A former pharmacist is to pay restitution of nearly $29 million and a $16 million monetary judgement, for his role in a “massive” health care fraud
US media including the Mississippi Clarion Ledger are reporting on the case of Marco Moran, who in September 2018 pleaded guilty to a count of conspiracy to commit health care fraud.
The fraud centred around a scheme to defraud Tricare – the health care program for uniformed service members, retirees, and their families – and other health care benefit programs, including those that provided coverage to employees of the city of Jackson, Mississippi.
At the time of the fraud, between 2014 and 2016, Mr Moran was the co-owner of the Medworx Compounding and Custom Care Pharmacy.
He had been licensed to practise pharmacy in Louisiana between 1998 and 2001, but his license was suspended; a Texas license, dating from 2002, was revoked due to disciplinary action. Mr Moran also held pharmacist registration in the state of Tennessee from 2007 to 2009.
The scheme involved expensive compounded pain creams and vitamin pills, some of which cost up to US$15,000 (AUD$19,756) each.
Mr Moran was one of more than 20 people convicted over the fraud.
“In total, the pharmacies submitted $22,068,144 (more than AUD$29 million) in fraudulent claims to Tricare and other health care benefit programs,” said Acting U.S. Attorney Darren J. LaMarca, Special Agent in Charge Michelle Sutphin of the Federal Bureau of Investigation in Mississippi, Special Agent in Charge James Dorsey of IRS Criminal Investigation (IRS-CI), Special Agent in Charge Cynthia Bruce of Defense Criminal Investigative Services (DCIS) Southeast Field Office, and Director Steven Maxwell of the Mississippi Bureau of Narcotics (MBN) in a media release.
“As part of the scheme, Moran and his co-conspirators, among other things, adjusted prescription formulas to ensure the highest reimbursement, paid marketers and physicians kickbacks and bribes to obtain prescriptions for high-yield compounded medications irrespective of whether they were medically necessary, and routinely waived and/or reduced the collection of copayments.”
He appeared before a Federal Court in Hattiesburg, Mississippi this week and was sentenced to 10 years in prison, followed by three years of supervised release.
He was also ordered to pay a monetary judgement of $12,195,740 (more than AUD$16 million), restitution in the amount of $22,096,697 (AUD$29.1 million), and a $20,000 fine (AUD$26,342).
Reporter Lici Beveridge writes that the former pharmacist apologised to the court, the US Government and his children and grandchild.
“This is not in my character,” he said, before sentencing. “I’ve learned my lesson in this.”
In his sentencing remarks, US Senior Judge Keith Starrett said that Mr Moran had been “caught up in this greed, this evil”.
“I’ve seen a lot of shows in my career as a judge and seen a lot of very sad cases through the years,” Judge Starrett said.
“The sad thing is the tremendous ability and potential you have for good.
“This involved so many people, so many lives ruined, so many careers lost.”
In November 2019, the AJP reported on the case of Thomas Spell Junior, another pharmacist who worked at Medworx and was part of the fraud scheme. Mr Spell was also handed a 10-year prison sentence and ordered to repay the entire amount he had falsely claimed.