NORFOLK, Va. — A Newport News woman pleaded guilty on Wednesday to her role in a conspiracy to defraud and a non-profit corporation that provides case management services and financial aid to Americans with chronic, life-threatening, and debilitating illnesses.
Court documents said 39-year-old Andrea Braxton Wallace, a Patient Advocate Foundation employee, was assigned to work with the organization’s Co-Pay Relief Program.
The program is designed to help low-income individuals pay for their medications and treatments associated with certain diagnosed illnesses, like Hepatitis C, various cancers, and HIV/AIDS. Eligibility for the program is based upon an individual’s diagnosed illness and annual household income.
If someone is approved, a PAF patient is awarded a grant, usually ranging from $12,000 to $25,000 per year. The patient can make claims for reimbursement for medications and treatments related to their disease.
The scheme, which was run by a group of PAF employees and several “outsiders”, involved creating fake patient accounts with false diagnoses, then making false claims for reimbursement against the grants that were awarded.
Court documents said once reimbursement checks were cut, the co-conspirators would cash them and split the proceeds.
Wallace was employed as a Verification Specialist at PAF. She recruited two outsiders to create fake applications, cash checks, and otherwise participate in the scheme. She was the direct cause of about $35,000 in losses to the Patient Advocate Foundation.
Wallace pleaded guilty to conspiracy to commit health care fraud. She faces a maximum penalty of 10 years in prison when she’s sentenced on July 11.