Government Collusion Against Pharmacies Needs to Be Stopped

I love it when I hear from the defendant in a government overreach case. That way we know and can publish the truth on a case to offset the lies published by the government and compounded by the media. So forget anything you’ve read about James “Wes” Moss in the press and learn the truth here. Here is Wes’s story:

I have been indicted on healthcare fraud and distribution of a controlled substance. My case will be in Tampa. I’ll explain.

In 2011 I joined a business in Russellville, Al that was managed by members of my family. It was a pharmacy that offered alternative therapies. Including topical creams for pain relief. At that time there was maybe 4 other businesses like ours across the country.

We caught lightning in a bottle and a year later we had grown from 50 reps in 15 states to 250 reps in 40+ states. We created an industry.

The conditions were ripe for an industry like the one we created. Opioids were becoming a big problem. The government had moved from targeting Pharma to targeting ‘pill mills’. From 2009 till 2016 or so Alabama had more opioid prescriptions written than population. The same for West Virginia and Kentucky. Probably more that I can’t remember off the top of my head.

We gave patients a choice of how they wanted to treat their pain issues. We offered doctors something that would insure them that they would not be labeled a ‘pill mill’

Topical creams treat the inflammation that causes pain. The average chronic pain patient is on 5.9 pills other than opioids.

Topicals work and by the end of 2012 there were thousands of other pharmacies like ours.

You would think that would be a good thing.

But Then There are the PBMs

Unfortunately for all Americans our healthcare system has middlemen. For pharmacies the middlemen are called PBMs, pharmacy benefits managers. The top 3 PBMs control almost 80% of all insured lives.

We have the highest healthcare costs in the world. We are also the only country with middlemen. For a pharmacy to get paid by an insurance company it has to sign a contract with the PBM that manages the insurance company. PBMs control prices and availability of prescribed medications 100%. They add $150 billion to the costs of medications each year. When you go to your pharmacy and your insurance no longer covers your prescription it is actually the PBM that won’t reimburse for your medicine because they get a bigger ‘rebate’,aka, kickback for your new prescription. You don’t get the medicine that your doctor thinks is best, you get what your PBM makes the most revenue off of.

In 2010 when the company started they used pharma reps to market their products. Pharma reps are W2 and usually carry 2 to 3 or more products in their ‘bag’. These little companies like ours 1099’d the reps and paid commissions on sales.

In 2012 PBMs’ stocks were priced around 20x earnings. The largest PBM, UnitedHealthcare, makes more money than Pfizer, McDonald’s and Coca Cola combined. Once we treated inflammation the pain patient would often get off of 3 or 4 or all of their pills. Our industry could become a problem if the PBMs didn’t do something.

What they did was brilliant. The top 3 PBMs had a meeting and laid out a plan to eliminate pharmacies like ours and to capitalize on the information and make an absolute gold mine in the process.

In 2012 the PBMs decided they were going into the mail order pharmacy business. It would take about 18 months to get set to open up. In the mean time they would change their contracts with pharmacies.

These new contracts included the ‘gag clause’. Twenty-three percent of the time a person walks into a pharmacy their copay, I repeat COPAY, is more expensive than the cash price of the medicine. The ‘gag clause’ said a pharmacist could not tell the patient a cash price was available to save them money.

They got rid of ‘discounting’. If a pharmacy thought that a prescription was over-priced and didn’t want to over-charge your insurance they could discount the cost. Yes the pharmacy made less money but so did the PBM. A patient would go where they got lower prices. That was usually a local independent pharmacy. This no discounting ‘leveled the playing field’ so the chain pharmacies that were PBM owned were guaranteed not to be undercut. CVS/Caremark owns CVS pharmacies. Yes that is a vertical monopoly. Illegal.

PBMs get paid on a percentage of the insurance claim. So the company that controls prices gets a commission on the costs of the prescriptions. It behooves them to raise prices. They did exactly that with topical creams. In 2011 a cream cost the insurance company $1200 or so. In 2012 the costs rose to $1600 or so. Every 90 days or so they would raise prices. They were giving themselves a raise. You’d think this was good because we were making more money. Long term we knew this was terrible. Unsustainable.

