A former pharmaceutical sales representative was charged today for his role in a scheme to defraud a telecommunications company’s health care plan by billing for medically unnecessary compounded prescriptions, Acting U.S. Attorney Rachael A. Honig announced.
Federal authorities said Carmine A. Mattia Jr., 60, of Cedar Grove, was indicted on one conspiracy to commit health care fraud and three counts of health care fraud. He will have his initial appearance on a date to be determined.
According to documents filed in this case and statements made in court:
Compounded medications are specialty medications mixed by a pharmacist to meet the specific medical needs of an individual patient.
Although 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 ingredients in the prescription.
The scheme centered on Mattia’s work as a sales representative for a marketing company and various compounding pharmacies. He sold compounded medications, including pain creams, scar creams, wound creams, and metabolic supplements/vitamins.
Mattia was also a full-time employee of the telecommunications company and was a union representative for the company’s employees.
Between April 2016 and July 2016, Mattia participated in a conspiracy to submit fraudulent prescriptions for compounded medications to the telecommunications company’s health care plan.
The compounding pharmacies paid Mattia a commission in exchange for each prescription for compounded medication Mattia caused to be billed to the company’s health care plan.
To fraudulently increase his profits as a sales representative, Mattia recruited Individual-1 to receive medically unnecessary compounded medications.
Mattia paid Individual-1 to induce Individual-1 to receive these medications.
Mattia also secured the signature of a New Jersey doctor, Robert Agresti, on prescription forms for Individual-1. Agresti and Individual-1 did not have a doctor/patient relationship, Agresti did not determine if Individual-1 needed the compounded medications selected, and he did not examine Individual-1.
On June 26, 2018, Agresti pleaded guilty to conspiracy to commit healthcare fraud and is awaiting sentencing.
Mattia’s participation in the scheme caused a loss to the telecommunications company’s health care plan of approximately $100,000.
The conspiracy charge and substantive health care fraud charges each carry a statutory maximum of 10 years in prison and a $250,000 fine, or twice the gross gain or loss from the offense, whichever is greatest.