett said. “Otherwise, I’m going to be outside doing something. That was especially true when we had kids.”

New opportunity to serve

Pruett said he had thought about applying for the VSO position in the past, including when Carpenter retired in 2016. But he and Annick were still busy home-schooling their children at the time, so he decided to wait.

When the opportunity became available again this spring, Pruett decided it was the right time in his life.

His appraiser office in Rifle was a popular spot for local Veterans to visit, and he would always enjoy talking to them about life and service.

“I’d chat with them and learn so much from each of them about their service, both tactically and historically, and I also learned a lot about their frustrations and struggles to connect with needed services,” he said.

Pruett said his primary focus will be on communicating with area Veterans who are in need of the various services that are available to them.

“I want them to know that I’m on their side,” he said. “I’ll do my best to take care of them and their families, and for anyone who may be struggling with depression or suicidal thoughts, remember that we’re all in this together, so let’s stick together.”

Another concern among Veterans advocates is for those who are experiencing homelessness, whether by circumstance or by choice.

“As I’ve seen it, there are several different reasons to be homeless,” Pruett said. “For some of them, that’s what they choose, having come from military combat and what they’ve seen. That’s how it impacted them.

“Some have mental disabilities and can’t hold a job or keep a home. But there are programs available for them, if they need them. We just need to find them, and get them in contact with the right people.”

A difficulty for many Veterans is that there’s no special privilege in civilian life based on rank, as they had become used to in the military.

“But you’re still a Veteran,” Pruett said. “You volunteered or were drafted, but No. 1, you served. And when you get out, you might not even be looking for those benefits. But if you need it, it’s my job to try to help them find that benefit.”

Learning the ropes

Pruett is now in the equivalent of basic training for Veterans services officers.

Every county in Colorado has at least one VSO. Shortly after his appointment last week, he was on a videoconference call with several of those officers learning about the latest programs that are available.

A particular focus right now is on suicide prevention, he said, as the suicide rate among Veterans remains a major concern.

“We just want people to know that we’re here, and can find them the help that they need,” Pruett said.

Pruett will be working out of the Veterans Services offices in both Glenwood Springs, 803 Colorado Ave., and Rifle, at 195 W. 14th Street, Building A.

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The Biden administration's plan to cover the cost of home COVID-19 tests does not apply to Tricare beneficiaries.

Beginning Saturday, private and group health insurers will be required to reimburse the cost of eight take-home COVID tests per month under an initiative announced by President Joe Biden on Jan. 10.

But as a federal health program, Tricare's nearly 8 million beneficiaries who aren't on active duty will not have the same access, although the military health system is reviewing its policies, according to a Defense Health Agency spokesman.

Under Tricare, tests are covered only when ordered by a doctor for patients with symptoms; who have had prolonged exposure but no symptoms; are having surgery; or are overseas and need to be tested.

All other reasons -- personal concern, workplace safety, returning to work or school, travel or access to services -- are not covered.

In a major effort to broaden access to testing across the U.S., Biden ordered insurers to cover the cost of eight COVID-19 test kits per month for people with health insurance starting Jan. 15.

The initiative requires insurers to reimburse for the full cost of take-home tests at their network pharmacies and at out-of-network retailers for a $12 copayment per test.

And under the directive, patients with an underlying health condition or other factors will not be limited on the number of tests they can be reimbursed for if they have a doctor's order.

Since the beginning of the COVID-19 pandemic, Tricare beneficiaries have been able to have their COVID-19 tests covered only if they have symptoms or have been in contact with a person who has tested positive and they have a doctor's order.

Tricare spokesman Peter Graves said Thursday that policy remains in place but the Department of Defense is reexamining its rules.

"The Defense Health Agency is reviewing the latest guidance on at-home testing kits in order to identify whether any changes to the current policy are warranted," Graves said in an email to Military.com.

The new insurance reimbursement plan also does not apply to Medicare, which provides the primary coverage for military beneficiaries who use Tricare For Life – meaning those patients are also excluded under the initiative.

Despite not being covered under the federal program's reimbursement plan, Tricare users should still be able to get access to free tests.

