Medicaid refusal appealed

Chris Thelen/Staff
South Augusta pharmacist Duncan Fordham was convicted of health care fraud in May 2005.

The wife of a south Augusta pharmacist convicted of health care fraud is appealing the state's refusal to allow her company to service Medicaid pharmacy patients.

 

Tereses Inc., doing business as Peach Orchard Drugs, filed the case against the Department of Community Health in Richmond County Superior Court on Friday. Terri Fordham, the wife of Duncan Fordham, who is serving a 52-month prison sentence, owns at least part of Tereses.

She is challenging an administrative hearing officer's decision on Dec. 22. It supported the Georgia Department of Community Health's decision to deny Ms. Fordham's application to be a Medicaid provider qualified to receive reimbursements for medical prescriptions.

At stake is millions of dollars. According to court documents, from January 2001 through June 2005 Mr. Fordham received $12.2 million in Medicaid reimbursements for prescriptions at his Duncan Drugs store on Peach Orchard Road.

Mr. Fordham lost his Medicaid provider standing after his heath care fraud conviction in May 2005. He was convicted with former state Rep. Robin Williams and three others of crimes related to the looting of the Community Mental Health Center of East Central Georgia.

Mr. Fordham was given a contract to run the mental health center's pharmacy. The contract included extravagant bonuses, one-third of which he kicked back to Mr. Williams.

State medical-care fraud investigators contend that on the same day a federal jury convicted her husband, Ms. Fordham took steps to create a shell company that would enable him to stay in the pharmacy business.

She opened Peach Orchard Drugs under the corporate name of Tereses Inc. It occupies the same building as the former Duncan Drugs and has the same telephone number, according to court documents.

The administrative law officer determined that he did not have to decide whether Tereses Inc. is Mr. Fordham's "alter ego," as state investigators contend. The state was justified in denying the application because Ms. Fordham did not completely and truthfully comply with the application requirements, the law officer determined.

Mr. Williams, who was sentenced to 10 years in prison, and Mr. Fordham are each responsible for paying more than $1 million in restitution to the center.

Judge James G. Blanchard has been assigned to preside over the appeal. No hearing date has been set.

Reach Sandy Hodson at (706) 823-3226 or sandy.hodson@augustachronicle.com.