FOUR PEOPLE CHARGED, FIFTH PLEADS GUILTY, IN $4.5 MILLION HEALTH CARE FRAUD CONSPIRACY TARGETING STATE HEALTH BENEFITS PROGRAMS
FOUR PEOPLE CHARGED, FIFTH PLEADS GUILTY, IN $4.5 MILLION HEALTH CARE FRAUD CONSPIRACY TARGETING STATE HEALTH BENEFITS PROGRAMS
CAMDEN, N.J. – Four people, including two doctors, are scheduled to appear in court today on charges they defrauded New Jersey state health benefits programs and other insurers of $4.5 million by submitting fraudulent claims for medically unnecessary prescriptions, U.S. Attorney Craig Carpenito announced. A fifth individual, a physician’s assistant, has pleaded guilty to participating in the health care fraud conspiracy.
Steven Monaco, 37, of Sewell, New Jersey; Daniel Oswari M.D., 48, of Bordentown, New Jersey; Michael Goldis D.O., of Mt. Laurel, New Jersey; and Aaron Jones, 25, of Willingboro, New Jersey, were all charged in a 33-count indictment with conspiracy to commit health care fraud and wire fraud. Monaco, Oswari, and Goldis also were each charged with individual acts of health care fraud and wire fraud, and Jones was charged with 10 false statement counts. Monaco and Oswari were charged with a conspiracy involving kickbacks for referrals for laboratory work.
The cases are assigned to U.S. District Judge Robert B. Kugler in Camden. The indicted defendants are expected to appear today before U.S. Magistrate Judge Karen M. Williams in Camden federal court.
According to the indictment:
Compounded medications are specialty medications mixed by a pharmacist to meet the specific medical needs of an individual patient. Although compounded drugs are not approved by the Food and Drug Administration (FDA), they are properly prescribed when a physician determines that an FDA-approved medication does not meet the health needs of a particular patient, such as if a patient is allergic to a dye or other ingredient.
From January 2014 through April 2016, the conspirators recruited individuals in New Jersey to obtain very expensive and medically unnecessary compounded medications from a Louisiana pharmacy, identified in the indictment as the “Compounding Pharmacy 1,” and a Pennsylvania pharmacy, identified in the indictment as “Compounding Pharmacy 2.” The conspirators learned that certain compound medication prescriptions – including pain, scar, antifungal, and libido creams, as well as vitamin combinations – were reimbursed for thousands of dollars for a one-month supply.
The conspirators also learned that some New Jersey state and local government and education employees, including teachers, firefighters, municipal police officers, and state troopers, had insurance coverage for these particular compound medications. An entity referred to in the indictment as the “Pharmacy Benefits Administrator” provided pharmacy benefit management services for the State Health Benefits Program, which covers qualified state and local government employees, retirees, and eligible dependents, and the School Employees’ Health Benefits Program, which covers qualified local education employees, retirees, and eligible dependents, and other insurance plans. The Pharmacy Benefits Administrator would pay prescription drug claims and then bill the State of New Jersey or the other insurance plans for the amounts paid.
Richard Zappala, who previously pleaded guilty to conspiracy to commit health care fraud, had agreements to receive a percentage of the amount that Compounding Pharmacies 1 and 2 received for prescriptions obtained by Zappala and his associates. Zappala had Monaco and other conspirators find people who would agree to receive prescriptions for compounded medications. Zappala’s sentencing is scheduled for Nov. 13, 2019.
The conspirators recruited public employees and others covered by the Pharmacy Benefits Administrator to fraudulently obtain compounded medications from Compounding Pharmacies 1 and 2 without any evaluation or determination by a medical professional that the medications were medically necessary. The defendants paid individuals to agree to receive prescription medications from the Compounding Pharmacy. The defendants completed prescriptions for these individuals and selected the most expensive medications with the highest number of refills to obtain the highest possible insurance reimbursement. The conspirators would have prescriptions signed by a doctor or medical professional who did not examine the patients or determine that the medications were medically necessary. Monaco paid kickbacks to Dr. Oswari and another medical professional to reward them for signing prescriptions, and Zappala paid Dr. Goldis for signing prescriptions. Jones, who was a medical assistant in Goldis’ office, also forged Goldis’ signature on other prescriptions.
