1. 

2. 

ITED STATES DISTRICT COURT 

FILED 

WESTERN DISTRICT OF TEXAS FE 0 5 2020 

SAN ANTONIO DIVISION 

CLER'11" DIsTrcT COURT 

O TEXAS 

UNITED STATES OF AMERICA, ) Criminal No. --7t7 

Plaintiff, SA2 Q CR0095 

v. ) INDICTMENT 

) 

JOSHUA LOPEZ (1), ) VIO: 18 USC § 371 & 

) 42 USC § 1320a-7b(b)(1) 

CHRISTOPHER MONTOYA (2), ) Conspiracy to Receive Health Care 

) Kickbacks; 18 USC § 1343 Wire 

) Fraud 

Defendants. ) ) THE GRAND JURY CHARGES: 

COUNT 1 

[18 U.S.C. § 371] 

Introduction 

At all times material to this Information: 

TRICARE 

TRICARE is a health care program of the United States Department of Defense (DoD) 

Military Health System that provided coverage for DoD beneficiaries world-wide, 

including active duty service members, National Guard and Reserve members, retirees, 

their families, and survivors. Individuals who are insured by TRICARE will be referred to 

as TRICARE beneficiaries.. 

TRICARE was a "health care program" as defined by 42 U.S.C. § 1320a-7b(b)(f), that 

affected commerce, and as that term is used in 42 U.S.C. § 1320a-7b(b). 

Case 5:20-cr-00095-FB Document 3 Filed 02/05/20 Page 1 of 11
3. TRICARE provided coverage for certain prescription drugs, including certain compounded 

drugs, which were medically necessary and prescribed by a licensed physician. Express 

Scripts, Inc. (Express Scripts) administered TRICARE'S prescription drug benefits. 

Compounding 

4. Compounding is a practice in which a licensed pharmacist, a licensed physician, or a person 

under the supervision of a licensed pharmacist, combines, mixes, or alters ingredients of a 

drug or multiple drugs to create a drug tailored to the specific needs of an individual patient. 

Compounded drugs are not FDA-approved, that is, the FDA does not verify the safety, 

potency, effectiveness, or manufacturing quality of compounded drugs. 

5. Compounded drugs may be prescribed by a physician when an FDA-approved drug does 

not meet the health needs of a particular patient. For example, if a patient is allergic to a 

specific ingredient in an FDA-approved medication, such as a dye or a preservative, a 

compounded drug can be prepared for that patient which excludes the substance that 

triggers the allergic reaction. 

CO-CONSPIRATORS 

6. A company known to the Grand Jury but referred to herein as Company 1 was a Texas 

Limited Liability Company having an office in San Antonio, Texas. Co-conspirator l(CC1), not charged herein, was the owner of Company 1 and routinely exerted direct control 

over various aspects of the operations of Company 1 that are relevant to this Indictment. 

7. CC-i, entered into an agreement with a pharmacy, known to the Grand Jury, but referred 

to herein as Pharmacy 1 to receive kickbacks from Pharmacy 1 for every compounded 

prescription that was referred to Pharmacy 1 by Company 1, CC-i or others working with 

CC-i. Pharmacy.1 had ffs principal place of business in California. 

Case 5:20-cr-00095-FB Document 3 Filed 02/05/20 Page 2 of 11
8. Defendant JOSHUA LOPEZ owned and operated Coastal Management Group, a Texas 

corporation. 

9. Co-Conspirator 2 (CC-2), not charged herein, was a member of the Texas Air National 

Guard. 

10. Defendant CHRISTOPHER MONTOYA was a licensed physician's assistant, authorized 

under the law to write prescriptions for, among other things, compounded drugs. 

11. Between on or about February 1, 2015 through on or about June 30, 2015 in the Western 

District of Texas, and elsewhere, the defendants, 

JOSHUA LOPEZ 

and 

CHRISTOPHER MONTOYA, 

together with coconspirators who are not charged herein, did knowingly and willfully 

combine, conspire, confederate, and agree with each other to commit offenses against the 

United States, that is, to knowingly and willfully solicit, receive, offer, pay, and aid and assist 

in the soliciting, receiving, offering and paying of remuneration (including any kickback, 

bribe, and rebate) directly and indirectly, overtly and covertly, in cash and in kind, in return 

for 

a. referring an individual to a person for the furnishing, and arranging for the furnishing, 

of any item and service for which payment may be made in whole or in part under a 

federal health care program, and/or 

b. purchasing, leasing, ordering, or arranging for or recommending purchasing, leasing, 

or ordering any good, facility, service and item for which payment may be made in 

whole or in part under TRICARE, a federal health care program, in violation of Title 

42, United States Code, Sections 1320a-7b(b)(l)(A) and (B); and 1320a-7b(b)(2)(A) 

Case 5:20-cr-00095-FB Document 3 Filed 02/05/20 Page 3 of 11
and(B). 

