Modern Day Robin Hood? MADISONVILLE PHARMACIST CHARGED WITH CONSPIRACY

SIAP.

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MADISONVILLE PHARMACIST CHARGED WITH CONSPIRACY TO COMMIT HEALTH CARE FRAUD

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Quoted the whole article because its a FB link.

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NEW ORLEANS - The United States Attorney’s Office, Eastern District of Louisiana announced that DARREN M. MARTIN, age 44, a resident of Madisonville, Louisiana, was charged on February 20, 2020 with one count of conspiracy to commit health care fraud.

According to the Indictment, MARTIN was a licensed pharmacist in the State of Louisiana who owned Willow Pharmacy, Inc. (“Willow), which was located in Madisonville, Louisiana. Between 2012 and 2015, Willow operated as a closed-door pharmacy that was in the business of mixing and filling prescriptions for compounded medications that were reimbursed by health care benefit programs, including Blue Cross & Blue Shield (“Blue Cross”). In 2012, MARTIN, on behalf of Willow, executed a provider agreement with CVS Caremark (“CVS”), a pharmacy benefit manager for Blue Cross. Under the terms of the agreement, Willow agreed to collect copayments from Blue Cross-covered patients and further agreed that it would not waive a copayment unless authorized by CVS to do so.

According to the Indictment, in or around June 2014, CVS notified Willow that Willow was the subject of an audit. At around the same time, to conceal the fact that Willow had not collected copayments for the claims at issue in the audit, Willow, through MARTIN, contracted with Joseph L. Wiley, II (“Wiley”) of Monroe, Louisiana and his company Affordable Medication Solutions, LLC (“AMS”). The purpose of the contract was to make it appear that Willow collected the copayments at issue in the CVS audit through AMS, a purported secondary payer. Between 2014 and 2015, as it conducted its audit, CVS requested information from Willow substantiating that AMS collected copayments on behalf of Willow for $567,710.39 worth of claims at issue in the CVS audit.

In actuality, according to the Indictment, AMS never collected copayments for Willow. Had CVS known that Willow had not collected copayments from Blue Cross-covered patients, it would have terminated Willow’s provider agreement. To conceal the fact that Willow had not collected copayments, Wiley created false documents, including copies of backdated checks and remittance advices, for certain of the claims at issue purporting to show that AMS collected copayments for Willow and sent those documents to MARTIN. Despite knowing that AMS had not collected copayments for Willow, MARTIN caused false statements to be made to CVS indicating that AMS had collected copayments for the claims at issue in the CVS audit for Willow.

If convicted, MARTIN faces a possible maximum sentence of 10 years’ imprisonment, up to three years of supervised release, a $250,000 fine, and a mandatory $100 special assessment.

The case is being investigated by the Federal Bureau of Investigation and the Defense Criminal Investigative Service. The United States Attorney’s Office, Eastern District of Louisiana stated that the Indictment is merely a charge and that the guilt of the defendant must be proven beyond a reasonable doubt.

The prosecution of the case is being handled by Jared Hasten of the Criminal Division’s Fraud Section and Assistant U.S. Attorney Kathryn McHugh.

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Big pharma wins?
So apparently instead of collecting co-pays on the spot, he was billing the customers, but if they couldn't pay he wasn't sending them to collections to recoup the money.
Definitely understand the breach of contract, and falsifying documents, but feel bad for the guy for trying to help people out and getting in trouble for it. He's got a lot of fans in the comment section of the article.

ETA: someone who worked for him said that he's going to pay a 250k fine and probation, but I haven't seen that reported anywhere.