In September of 2012 I was asked to open a pharmacy in Florida. I moved to Florida. I’ll come back to why 2012 is important personally to me. In 2012 we hired marketing companies and pharma reps. My business partner handled the ‘in office’ stuff and our contracts were like the one the company I left used to pay reps.

In 2013 we were ready to open up and start selling. I left a company that had created the market to a new venture that had 4 or 5 thousand competitors.

In 2014 I replaced my partner in the office. I mean she went into the field and I ran the business.

When I got into the office I discovered something. Express Scripts, the PBM for Tricare, was overcharging the government. Not just once but twice.

The government is guaranteed lowest pricing. What ESI was doing was charging the government $3k or $4k for a month of cream. They would charge commercial insurance $1800 or so. That’s not all. The contract between Tricare and ESI stated that Tricare would not pay more than $998.00 for any compounded medication.
So any time Express Scripts got a Tricare prescription for a topical cream they would make the pharmacy call Express Scripts. This call is called a prior authorization. They charged Tricare $200 for this call. They would then over ride their contract and charge Tricare an astronomical amount. You’ve probably seen the obscene amounts pharmacies were being charged for fraud. ESI was controlling the prices.

About the same time I was contacted by a former Vietnam vet medic. He had decided late in life to get his PHD. He was a nurse practitioner but an expert in addiction, opioids and pain creams. His PHD would give him credibility. His mentor is a neurologist that makes topicals to treat Alzheimer’s with great success.

Together we were trying to get into VA’s or the Pentagon or the DoD to show them how we could save lives and show them how they were getting ripped off by their PBM.

Those guys created a 14 point protocol for veterans. One of those steps would be using our creams. This would be what the nurse practitioner would use to get his PHD. They had 30 former Vietnam Vets with severe PTSD use their protocol. They had a 70% reduction in opioid use among those Vets. They had a huge reduction in anxiety and depression as well. We were saving lives.

In late 2014 or so we had a meeting set up with some DoD officials. They were interested. In 2015 there was another meeting where “my guys” and the DoD had agreed to move forward with the plan and for us to cap the price of our cream to save them money. In fact we were trying to get a grant so we could give veterans that participated in our protocols free medications from us.

The DoD told Tricare what we were going to do. Tricare alerted ESI of our plans.
ESI cancelled our contract killing the whole program. In May of 2015 we could no longer get reimbursed for Tricare prescriptions. In June we paid our last commissions. Express Scripts wrote a letter to all of our pain patients stating that they could get their pain pills 90 days at a time from their new mail order pharmacy. Talk about pill pushers.

In 2016 PCCA, the company that provides most things for independent pharmacies, asked pharmacy owners and pharmacists to go to DC to talk to our elected representatives about the over reach of the federal government in regard to local pharmacies. The FDA was closing independent pharmacies and they had no right to do so. ( I suspect the PBMs were directing this).

I used this time to create a presentation that I would show my reps, Rubio and Nelson, and whoever else I could talk to.

I had dinner with Buddy Carter a rep from Georgia. The lobbyist for PCCA was Bud Cramer, the former rep from Huntsville, Al. I’m from Huntsville and Bud took my under his arm. He directed me what to say and who to try and see.

At the end of the second day Bud told me I was making people nervous with my presentation. My presentation showed the similarities between lobby money from the PBMs and the rise in opioid deaths. I showed them how veterans were committing suicide by the actions of ESI. I had screenshots of how the government was being defrauded. I told them independent pharmacies would be extinct soon. I thought I was doing a noble thing. What I was doing was setting myself up for misery. I’ve had two prominent defense attorneys (that I can’t afford) tell me that was when the government targeted you for destruction. I was messing with lobby money. Graph the rise in drug prices since 2009 and the ACA and the PBMs lobby money. I’ll bet the graphs are identical.

Shortly after my trip a federal bankruptcy trustee contacted me and said I, as a former employee of the company I left in 2012, had to pay the remainder of their bankruptcy that had happened in 2015. Slam dunk no brainer here. No way I’d be responsible for that. I was wrong.

I obtained a lawyer and he advised I settled with the BK court and pay a million dollars and go on my way. We did that.

A few months later the BK court garnished every cent I had in my personal and business accounts. Total about $7 million. I called my lawyer and he declined to help me without paying him first. Of the $7 million the creditors received about $30k and I am still on the BK. Everyone else is released and I’m still on. Figure that out.

