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Another pharmacist pleads guilty in TRICARE fraud

Another pharmacist has pled guilty in the largest healthcare fraud case in the state’s history. Marco Bisa Hawkins Moran, 45, of Raymond, pled guilty before U.S. District Judge Keith Starrett to a Criminal Information outlining his role in a more than $22 million dollar scheme to defraud TRICARE which is the health care benefit program serving  America’s military, veterans, and their family members.

According to a release from the Office of U.S. Attorney Mike Hurst, from approximately May 2014 through January 2016, Moran co-owned and operated Medworx Compounding, LLC in Madison County, Mississippi, and Custom Care Pharmacy, LLC in Hinds County, Mississippi.

During this time, Moran and other co-conspirators mass-produced high-yield compounded medications on behalf of the pharmacies. Rather than formulating compounded medications based on the individualized needs of patients, formulas were selected to maximize profit based upon reimbursements from TRICARE and other health care benefit programs.

Moran’s pharmacies submitted fraudulent claims to TRICARE and other health care benefit programs. In order to further their scheme, Moran and his co-conspirators took measures to conceal their waiver of beneficiary copayments from TRICARE and other health care benefit programs.

RELATED: Man pleads guilty in TRICARE fraud case

Acting on behalf of Medworx and Custom Care, Moran and his co-conspirators paid kickbacks and bribes to marketers and physicians in order to obtain prescriptions for compounded medications from prescribers for beneficiaries who were covered by the most lucrative health care benefit programs, including TRICARE, irrespective of whether the compounded medications were medically necessary for the treatment of beneficiaries.

As a result of this fraudulent activity, Medworx and Custom Care submitted fraudulent claims to TRICARE and other health care benefit programs totaling approximately $22,068,144.00.

This case is a part of a larger framework of fraud that took place from approximately 2014-2016 and is related to cases charged earlier this year in the Southern District of Mississippi.

Thomas Edward Spell, Jr., a licensed pharmacist, pled guilty on August 9, 2018, to conspiracy to commit health care fraud regarding a scheme to defraud health care benefit programs, including TRICARE, of more than $243 million. To date, a total of 12 people have been charged and 9 convicted in the compounding pharmacy scheme in the Southern District of Mississippi. The investigation is ongoing and prosecutions are occurring nationwide to include California, Tennessee, Arkansas, and Connecticut.

Moran will be sentenced by Judge Starrett on November 27, 2018, at 9:45 a.m. announced U.S. Attorney Mike Hurst, FBI Special Agent in Charge Christopher Freeze, IRS-Criminal Investigation Acting Special Agent in Charge Thomas Jay Holloman, III, and Special Agent in Charge John F. Khin of the Defense Criminal Investigative Service’s Southeast Field Office.

The case is being prosecuted by Assistant United States Attorney Mary Helen Wall and U.S. Department of Justice trial attorneys Katherine Payerle and Sean Welsh.

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