Consolidated Mail Outpatient Pharmacy

The Consolidated Mail Outpatient Pharmacy (CMOP) initiative of the United States Department of Veterans Affairs provides mail order prescriptions to veterans using facilities with highly automated distribution systems at strategic locations throughout the country.

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History

During the 1970s and 1980s, the VA began experimenting with the consolidation of mail prescription workloads. By 1994, it was ready for a computerized test project.

The CMOP program is now serving the entire country from seven locations: Chelmsford, Massachusetts; Dallas, Texas; Hines, Illinois; Charleston, South Carolina; Leavenworth, Kansas; Murfreesboro, Tennessee; and Tucson, Arizona.

There are plans for an eighth CMOP to be built in the Seattle, Washington area.

Operations

The CMOP program fills continuation of therapy or refill prescriptions only. Initial prescriptions are written for veterans at one of the Veteran Administration’s health care facilities. When a refill is needed, the heath care facilities process the prescriptions. The CMOP then uploads this information from multiple facilities in its region. Once filled, the US Postal Service or Fed-Ex delivers the prescriptions. The health care facility or clinic is notified of the prescription’s completion electronically. As of 2000, the annual workload was near 50 million prescriptions. Processing and filling prescriptions took two days; three more days were required for mail delivery. The CMOP in Hines, Illinois has the best site turn around for work load, it can currently can process over 62,000 scripts a shift of 8.5 hours.

Government efficiencies

Because of congressional interest in exploring if CMOP could provide cost savings for Department of Defense beneficiaries picking up outpatient refill prescriptions from military treatment facilities, the DOD and VA conducted a pilot program in FY 2003. In its 2005 report, GAO-05-555, the Government Accountability Office (GAO) found that the DOD could generate savings because CMOP's size allows it to negotiate volume discounts.

Controversies

On 29 November 2005, two employees at the Murfreesboro, Tennessee CMOP, Joseph Haymond and Natalie Coker, were indicted for accepting kickbacks from a vendor selling red tape. In addition, vendor R. Michael Walsh was indicted.

From about August 1999 to July 2001, R Michael Walsh sold more than 100,000 rolls of red tape to the CMOP. Walsh paid his supplier about $2.50 per roll of tape, but Haymond instructed Walsh to charge the CMOP $6.51 per roll, a markup of more than 150%, and to give Haymond and Coker a kickback of $1.00 each for every roll of tape he sold to the CMOP. Coker and Haymond instructed CMOP employees to buy the tape in increments of less than $2,500 so that the CMOP employees could use their government credit cards, thereby avoiding using the VA’s Acquisition Service Center. Coker and Haymond each received more than $100,000 in kickbacks from Walsh related to the red tape he sold to the CMOP at inflated prices.

On 30 November 2005, Haymond died of a self-inflicted gunshot wound outside his home in Auburntown, Tennessee. The case against him was dismissed on 7 December 2005.

On 24 March 2006, Walsh plead guilty to one count of Conspiracy to Defraud the United States.

Coker was charged with one count of conspiracy to defraud the United States, three counts of acceptance of bribes by a public official and one count of having a conflict of interest by participating as a government official in a matter involving a company with whom she was negotiating for prospective employment in violation of Title 18, United States Code, Sections 371, 201(b)(2) and 208(a) and 216(a)(2), respectively. On 24 March 2006, Coker plead guilty to the conflict of interest charge. Coker began serving a 46 month prison sentence at Alderson Federal Prison on 18 Dec 2006. With time off for good behavior she will be eligible for release sometime in April, 2010. The January minutes of the Tennessee Department of Commerce and Insurance displinary board shows that Natalie Coker's pharmacy license has been revoked due to "unprofessional conduct".

The third defendant in the case to plead quilty, Robert Michael Walsh, received 36 months probation and will be required to make restitution in the sum of $263,620. Mr. Walsh was given consideration for his complete cooperation and was given financial credit for having paid excess income tax of approximately $120,000. He had paid taxes on the kickbacks given to the other conspirators along with his own profit.

During Mr. Walsh's sentencing hearing it was brought out that the last conspirator who received monies from this enterprise, Dick Pruitt, has not been charged with any criminal offense. Dick Pruitt accepted about $20,000 from the scheme but was bought out early on by Mr. Walsh.

Sources

US House of Representatives, Committee on Veterans Affairs, Subcommittee on Oversight and Investigations. May 25, 2000. Testimony of John E. Ogden, M.S. Chief Consultant for Pharmacy Benefits Management, Department of Veterans Affairs. VA’s Consolidated Mail Output Pharmacy Program.

United States of America v. Joseph Haymond, Case 3:05–03107. United States District Court, Middle Tennessee District, Nashville Division.

United States of America v. Natalie Coker and R. Michael Walsh, Case 3:05-00232. United States District Court, Middle Tennessee District, Nashville Division.

"VA Suspect Takes Own Life". The Daily News Journal, Murfreesboro, Tennessee. 1 December 2005.

United States District Court for Middle District of Tennessee at Nashville - Transcripts from the Sentencing hearings of Natalie Coker and Robert Michael Walsh.