Feds: Gloucester County, NJ, Man Indicted in $4M Healthcare Fraud Conspiracy
A man from Gloucester County has been indicted for allegedly defrauding his employer's health insurance plan out of more than $4 million by submitting fraudulent claims for medically unnecessary compounded medications.
Acting U.S. Attorney Rachael Honig says 48-year-old Christopher Gualtieri of Franklinville has been charged with conspiracy to commit health care fraud, mail fraud, and individual acts of mail fraud. He was also charged with making false statements to federal agents during the investigation and for preparing and filling fraudulent oxycodone prescriptions.
Gualtieri and others learned that certain compound medication prescriptions ... were reimbursed by their health insurance plan for up to thousands of dollars for a one-month supply. Gualtieri recruited co-workers who were covered by their employer’s self-funded health insurance plan to agree to receive medically unnecessary compounded medications for themselves and their family members. Gualtieri and others caused the submission of fraudulent prescriptions to compounding pharmacies, which filled the prescriptions and billed the health insurance plan’s pharmacy benefits administrator. The pharmacy benefits administrator paid the compounding pharmacies more than $4 million for compounded medications arranged by Gualtieri and two conspirators for themselves, their dependents, and other family members.
Authorities say Gualtieri received a portion of the money that was paid by the pharmacy benefits administrator to the compounding pharmacies and then he paid his conspirators for their participation in the scheme.
When questioned by the FBI, Gualtieri falsely denied recruiting others and falsely denied paying cash to others for their roles in the scheme, according to Honig.
Meanwhile, officials say as the compounded medication scheme was playing out, Gualtieri also prepared and filled fraudulent prescriptions for oxycodone for himself and a family member.
Gualtieri faces potentially over 20 years in prison and hundreds and thousands of dollars in fines in convicted. He was scheduled to appear before a judge on Friday.