The completed prescriptions were faxed to the Compounding Pharmacies, which filled the prescriptions and billed the Pharmacy Benefits Administrator. The Pharmacy Benefits Administrator paid Compounding Pharmacies 1 and 2 over $4.5 million for compounded medications obtained by the conspiracy. Compounding Pharmacies 1 and 2 paid Zappala a percentage of that amount, which he used to pay members of the conspiracy.
The indictment charges Monaco and Oswari with a second conspiracy in which Monaco caused Oswari to receive kickbacks for referring laboratory work and signing prescriptions. Monaco, who worked for a blood and urine testing lab, arranged for his employer to hire Oswari’s medical assistant as a phlebotomist, while continuing to do medical assistant work for Oswari. In return for receiving the free services of an employee for over two years, Oswari referred his blood and urine samples to Monaco’s employer for testing, and Monaco received a commission from the insurance payments made for tests run on those samples. It was also part of this conspiracy that Monaco paid kickbacks to Oswari for writing prescriptions for compounded medications and received money from the resulting insurance payments.
The health care fraud and wire fraud conspiracy count with which all indicted defendants are charged carries a maximum potential penalty of 20 years in prison and a $250,000 fine, or twice the gain or loss from the offense. Each wire fraud count carries a maximum potential penalty of 20 years in prison and a $250,000 fine, or twice the gain or loss from the offense. Each health care fraud count carries a maximum penalty of 10 years in prison and a $250,000 fine, or twice the gross gain or loss from the offense. The kickbacks conspiracy count and the false statement counts each carry a maximum penalty of five years in prison and a $250,000 fine, or twice the gross gain or loss from the offense
On Oct. 2, Jason Chacker, 36, of Feasterville, Pennsylvania, a physician’s assistant who practiced in Mercer County, pleaded guilty before Judge Kugler to conspiracy to commit health care fraud. Chacker admitted that he and his conspirators recruited individuals who had prescription drug benefits administered by the Pharmacy Benefits Administrator that covered compounded medications. At the request of a conspirator, Chacker signed prescriptions for individuals without ever meeting them or evaluating whether they needed the compounded medications. He also paid one individual to receive compounded medications. Chacker received $3,200 and other valuable items from a conspirator for his role. The Pharmacy Benefits Administrator paid $365,454 for prescriptions fraudulently obtained by Chacker and his conspirators.
Chacker faces a maximum penalty of 10 years in prison and a $250,000 fine, or twice the gross gain or loss from the offense. Sentencing is scheduled for Feb. 5, 2020.
U.S. Attorney Carpenito credited agents of the FBI’s Atlantic City Resident Agency, under the direction of Special Agent in Charge Gregory W. Ehrie in Newark; IRS – Criminal Investigation, under the direction of Special Agent in Charge John R. Tafur in Newark, and the U.S. Department of Labor, Office of Inspector General, New York Region, under the direction of Special Agent in Charge Michael C. Mikulka, with the investigation leading to the indictment and guilty plea. He also thanked the Division of Pensions and Financial Transactions in the State Attorney General’s Office, under the direction of Attorney General Gurbir S. Grewal and Division Chief Eileen Schlindwein Den Bleyker, for its assistance in the investigation.
The government is represented by Assistant U.S. Attorneys R. David Walk Jr. and Christina O. Hud of the U.S. Attorney’s Office in Camden.
The charges and allegations contained in the indictment are merely accusations, and the defendants are presumed innocent unless and until proven guilty.
19-299
Defense counsel:
Monaco: Gerard Egan Esq., Exton, Pennsylvania
Daniel Oswari: Scott Krasny Esq., West Trenton, New Jersey
Michael Goldis: Ralph Kramer Esq., Haddon Heights, New Jersey
Aaron Jones: Christopher O’Malley Esq., Camden, New Jersey
Jason Chacker: Teri Lodge Esq., Marlton, New Jersey