So now I’m out of business and broke. My fiancé didn’t think I was as good looking either. I moved into by business having lost my home to the BK court too.

The Standard “Knock and Chat” is a Government Trap

In the fall of 2016 the FBI knocked on my door. I asked 3 times if I needed a lawyer. They said no that they needed my help to look for bad guys in the pharmacy industry.

I gave them shady marketing guys and other pharmacies that were trying to buy stuff off of me. They told me to ‘work’ with the shady pharmacy people and document everything. It would be ‘great’ they said.

I also showed them how the government was being defrauded of millions if not billions of dollars.

They left. A few months later they returned and said they needed my records because they were investigating doctors, marketing companies and telemedicine doctors that I used to do business with. I said I think I need a lawyer for this. They assured me that they were not investigating me and that these records were important and if I had nothing to hide then it shouldn’t be a problem. If I was hiding something it would be bad. I naively gave them all of my records.

Months and months later they returned to my office (home) and asked me questions about the people I had done business with and moved on to genetic testing and telemedicine. One agent asked me how telemedicine doctors get paid. I said I wasn’t sure. At that point they said I was lying to them and I needed a lawyer. I said I didn’t have one and they gave me a card of a public defender. They also asked if I was still in contact with other pharmacies. I said yes. They said to continue with them and “all of this could go away if you help us enough”. This was in 2017.

The pharmacy I was talking with kept telling me that they were coming up from Miami to look over the pharmacy, perhaps buy the building and they needed some stuff including ketamine. They probably planned 3 or 4 such trips but never came up

In 2018 they contacted me and said that if I could bring some office supplies and ketamine to Miami they would pay me. I looked into how to do this and as an owner of the pharmacy I could do this as long as I transferred it to the pharmacy and got the appropriate paperwork. When I got down there the pharmacy rep said to meet him and he’d give me the money. I told him to bring the pharmacist with the paperwork. He showed up with neither. At this point I started taking pictures to document in case he wasn’t on the up and up. He assured me that they’d send the paperwork.

Months later they still had not furnished the paperwork. My pharmacist had to report this. The police was called. I was arrested. The DEA got involved and I was arrested again. I did what the FBI told me to do and not say anything. Eventually the local and the DEA dropped all the charges. The DEA said the pharmacy rep and the pharmacy was buying ketamine all over Florida. My information was very helpful. Crazy thing the rep and the pharmacy are still doing their thing. Not one thing has happened to them.

So from 2018 till April of 2020 I heard absolutely nothing. Then my PD called me and said Tampa had a new US Attorney and he was going forward with healthcare fraud against me and 3 others. Of course I have the ketamine.

They claim that we targeted Tricare. We did not. They say that paying commissions on government insurance is a kickback. Specifically, if you pay commissions to a W2 employee you’re fine. If it’s a 1099 rep you go to jail for 10 years. Why? Big Pharma paid reps a commission. They were W2. Little companies paid 1099 reps. Big Healthcare pays a small fine for things small business owners go to jail for.

The other guys have good lawyers. Two guys have former US Attorneys from Tampa. They assure their clients there is no case here. They will win at trial.

The government expanded the AKS (Anti Kickback Statute) sometime after we quit paying commissions. I found a September, 2016 case. (Yes I did talk to lawyers during 2013, 14 and 15 about how we should pay reps. They said they didn’t have precedent so they couldn’t tell me how to pay.

I’d love to get my story out there. The same industry that makes insulin $2000 instead of $20 is defrauding the government of billions of dollars and they direct the government to eliminate their competition.

Thank you for your time.
Wes Moss

 

 

Go Fund Me Page

Mr. Moss can’t cave to a plea agreement on this.  If he does, it will set a precedence, and the government will go after more independent pharmacies trying to fight the government-colluding monopolies of PBMs and insurance companies.  Please, if you are a pharmacy owner, especially independent, please contribute to this case financially.  Mr. Moss has a Go Fund Me page to help with the legal expenses.  If he doesn’t get enough support, he will be forced to take a plea, and you will be next! So for your own good, make a substantial donation.  

Even patients should contribute to this, because if they start closing down independent pharmacies, you will see the prices of drugs rise due to the monopolies created.