Insurance Fraud NEWS
Jersey woman faces up to 10 years for compound kickbacks
October 16, 2018, Ocean County, NJ
An Ocean County woman faces up to 10 years in prison after she admitted she was part of a massive scheme to defraud state health benefits programs and led to her receiving $388,600 in kickbacks for unnecessary prescriptions.
The guilty plea is part of a wide-ranging federal probe into the prescription fraud scam involving an out-of-state compounding pharmacy that supplied $50 million in medications "including pain, scar, antifungal, and libido creams, as well as vitamin combinations."
Kristie Masucci, 36, of the Cedar Run section of Stafford, conspired with others to recruit state and local government and education employees, including teachers, firefighters, municipal police officers, and state troopers to obtain the unnecessary medication, authorities said.
Her role in the scheme accounted for $1.88 million in fraudulent claims between January 2015 and February 2016, authorities said. Masucci pleaded guilty in federal court in Camden on Monday to conspiracy to commit health care fraud, the U.S. Attorney's Office said.
She will have also have to pay restitution and forfeit the money she stole, officials said. Her sentencing is scheduled for Feb. 5.
The scam involved doctors who signed prescriptions without ever evaluating patients, prosecutors have said. The prescriptions were filled by the unnamed compounding pharmacy. The medications prescribed were those that offered the highest-possible reimbursement.
The pharmacy's benefits administrator then reimbursed the claims, paying up to thousands of state dollars for each prescription, authorities said.
Drugs from compounding pharmacies cost far more than regular drugs because they are mixed for individual patients. For example, a doctor could order a prescription from a compounding pharmacy if a patient is allergic to a component of an existing medication.