A former sales representative was convicted by a federal jury for his role in a scheme to defraud public health benefits programs by billing for medically unnecessary compound prescriptions, U.S. Attorney Philip R. Sellinger announced today.
According to U.S. Attorney Sellinger, Matthew Puccio, 40, of Randolph, was convicted on July 19 of conspiracy to commit health care fraud following a seven-day jury trial before U.S. District Judge John Michael Vazquez.
According to documents in this case and the evidence at trial:
Compound medications are specialty medications mixed by a pharmacist to meet the specific medical needs of an individual patient.
Although compound 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 ingredients in the prescription.
From November 2014 to March 2016, Puccio participated in a conspiracy that involved submitting fraudulent prescriptions for compound medications to public health benefits programs.
Marketing companies recruited and paid sales representatives, such as Puccio, to obtain compound medications for themselves and others regardless of medical necessity, targeting health plans that reimbursed for compound medications at high rates.
Puccio exploited this opportunity by working as a sales representative for several compounding pharmacies.
He targeted individuals who had health plans that covered compound medications and then convinced those individuals to obtain prescriptions for compound medications, regardless of medical necessity.
Puccio and others induced two New Jersey-based physicians to sign medically unnecessary prescriptions for beneficiaries that Puccio and others had recruited.
Once the prescriptions were written, they were filled by the compounding pharmacies with which Puccio worked.
The compounding pharmacies would then receive reimbursement from the health plans and would pay Puccio a percentage of the reimbursement amount. Puccio and his conspirators caused a significant loss to public health benefits programs.