A Mississippi businessman was sentenced to 18 years in prison for his role in a $510 million health care fraud scheme.

U.S. Senior Judge Keith Starrett characterized Hattiesburg businessman Wade Walters,54,  as a kingpin in the scheme in what is most likely the state’s largest fraud case.

Walters was ordered to pay $287.7 million in restitution and fined $250,000. Additionally, he has to forfeit more than $56.5 million in cash and other assets.

The elaborate compounded pain cream scheme bilked TRICARE and other health benefits providers of more than $510 million.

During his allocation, Walters objected to being described as a kingpin, saying he didn’t start the fraud but got involved once it had begun.

Starrett disagreed and said the fraud would never have gotten so big if it had not been for Walters’ involvement.

“You organized and orchestrated the fraud by your management skills,” Starrett told Walters. “You involved so many people — good people. Maybe they would not have been involved if they hadn’t been recruited (by Walters).”

Starrett said Walters was not just stealing money. He was also cheating on his taxes.

Starrett said the fraud caused TRICARE to cut some of its medical programs for veterans and their families and was so big that TRICARE had to ask the government for more money to keep operating.