Back in January the bottom fell out of the world of some high profile individuals here in the Pine Belt. Their jet set lives became grounded in a new reality of seizure notices for allegedly defrauding our veterans, workman’s compensation, and insurance companies. If charges are indeed filed against individuals by the U.S Attorney’s office, lavish lifestyles and #1200DollarPants could be exchanged for federal prison jail and over sized, orange jumpsuits.
The story broke with a whimper on a local TV station, then, a few days later, a source of sources contacted this site, and the Hattiesburg Patriot broke the story wide open over the span of three weeks.
Over a period of a few weeks on HP Facebook, names like Brett Favre, Bus Cook (Favre’s agent), Dr. Joe Story (the co-founder of the Andrew’s Institute), Wade Walters, Joelle Smith (pro bodybuilder, and wife to prominent cardiologist Randall Smith), Hope Thomley, Doyle Beech, and others were were reported on this site’s Facebook page.
After the news broke, and information flooded in to this site, it became apparent that there were two main cream syndicates in action. One was world Health Industries (connected to Brett Favre), and the other was the Advantage Pharmacy Syndicate connected to Wade Walters, Hope Thomley, Joelle Smith, and Doyle Beach. All four had millions of dollars in property seized in total. It also became apparent that the FBI had a medicare and Tricare fraud expert on the case.
And here on this site, for the first time, exclusive details will be revealed that have never before been made public. But first, the foundation must be laid with the declaration of Special Agent Darren Mayer. test
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Under Facts and Circumstances #2, Agent Mayer asserts that the pharmacies involved engaged in a fraud tactic called “price rolling.” He states,” This type of fraud occurs when a pharmacy employee submits a claim to an insurance provider to ‘test’ the amount of reimbursement for a specific prescription. The claim is often retracted or cancelled and a ‘new’ claim is submitted using a different compounding formulation to determine if the ‘new’ claim is reimbursed at a higher rate.”
Split Billing is when a prescription that is written for a specific period (e.g. 30 days) is split into multiple, smaller prescriptions. Pharmacies avoid caps for prescriptions and get to add on multiple “dispensing fees,” regardless if the medications are actually sent separately.
The subject pharmacies are known to automatically refill prescriptions in spite of doctor’s orders and/or patient’s wishes not to refill the prescriptions. In some instances, patients were offered payments, or told to destroy the medications, to keep the patients from cancelling the automatic refills or from returning the medications. If a patient returns the medication, the pharmacy is obliged to reverse its claim to the insurance program.
WAIVING / PAYING CO-PAYS
In order to keep patients using their product, many pharmacies would tell their patients that they don’t have to pay a co-pay or make no effort to collect the co-pay. Some pharmacies would offer “co-pay” rebates, or they would even pay the copay using their green dot card., thereby creating a documented transaction of fraud.
PRESCRIPTIONS WITH NO PHYSICIAN INTERACTION
Patients have reported having received prescriptions without every having seen or knowing the doctor who prescribed the medications.
Altering Prescriptions for Financial Gain
The subject pharmacies are believed to bill for ingredients that are not contained in the actual compounded medications in order to receive a higher reimbursement from the insurance programs. The pharmacies may also substitute ingredients without the knowledge of the patient and/or the prescribing doctor.
SHELL COMPANIES TO CONCEAL
Many of the pharmacies are known to use affiliates or shell companies to hide their involvement from certain insurance programs, This arrangement often occurs if the pharmacy has been audited and prohibited from submitting claims to a particular insurance program
KICKBACKS TO DOCTORS
Through marketing companies, which are under the control or direction of the co-conspirators, kickbacks or incentives were paid to health care providers to prescribe compounding medications that were filled by subject pharmacies.
People want to know will these individuals get to keep their property? That’s for a court to decide, but one thing is certain. No one is just going to walk away from millions of dollars without a deal in place. Public, criminal charges haven’t been filed, but according to legal experts, with experience in both criminal prosecutions and criminal defense, the blood is in the water.