Objective 

12. The objective of the conspiracy was to enrich LOPEZ, MONTOYA, CC-i, CC-2, and 

Pharmacy 1. 

Manner and Means 

13. As part of the manner and means of the conspiracy LOPEZ and MONTOYA, and their coconspirators, devised and executed a scheme to defraud TRICARE by making and 

receiving kickbacks in connection with the prescription of compounded drugs to TRICARE 

beneficiaries. 

14. As part of the scheme, CC-2 induced members of his military unit who were TRICARE 

beneficiaries to fill out computer health surveys. CC-2 advised the TRICARE beneficiaries 

that if they completed the surveys they would get pain creams and/or weight loss aids that 

would be fully paid for by TRICARE. The online surveys required the TRICARE 

beneficiaries to provide information such as their social security number and date of birth 

as well as other general information. 

15. As part of the scheme, CC-i sent the TRICARE beneficiaries' information to MONTOYA, 

who then wrote a prescription for one or more compounded drugs without ever examining 

or even speaking with the TRICARE beneficiaries, which MONTOYA then returned to 

CC-i. 

16. As part of the scheme, CC-i then sent the prescription to Pharmacy 1. Pharmacy 1 would 

then either fill the prescription itself or send the prescription to another pharmacy who 

would fill the prescription for Pharmacy 1. Pharmacy I or the pharmacy working with 

Pharmacy 1 then billed TRICARE for the prescription. Pharmacy 1 paid CC- 1 a percentage 

ru 

Case 5:20-cr-00095-FB Document 3 Filed 02/05/20 Page 4 of 11
of the money obtained from TRICARE as a kickback for each prescription referred by CC2 and other co-conspirators both known and unknown. 

17. As part of the scheme, CC-i paid CC-2 a monetary kickback for every TRICARE 

beneficiary that CC-2 got to complete the online survey and for which TRICARE was 

billed. These payments were made by CC-i to Coastal Management Group, and LOPEZ 

then paid the money to CC-2 through Coastal Management Group's bank accounts. 

18. As part of the scheme CC-i paid MONTOYA a monetary kickback for every TRICARE 

beneficiary prescription written by MONTOYA for which TRICARE paid Pharmacy 1. 

19. In some instances, CC-2 induced TRICARE beneficiaries to fill out the online surveys by 

giving them iPads or laptop computers. In other instances, when TRICARE beneficiaries 

who had completed the online survey did not receive their compounded prescription, CC2 would give them an iPad or laptop computer. 

20. While the prescriptions submitted to Pharmacy 1 bore the signature of MONTOYA, the 

TRICARE beneficiaries did not see or consult with MONTOYA. In fact, the TRICARE 

beneficiaries did not see or consult with any medical professionals in order to obtain the 

prescriptions, but instead only filled out the online survey. 

21. It was part of the scheme that payment for the prescriptions were submitted to TRICARE 

electronically. Payment requests to TRICARE falsely represented material facts, namely, 

that there was a medical necessity for the prescription being billed and that MONTOYA 

had a medical relationship with the TRICARE beneficiary being billed for the prescription. 

22. During the course of the conspiracy, LOPEZ, MONTOYA, and their co-conspirators 

caused TRICARE to be billed more than $3.5 million. 

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Case 5:20-cr-00095-FB Document 3 Filed 02/05/20 Page 5 of 11
Overt Acts 

23. In furtherance of the conspiracy and to effect its objects and purposes, the conspirators 

committed the following overt acts and others: 

a. On or about February 11, 2015 LOPEZ, MONTOYA, CC-i, CC-2, and Pharmacy 1 

caused TRICARE to be billed $74,282.30 for prescriptions in the name of TRICARE 

beneficiary CC-2. 

b. On or about February 12, 2015 LOPEZ, MONTOYA, CC-i, CC-2, and Pharmacy 1 

caused TRICARE to be billed $74,282.30 for prescriptions in the name of TRICARE 

beneficiary 1. 

