A former pharmaceutical sales representative admitted his role in two criminal conspiracies involving health care fraud and wrongful obtaining and disclosure of patients’ protected personal health information, federal officials announced today.
According to federal officials, Keith Ritson, 42, Bayville, pleaded guilty on Oct. 19, to superseding information charging him with one count of conspiracy to commit health care fraud and one count of conspiring to wrongfully disclose and obtain patients’ individually identifiable health information in violation of the criminal provisions of the Health Insurance Portability and Accountability Act (HIPAA).
According to documents filed in this case and statements made in court:
From 2014 to 2016, Ritson was a pharmaceutical sales representative who promoted compound prescription medications and other medications.
Officials said, Ritson and his conspirators discovered that certain insurance plans with pharmacy benefit management services – including plans for state and local government employees and eligible dependents – covered compound medications from a Louisiana pharmacy, Central Rexall Drugs, Inc. (Central Rexall).
The pharmacy benefits administrator paid prescription drug claims and billed the state of New Jersey and other insurance plans for the amounts paid.
The conspirators identified that certain compound medication prescriptions would reimburse by insurance for thousands of dollars every month.
Ritson received a percentage of Central Rexall's amount from the pharmacy benefits administrator for the prescriptions he arranged.
Court documents say, Ritson recruited individuals with insurance plans that covered the compound medications to receive the medications, regardless of their medical need for them. Ritson himself also received medically unnecessary compound medication prescriptions.
Ritson earmarked patients who had insurance plans that covered the compound medications at the medical practices of Dr. Frank Alario.
According to court documents, as a pharmaceutical sales representative not associated with Alario’s medical practices, Ritson was not permitted to access and obtain patients’ individually identifiable health information and protected health information.
As part of the criminal HIPAA scheme, Alario permitted Ritson to have significant access to his medical offices, medical files, and patient information.
Officials said, Ritson was present in the office during and outside regular business hours and had access to areas of the office restricted to staff, including areas with patient files and office computers.
Ritson looked up patients’ information in files and on office computers to determine if they had insurance that covered the compound medications.
Court documents say, Ritson then would earmark files in advance so that Alario knew to whom to prescribe the medications.
Ritson also joined Alario in patient exam rooms during appointments, which gave patients the impression that Ritson was employed by or affiliated with the medical practices.
Officials said, Ritson used patients’ confidential information to fill out prescription forms that Alario authorized, and then Ritson received commissions on those prescriptions. Alario pleaded guilty on Oct. 7, to conspiring to disclose patients’ individually identifiable health information wrongfully.
He is scheduled to be sentenced on Feb. 7, 2023.
Three former executives of Central Rexall – Christopher Kyle Johnston, 43, of Mandeville, Louisiana; Trent Brockmeier, 60, of Pigeon Forge, Tennessee; and Christopher Casseri, 54, of Baton Rouge, Louisiana – were charged on Sept.17, 2020, in a 24-count indictment with health care and wire fraud and other offenses.
The charges against them remain pending.
A fourth former pharmacy executive, Hayley Taff, 39, of Hammond, Louisiana, pleaded guilty to health care fraud conspiracy on Aug. 12, 2020, and is scheduled to be sentenced on March 13, 2023.
Ritson faces a maximum penalty of 10 years in prison and a $250,000 fine on the health care fraud conspiracy count and a maximum penalty of one year in prison and a $50,000 fine on the criminal HIPAA conspiracy count.
Sentencing is scheduled for Feb. 21, 2023.