By: Najla Alexander
NJ authorities announced that a Gloucester County man was sentenced today to 42 months in prison for defrauding his employer’s health insurance plan out of more than $4 million by submitting fraudulent claims for medically unnecessary compounded medications.
Attorney for the United States Vikas Khanna stated Christopher Gualtieri, 51, of Franklinville, previously pleaded guilty before U.S. District Judge Robert B. Kugler to one count of an indictment charging him with conspiracy to commit health care and mail fraud and one count charging him with obtaining oxycodone through fraud.
U.S. District Judge Christine P. O’Hearn imposed the sentence today in Camden federal court, officials stated.
According to documents filed in this case and statements made in court:
Officials said compounded medications are specialty medications mixed by a pharmacist to meet the specific medical needs of an individual patient.
Compounded drugs can be 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, officials say.
According to officials, 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, officials stated.
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, authorities say.
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, officials said.
Gualtieri received a portion of the amount paid by the pharmacy benefits administrator to the compounding pharmacies. Gualtieri admitted to paying cash to his conspirators for their participation in the scheme, according to officials.
Officials say when questioned by special agents of the FBI, Gualtieri falsely denied recruiting others to receive compounded medications and falsely denied paying cash to others for their participation in the scheme.
During the same time period as the conspiracy involving compounded medications, Gualtieri also prepared and caused the filling of fraudulent prescriptions for oxycodone for himself and a family member, authorities say.
In addition to the prison term, Judge Kugler sentenced Gualtieri to three years of supervised release and ordered him to pay $5.4 million in restitution, officials stated.