c. On or about February 21, 2015 LOPEZ, MONTOYA, CC-i, CC-2, and Pharmacy 1 

caused TRICARE to be billed $59,362.33 for prescriptions in the name of TRICARE 

beneficiary 2. 

d. On or about February 23, 2015 LOPEZ, MONTOYA, CC-i, CC-2, and Pharmacy 1 caused TRICARE to be billed $59,362.33 for prescriptions in the name of TRICARE 

beneficiary 3. 

e. On or about February 26, 2015 LOPEZ, MONTOYA, CC-i, CC-2, and Pharmacy 1 

caused TRICARE to be billed $59,362.33 for prescriptions in the name of TRICARE 

beneficiary 4. 

f. On or about March 26, 2015 LOPEZ, MONTOYA, CC-i, CC-2, and Pharmacy 1 through 

a pharmacy working with Pharmacy 1 caused TRICARE to be billed $166,080.19 for 

prescriptions in the name of CC-2. 

g. On or about March 26, 2015 LOPEZ, MONTOYA, CC-i, CC-2, and Pharmacy 1 

through pharmacy working with Pharmacy lcaused TRICARE to be billed $78,352.67 for 

Case 5:20-cr-00095-FB Document 3 Filed 02/05/20 Page 6 of 11
prescriptions in the name of TRICARE beneficiary 5. 

h. On or about March 26, 2015 LOPEZ, MONTOYA, CC-i, CC-2, and Pharmacy 1 

through a pharmacy working with Pharmacy 1 caused TRICARE to be billed $33,395.36 

for prescriptions in the name of TRICARE beneficiary 6. 

i. On or about April 6, 2015 LOPEZ, MONTOYA, CC-i, CC-2, and Pharmacy 1 through 

a pharmacy working with Pharmacy 1 caused TRICARE to be billed $161,824.57 for 

prescriptions in the name of TRICARE beneficiary 7. 

j. On or about April 6,2015 LOPEZ, MONTOYA, CC-i, CC-2, and Pharmacy 1 through 

a pharmacy working with Pharmacy 1 caused TRICARE to be billed $50,399.21 for 

prescriptions in the name of beneficiary 6. 

k. From on or about December 12, 2014 through on or about April 20, 2015, Company 1 and/or CC-i received approximately $3,405.293.iO from Pharmacy 1 as payments for 

prescriptions referred to Pharmacy 1 by Company 1, LOPEZ, CC-i, CC-2, and others both 

known and unknown that were billed to TRICARE. 

1. From on or about March 25, 2015 through on or about April 22, 2015, LOPEZ and/or 

Coastal Management Group received approximately $983,517.56 from Pharmacy 1 as 

payments for prescriptions referred to Pharmacy 1 by Company 1, LOPEZ, CC-i, CC-2, 

and others both known and unknown, that were billed to TRICARE. 

m. From on or about March 19, 2015 through on or about April 23, 2015 CC-2 received 

approximately $82,000 from LOPEZ, CC-i, and Pharmacy 1 as payments for prescriptions 

that CC-2 referred and that were billed to TRICARE. 

All in violation of Title 18, United States Code, Section 371. 

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Case 5:20-cr-00095-FB Document 3 Filed 02/05/20 Page 7 of 11
COUNTS TWO THROUGH NINETEEN 

[18 U.S.C. § 1343] 

The Introduction to Count One of this Indictment is incorporated herein as if fully 

restated. 

The Scheme 

Between on or about February 1, 2015 through on or about June 30, 2015 in the Western 

District of Texas, and elsewhere, the defendants, 

JOSHUA LOPEZ 

and 

CHRISTOPHER MONTOYA, 

aided and abetted by CC-i and CC-2, did knowingly and willfully did unlawfully, willfully, and 

knowingly devise and execute a scheme to defraud TRICARE and to obtain money by means of 

false and fraudulent pretenses, representations and promises through the actions set forth in the 

"Manner and Means" portion of Count One, which are incorporated herein as if fully restated. 

The Executions of the Scheme 

On or about the date stated below, for the Count listed below, in the Western District of 

Texas and elsewhere, the defendants, 

JOSHUA LOPEZ 

and 

CHRISTOPHER MONTOYA, 

aided and abetted by CC-i and CC-2, and for the purpose of executing the scheme to defraud and 

to obtain money by means of false and fraudulent pretenses, representations and promises, 

transmitted and caused to be transmitted by wire iii.interstate and foreign commerce email 

sending prescriptions for a named TRICARE beneficiary, known to the Grand Jury but identified 

herein only by initials from CC-i in San Antonio, Texas, to Pharmacy 1 in California, as set 

forth below. 

