Given an enticing enough opportunity, almost anyone can be bought off in the absence of ethical expectations and ethical training, including physicians, pharmacists and members of the military. Pain cream kickbacks and massive fraud ensnare, otherwise good people.
The scandal we are about to examine has so far cost us, taxpayers, at least $65 million. Imagine you are a member of the military, the U.S. Marines, and a physician offers you a deal 
too good to refuse. Here’s the scam. The doctor will write you a prescription for a specialty pain cream you don’t need, and in fact, when the cream is shipped to you all you need do is throw it out. By the way, the doctor is in Tennessee and you have no idea who he is, just a friend of a buddy. The actual cream is compounded in another state. For your trouble, you get a kick-back. Who could it possibly hurt?
The scandal got uncovered almost completely by accident. I describe it in that manner as arrogance helped to create the scandal. No one seemed to care, and apparently, no one was bothered.
An investigative reporter who happened to know the Marine was visiting the young man in his quarters, just for casual conversation. The reporter glanced about the spartan quarters and noticed tubes of prescription cream. He wondered what they were. To the reporter’s surprise, the Marine said he had no idea. He related that a buddy got him involved and that he was one of a dozen Marines getting kickbacks for something they never ordered, didn’t want and threw away.
Uncovering the Fraud
The reporter asked the Marine if he wouldn’t mind diverting the samples to him. Sure, why not? After two sets of samples arrived, the reporter grew suspicious that some kind of fraud was occurring.
From that beginning, the investigative reporter and the government exposed a scandal on top of a scandal involving fraud that spread across four states that involved scamming the military insurance program known as Tricare.
The players included a “prescription mill” known as Choice MD, the compounding pharmacy, The Medicine Shoppe, two physicians and a nurse practitioner in another location who were convinced to write prescriptions for people they never met, and 12 Marines are all guilty of fraud in excess of $65 million. The pain/scar removal cream was made from scratch. The cream was unbelievably priced at $14,500 per tube.
The doctors grew wealthy. Though they said that they were aware that something “wasn’t right,” they were far from the biggest beneficiaries. As rich as they became, the compounding pharmacy with its four pharmacists became wealthier, and the prescription mill pushing the whole scam was wealthier still. In total, the 12 Marines had more than 4,500 cream prescriptions written for them. The Marines were duped, the biggest fool of all being the sucker who got talked into recruiting his buddies. The Marines got a grand total of $300 each month for their participation, not even chicken-feed in the overall scheme of things.
Where fraud thrives
I have only touched upon the complexities of this massive fraud however, it always boils down to the same three elements: opportunity, need and rationalization. Tricare was viewed as a giant bank account with hundreds of millions of dollars ripe for the taking. It was an opportunity.
The compounding pharmacists and physicians saw it as a huge government program where the money that had been placed in it was “anonymous.” It wasn’t a crime against any person per se, but withdrawals of bags of cash from a “wasteful” government agency.
The need is obvious: cash. They wanted more money, they wanted the power that it would bring.
The rationalization here underscores what happens in the absence of ethical training. That stealing just didn’t matter because the government is a huge entity where “no one cares.” We often equate education with ethics. It is a huge mistake. This fraud involved physicians, pharmacists, and nurses, people presumably educated at the very highest levels of our school systems. They were crooks despite education and wealth. Something terrible is lacking.
In the absence of meaningful ethical training, this is what our society gets for professionals. Pain cream kickbacks and massive fraud could have been avoided.
