A Madisonville Pharmacy Indicted with Conspiracy to Perpetrate Health Care Fraud

A Madisonville Pharmacy Indicted with Conspiracy to Perpetrate Health Care Fraud

New Orleans– The United States Attorney’s Office for the Eastern District of Louisiana announced on 26th February 2020 that Darren M. Martin, 44, an inhabitant of Madisonville, Louisiana, was indicted on 20th February 2020, with a single count of conspiracy to perpetrate health care fraud.

As per the charge, Martin was a licensed chemist in the State of Louisiana who possessed Willow (Willow Pharmacy Inc.), which was situated in Madisonville, Louisiana. Between 2012 and 2015, Willow ran as a closed-door chemist that was in the trade of blending and refilling prescriptions for compounded drugs that were remunerated by health care benefit systems, such as Blue Cross (Blue Cross and Blue Shield). In 2012, Martin, in place of Willow, effected a provider contract with CVS (CVS Caremark), a chemist benefit administrator for Blue Cross. According to the terms of the deal, Willow accepted to acquire copayments from Blue Cross-insured patients and also accepted that it would not surrender a copayment unless sanctioned by CVS to do so.

As per the charge, in or around June 2014, CVS informed Willow that Willow was to go through an audit. At around the same period, to hide the reality that Willow had not accepted copayments for the allegations at issue in the audit, Willow, using Martin, signed a contract with Wiley (Joseph L. Wiley, II) from Monroe, Louisiana and his enterprise AMS (Affordable Medication Solution LLC). The aim of the agreement was to make it look like willow accepted the copayments at issue in the CVS audit via AMS, an alleged secondary party. Between 2014 and 2015, as it performed its audit, CVS asked for information from willow, indicating that AMS accepted copayments in place of Willow for allegations at issue amounting to 567,710.39 USD in the CVS audit.

In reality, as per the charge, AMS never accepted copayments for Willow. If CVS were aware that Willow had not accepted copayments from Blue Cross-insured patients, it would have ended Willow’s provider contract. To hide the reality that Willow had not accepted copayments, Wiley generated falsified records, such as duplicates of backdated checks and payment advice, for some of the allegations at issue alleging to indicate that AMS accepted copayments for Willow and transferred those records to Martin. Despite being aware that AMS had not accepted copayments for Willow, Martin resulted in falsified declarations to be made to CVS, showing that AMS had accepted copayments for allegations at issue in the CVS audit for Willow.

If sentenced, Martin will face a maximum possible conviction of ten years in prison, approximately 3 years of supervised liberation, a fine of 250,000 USD, and a mandatory special evaluation of 100 USD.

The investigation for the case was conducted by the Defense Criminal Investigative Service and the Federal Bureau of Investigation. The United States Attorney’s Office for the Eastern District of Louisiana said that the charge was just an allegation and the defendant must be proven guilty beyond a reasonable doubt in a court of law.

The prosecution for the case was conducted by Assistant U.S. Attorney Kathryn McHugh and Jared Hasten of the Criminal Division’s Fraud Section.

You risk a severe imprisonment sentence and hefty fines if found guilty of breaching the False Claim Statute, Anti-Kickback Statute, or the Controlled Substance Act. Plotting to commit health care fraud by swindling state-sponsored programs such as TRICARE or Medicaid could also have you locked up in the big house as fast. Individuals accused of committing the above crimes are treated as lawbreakers, and they can face severe punishment when and if found guilty. When charged with any health care fraud-related offenses, seeking the services of an excellent and experienced legal team is a matter of when not if.

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