United States Attorney David Metcalf announced that Scottie Girl, LLC, operating as The Breastfeeding Shop in Emmaus, Pennsylvania, and its owner Patricia Gatter have agreed to pay $1 million to resolve allegations of submitting false claims for reimbursement for breast pumps and related equipment provided to TRICARE beneficiaries.
TRICARE is the health care program managed by the Defense Health Agency for U.S. military service members, retirees, and their families worldwide. In 2015, TRICARE introduced a new benefit covering breast pumps and related equipment for nursing mothers.
According to the United States, The Breastfeeding Shop billed TRICARE significantly more per breast pump than it charged the Pennsylvania Medicaid Program during the early years of this benefit. This practice constituted a prohibited dual fee schedule. Additionally, it was alleged that The Breastfeeding Shop engaged in “unbundling” by billing TRICARE separately for accessories that were already included in standard breast pump kits as replacement parts.
“Durable medical equipment suppliers play a vital role in providing safe and effective medical products to patients in need, and especially to our brave service members and their families,” said U.S. Attorney Metcalf. “As alleged, The Breastfeeding Shop and Gatter prioritized their own financial interests through a billing scheme that was to the detriment of the government. This conduct will not be tolerated by my office.”
Christopher M. Silvestro, Acting Special Agent in Charge of the Defense Criminal Investigative Service Northeast Field Office, stated: “Today’s settlement is a direct result of the relationship we have with our partners at the Department of Defense Office of Inspector General’s Audit component and the Department of Justice.” He added: “Fraud involving TRICARE, the healthcare system for military members and their families, is something we take seriously and will investigate fully.”
Dr. Glen Diehl, Acting Deputy Director of the Defense Health Agency, commented: “Protecting the integrity of the TRICARE program and ensuring responsible stewardship of taxpayer dollars are top priorities for the Defense Health Agency. This settlement sends a clear message that we will not tolerate practices that exploit the program and inflate costs at the expense of our service members, veterans, and their families. Access to essential medical equipment, like breast pumps, is vital for the health and well-being of new mothers and infants within our TRICARE community. We thank the U.S. Attorney’s Office and the Defense Criminal Investigative Service for their continuing dedication to the pursuit of justice.”
The case was handled by Assistant United States Attorney Judith Amorosa along with former Auditor Dawn Wiggins from the Eastern District of Pennsylvania. The investigation was conducted by agents from Defense Criminal Investigative Services under the U.S. Department of Defense.
It was noted that these claims are allegations only; there has been no determination of liability.