Pharmacist in New Orleans charged with healthcare fraud

Pharmacist in New Orleans charged with healthcare fraud

Darren Martin of Madisonville, Louisiana was given sentencing before the court In the Eastern District of Louisiana for conspiracy to commit healthcare fraud. The accused is a licensed pharmacist who had access to operations as a closed-door pharmacy, therefore was able to commit healthcare fraud. The investigation revealed that Martin was an owner of Willow Pharmacy, Inc., based in Madisonville, Louisiana, and would often mix and fill prescriptions that were deemed medically unnecessary, in order to collect reimbursements from government agencies and other healthcare benefit programs. This included the services of the institutions Blue Cross and Blue Shield.

According to legal reports, these illegal practices were carried out from 2012 to 2015 and were made easier to carry out due to the fact that Martin was in agreement with CVS, which is a pharmacy benefit manager for the Blue Cross. This meant that, according to the agreement, Willow Pharmacy was able to collect several thousand in co-payments from the patients covered by Blue Cross. Martin also ensured that he would not have to waive the co-payment unless it was authorized by CVS. Thereby, Martin’s operations came under scrutiny by means of an audit.

Investigations revealed that during the time he was being audited, Martin had sought out the services of Joseph I. Wiley, II., belonging to Monroe, Louisiana, through his company Affordable Medication Solutions, LLC. This was done through Willow Pharmacy, and the contract was thereby drawn up to ensure Willow would be able to successfully collect co-payments when the CVS audit occurred, through AMS, which was a purported secondary payer. During the years 2014 and 2015, it was reported that CVS had put in a request for information from Willow Pharmacy, asking to substantiate the claim that AMS had indeed already collected the co-payments made on behalf of Willow, which came up to $567,710.39 in claims during the CVS audit.

As per the indictment, however, it was revealed that AMS had not, in fact, collected the aforementioned co-payments for Willow. If CVS was informed about Willow’s lack of collection of the co-payments from the patients covered by Blue-Cross, the contract would have been terminated for Willow. To hide this fact, Wiley was pursued to ensure that he could create false documentation that would include fabricated checks and remittance advice. These falsified documents would aim to show that AMS had indeed collected co-payments for Martin’s pharmacy and that he had received those documents.

Thus, Martin wad fully aware of his involvement in the aforementioned fraud and had designed the false statements that were made to CVS that would indicate that AMS had collected the earlier co-payments for the claims of reimbursement during the CVS’s audit for Martin’s pharmacy, Willow. The court charged Martin for healthcare fraud, sentencing him with a 10-year prison sentence and up to three years of supervised release. He was also sentenced to pay a $250,000 fine and a $100 special assessment.

The law enforcement authorities connected with this case were quick to assess Martin’s case as being harrowing in the way it had committed a long-con, concealing lies and secrets with layers and causing complications that affected many different operations. If you or anyone you know is in need of legal assistance, or is involved in a similar situation and would require help with the legalities of healthcare fraud, please feel free to contact the Healthcare Fraud Group on 888-402-4054 for a free consultation.

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