The federal government saw a spike in utilization in the prescription compounding industry that led investigators to an estimated $2 billion in fraud in claims to Tricare nationally beginning in 2013 and running into last year. There have been civil settlements and federal investigators said criminal charges are likely early this year.

Across the country compounding pharmacies were charging as much as $10,000 to $20,000 each for prescriptions and some hired marketers who used Facebook and other social media to target military families, enticing them with inclusion in research studies and telling them of creams and salves that were pain relievers, migraine headache medicines and scar reducers, said Jason Mehta, a Jacksonville-based assistant U.S. attorney for the Middle District of Florida.

The cost to actually compound these creams was often only about 5 percent of the submitted cost, according to the Department of Justice. Compounding pharmacies were making in the range of 90 percent profit on each prescription.

According to the Defense Health Agency that oversees Tricare, costs for compound drugs skyrocketed from $5 million in 2004 to $514 million in 2014. Costs topped $1 billion in the first six months of 2015. Tricare went to Congress for help so the agency could make the payments, and rules were changed to make approvals of compound prescriptions more stringent. The agency was on track to lose $2 billion in 2015 alone until the controls were put in place in May, said George Jones, chief of pharmacy operations at the agency.

The safeguards have resulted in a 98 percent reduction in cost, he said.

Of the $2 billion in estimated fraud, about $500 million is believed to have occurred in Florida, Mehta said. One-quarter to a third of that was in the Jacksonville region. Since March the U.S. Attorney’s Office that covers Florida from Jacksonville to Fort Myers has collected at least $50 million in civil settlements related to compounding pharmacies.

Investigations are taking place in other states, Mehta said. In Mississippi recently about 1,000 federal agents conducted a mass seizure of about $15 million, as well as boats, cars and airplanes all related to compounding cases, Mehta said. So far Florida is the only state to have settlements.