Case 5:20-cr-00095-FB Document 3 Filed 02/05/20 Page 8 of 11
Count Date TRICARE Beneficiary Claim amount 

Two 2/11/2015 J.G. $59,362.33 

Three 2/12/2015 G.G. $74,282.30 

Four 2/23/2015 T.C. $54,255.26 

Five 2/17/2015 J.H. $59,362.33 

Six 2/18/2015 I.G. $59,362.33 

Seven 2/20/2015 R.H. $59,362.33 

Eight 2/21/2015 T.M. $59,362.33 

Nine 2/21/2015 L.M. $59,362.33 

Ten 2/23/2015 W.B.D.R. $59,362.33 

Eleven 2/23/2015 K.W. $59,362.33 

Twelve 2/24/2015 M.R. $59,362.33 

Thirteen 2/24/2015 Z.P. $59,362.33 

Fourteen 2/24/2015 C.P. $59,362.33 

Fifteen 2/24/2015 A.M. $59,362.33 

Sixteen 3/13/2015 V.D. $90,442.03 

Seventeen 3/14/2015 V.D. $32,679.90 

Eighteen 3/14/2015 M.D. $123,121.93 

Nineteen 3/26/2015 J.G. $166,080.19 

All in violation of Title 18, United States Code, § 1343. 

Case 5:20-cr-00095-FB Document 3 Filed 02/05/20 Page 9 of 11
NOTICE OF UNITED STATES OF AMERICA'S DEMAND FOR FORFEITURE 

[See Fed. R. Crim. P. 32.21 

I. Health Care Fraud Violations and Forfeiture Statute 

[Title 18 U.S.C. § 371 and 1343 and Title 42 U.S.C. § 1320a-7b(b)(1), 

subject to forfeiture pursuant to Title 18 U.S.C. § 982(a)(7)] 

As a result of the foregoing criminal violations set forth in Counts One through Thirteen, 

the United States of America gives notice to the Defendants of its intent to seek the forfeiture of 

property, including the below described properties, upon conviction and pursuant to Fed. R. Crim. 

P. 32.2 and Title 18 U.S.C. § 982(a)(7), which states: 

Title 18 U.S.C. § 982. Criminal forfeiture 

(a)(7) The court, in imposing sentence on a person convicted of a Federal 

health care offense, shall order the person to forfeit property, real or 

personal, that constitutes or is derived, directly or indirectly, from gross 

proceeds traceable to the commission of the offense. 

This Notice of Demand for Forfeiture includes but is not limited to the properties described 

below in Paragraphs IT-TV. 

II. 

Real Property 

Real Property located and situated at 12526 Red Maple Way, San Antonio, Texas 

78253, Bexar County, Texas with all buildings, appurtenances, and 

improvements, thereon and any and all surface and sub-surface rights and interests, 

if any, and being more fully described as: 

Lot 4, Block 32, ALAMO RANCH UNIT 10, a Subdivision in Bexar County, 

Texas, According to the map or plat thereof recorded in Volume 9612, pages 170- 

172, Deed and Plat Records of Bexar County, Texas. 

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Case 5:20-cr-00095-FB Document 3 Filed 02/05/20 Page 10 of 11
III. 

Money Judgment 

Money Judgment: A sum of money which represents the proceeds derived, 

directly or indirectly, as a result of the violations set forth above for which each 

Defendants is solely liable. 

Iv. 

Substitute Assets 

If any of the proceeds, including the property described above, subject to forfeiture for the 

violations set forth above, as a result of any act or omission of the Defendants: 

a. cannot be located upon the exercise of due diligence; 

b. has been transferred or sold to, or deposited with, a third party; 

c. has been placed beyond the jurisdiction of the court; 

d. has been substantially diminished in value; or 

e. has been commingled with other property which cannot be divided without 

difficulty; 

it is the intent of the United States of America to seek forfeiture of any other property, up to the 

value of said money judgment, as substitute assets pursuant to Title 21 U.S.C. § 853(p) and Fed. 

R. Crim. P. 32.2(e)(1). 

JOHN F. BASH 

United States Attorney 

;; IT1IAM R. HARRIS 

Assistant United States Attorney 

isfi cc 

Assistant United States Attorney 

11 

A TRUE BILL 

FOKEPERSON 

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