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Madisonville man pled guilty to health care fraud

Posted: Friday, June 12, 2020 | Views: 2165

Madisonville man pled guilty to health care fraud


Press Release from the U.S. Attorney's Office:

NEW ORLEANS - The U.S. Attorney’s Office for the Eastern District of Louisiana, announced that DARREN M. MARTIN (“MARTIN”), age 44, of Madisonville, pled guilty on June 9, 2020 in federal court before U.S. District Judge Greg Guidry to Count 1 of an Indictment charging him with conspiracy to commit health care fraud, in violation of Title 18, United States Code, Section 1349 and 1347.

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 2019, Wiley pleaded guilty in the Southern District of Mississippi to one count of attempt and conspiracy to commit health care fraud.

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.

The Court set sentencing in this matter for September 8, 2020. MARTIN faces a maximum term of imprisonment of ten (10) years, a maximum $250,000 fine, three (3) years supervised release following any term of imprisonment, and a $100 special assessment fee.

The U.S. Attorney’s Office praised the work of the Federal Bureau of Investigation and the Defense Criminal Investigative Service.

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

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