As part of the announcement, the government will establish "thousands of locations," according to Biden, to distribute free take-home tests and will create a website for anyone to order free rapid antigen tests for delivery.

Beginning Jan. 19, anyone can order free tests for home delivery at www.COVIDTests.gov.

Some states like Vermont already have programs in place that require insurers to reimburse for tests. Other states, including Colorado, Connecticut, Iowa, Maryland, Massachusetts, New Hampshire, New Jersey and Washington, as well as the District of Columbia, already have been giving away free tests at COVID-19 test sites, community centers, libraries and community health clinics.

With the spread of the Omicron variant of the illness, test kits have remained in short supply at retailers and via community distribution.

Earlier this month, the Defense Department awarded contracts to a number of rapid antigen test makers, including Abbott, maker of the BinaxNOW test; iHealth Lab; and Roche Diagnostics for the purchase of 380 million over-the-counter tests, and to Goldbelt Security for distribution of a planned 500 million tests.

The DoD is the contracting agency because it has the infrastructure and capability to "acquire goods and services as rapidly and effectively as possible for the federal government in support of the American public," according to Pentagon spokeswoman Jessica Maxwell.

There have been more than 460,000 cases of COVID-19 diagnosed in the military community since the beginning of the pandemic, including military personnel, family members, civilian employees and contractors.

Nearly 650 have died, including 88 troops, 34 dependents, 394 civilians and 133 contractors, according to the DoD.

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Nearly 80 percent of Veterans surveyed said they trust the Department of Veterans Affairs to deliver their health care and benefits, a significant jump over past years’ levels according to federal officials.

The level matches the rate VA researchers found one year ago. As recently as 2016, only about 55 percent over Veterans surveyed said they had confidence in the department’s operations.

John Boerstler, VA’s chief Veterans experience officer, called the improvement since then an encouraging sign for the agency.

“These types of comments are incredibly important to us to know what’s going right and also what’s going wrong, so we can solve those important issues,” he said. “And so we’re continuing to ask all Veterans who are enrolled to fill out these surveys when they receive them, because we’re listening.”

The latest responses come from a survey of more than 257,000 Veterans nationwide who were asked by VA to rate their recent interactions with VA staff, including initial claim filings, appeals and health care appointments.

VA began focusing on better customer service and more internal assessments following the 2014 wait time scandal which forced the resignation of then-VA Secretary Eric Shinseki and caused widespread negative response to the department.

The surveys began during the final year of President Barack Obama’s term in office and continued throughout President Donald Trump’s administration, showing improvement during both.

The responses do not include Veterans outside the VA system, and participation in the survey was voluntary. As such, many individuals who are unhappy with VA or untrusting of the department could be self-selecting out of the surveys. The number of those individuals is unknown.

But the data has been collected in the same way each quarter for the last five years, showing a steady improvement over that time.

VA officials have collected more than 6 million surveys from Veterans over the last five years, but are making most of that data public for the first time now in an effort to increase transparency into their efforts at reform and improvements.

“As we continue to learn more about different populations that we know we can serve better and make VA a safer, more trustworthy, more respectful place for their care and for their benefits delivery, we’re going to continue to do that,” Boerstler said.

The survey showed some disparity among Veterans based on age and gender. Men were more likely to trust VA than women (80 percent to 74 percent). Veterans 50 and older were more trusting of the department (80 percent plus for all age groups) than Veterans 49 and younger (75 percent or lower for all age groups).

Differences between races were insignificant. Boerstler said the department is working on additional surveys to dig deeper into potential challenges and differences based on Veterans’ ethnicities.

The ongoing surveys — 88 are being circulated among Veterans connected to the VA system at the moment — will also be used to troubleshoot initiatives such as future vaccination efforts and new benefits deliveries.

Boerstler noted even with the 79 percent trust level, the negative side of the survey still translates into tens of thousands of Veterans with issues that the department needs to improve.

“[Veterans] can contact their patient advocate’s office … and when a Veteran leaves a compliment or concern or recommendation, we do follow up and address that,” he said. “We are not only learning and adjusting the delivery of care and benefits based on the feedback, but we do want to make sure they know they are being heard.”

The trust data is available at a new page on the VA web site.

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