Texas man scams TRICARE for more than $50 million

Dallas pharmacy president admitted to participating in a wide-ranging scheme to defraud the military insurance provider

Texas man scams TRICARE for more than $50 million

Life & Health

By Ryan Smith

A Dallas man has admitted to defrauding a military health insurance program for $50 million.

Andrew Joseph Baumiller, 58, pleaded guilty in federal court Tuesday to conspiracy to commit healthcare fraud. Baumiller and others conspired to scam TRICARE, the health insurance program for members of the military and their families. Baumiller faces up to 10 years in prison and a $250,000 fine, plus restitution.

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According to prosecutors, Baumiller and his co-conspirators – Richard Cesario, John Paul Cooper, Dr. Walter Simmons, Dr. William Elder-Quintana, Joe Larry Straw, Luis Rafael Rios, Michael John Kiselak and others – scammed TRICARE for more than $50 million between 2014 and 2016. Baumiller is the first defendant to plead guilty in the case.

Prosecutors suggested that Cesario and Cooper masterminded the scheme, which involved generating prescriptions by paying illegal kickbacks to TRICARE beneficiaries and doctors, as well as receiving kickbacks from four Texas-based compounding pharmacies in exchange for those prescriptions.

Baumiller, who was president of one of those pharmacies – Trilogy Pharmacy in Dallas – admitted that TRICARE paid Trilogy more than $50 million “tainted by the payment of illegal kickbacks,” the Department of Justice said. The DOJ estimates that TRICARE may have suffered actual losses of more than $100 million.

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Pharmacy owner charged in $10 million health insurance scam
US Marines used in $67 million insurance kickback scheme

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