$6 Million Health Fraud Scheme on Health Benefit Programs

$6 Million Health Fraud Scheme on Health Benefit Programs

Healthcare fraud is a common concept in modern-day society. Different sources have outlined the numerous cases presented in court on fraudulent activities in the healthcare sector. First and foremost, it is well established that the most common cases under the healthcare fraud facet have been on defrauding the healthcare programs meant to take care of American patients. This form of the case has been common and numerous culprits have been presented to the court in the previous years.

First and foremost, one of the most famous cases includes the one that involved three individuals. These individuals were charged in a conspiracy to commit healthcare fraud that involved a sum of $6 Million loss from a state health benefits program. Such cases have been common in modern-day society, specifically America. According to The United States Attorney’s Office, three individuals, including a nurse and a doctor have been charged in this indictment. It is well established that these defendants submitted claims for medically unnecessary prescriptions and as a result, they were paid from the funds given by the state for medical attention.

This case was presented in court with tangible evidence that made the basis of the argument in court. This case involved the reimbursement of Compounded medications (A mixture of medications mixed by a pharmacist to meet the medical need of a specific patient). These typed of medications are often not approved by the Food and Drug Administration. However, they have to be approved for their efficiency as per the needs of the patients. According to the announcement by Craig Carpenito, a US Attorney, the fourth patient these individuals submitted claims that they had offered a medically unnecessary prescription. The fourth person in this case admitted to signing prescriptions to patients that he had not met. This individual was a doctor from Mt. Laurel, New Jersey.

First and foremost, this case included Brian Sokalsky and Vincent Tornari. These individuals were 42 and 46 respectively. Additionally, they were all from New Jersey. These individuals were charged with commenting on wire fraud and healthcare fraud due to the fraudulent acts that they were involved in. On the other hand, Tornari and Ashley Lyons-Valenti, a 63-year-old and from Swedesboro were also charged with a conspiracy that involved a bribery claim. These two individuals conspired to bribe Lyons-Valenti. Tornari and Sokalsky were further charged with both acts of wire and healthcare fraud. Lyons-Valenti was however charted with an individual cat of wire fraud.

This case involved numerous details and information that fall under the healthcare fraud facet. This case was assigned to Robert B. Kugler, the US District Judge. According to the indictment for this case, this case involved a conspirator that had the obligation of recruiting individuals from all over New Jersey. These individuals were meant to acquire prescriptions for expensive and medically unnecessary prescriptions from two pharmacies one of which was located in Pennsylvania. These prescriptions were for compounding medication that included libido, scar, antifungal, and pain creams. Also, some reimbursed medication included those with vitamin combinations.

In addition to this scheme, these individuals also extended their reach. According to the case presented in the court, the conspirator learned that the state employees had health insurance. As part of the Pharmacy Benefits Administrator program, they were entitled to this sort of attention. According to the setup for the operation of these programs, the Pharmacy Benefits Administrator had to pay for the medical needs of the state workers and then bill the New Jersey State and the other insurers for the money paid. Therefore, this made it easier for the conspirator to access the funds and therefore gain more income from, the scheme.

According to the case presented in the court, Matthew Tedesco had an arrangement with Sokalsky. This arrangement included an unnecessary medical prescription by Sokalskyby patients who went to the healthcare center. First and foremost, this agreement included only the patients that Tedesco sent to Sokalsky medical practice. Additionally, this arrangement only included expensive Compounding Pharmacy medications. After this transaction, some percentage of the amount received from the prescriptions was paid to Tedesco. Since the learning of the programs meant to cater for the state workers who needed the state funds for medical attention, Tedesco recruited some state workers who were a part of these programs.

This scheme involved the workers and other government employees that were covered by the Pharmacy Benefits Administrator. They talked them into agreeing to the terms of this scheme for some cash in return. Therefore, the same arranged scheme continued between Sokalsky and Tedesco. This was considered fraud as Tedesco sent the patients for compounded medication from Sokalsky. Sokalsky on the other hand did not bother to ask any questions. He instead gave the prescriptions without any tests or proof of tests. Sokalsky, therefore, billed the insurance companies for over 30 patients. However, it is well established that Tedesco tipped Sokalsky on the recruited patients. Therefore this was considered healthcare fraud for state programs meant to cater to some state workers.

Through this scheme, Tedesco and Sokalsky gained profits in terms of millions. As the prescriptions were posted to a Compounding Pharmacy, the Compounding Pharmacy billed Pharmacy Benefits Administrator which in turn paid the Compounding Pharmacy over $ 5 million for the alleged compounded medication that was prescribed by Sokalsky. Therefore, this is a scheme that allegedly benefited the involved healthcare specialists over $5 million. On the other hand, the court outlined that the defendants were not new in fraudulent acts.

In another case presented in court, Mark Bruno was hired to locate and bring forth the patients that needed compounded medication. Tornari had Sokalsky agreed to write prescriptions to the patients. These prescriptions were however not medically necessary. Bruno then alerted on the patients that he sent to Sokalsky before their arrival. Approximately $500,000.was lost through this scheme. However, Bruno pled guilty for conspiring in committing healthcare fraud. He admitted the charges and his participation in this scheme and was sentenced accordingly.

Other counts presented in court that involved Tornari and Sokalsky involved other individuals and healthcare. One such case involved Lyons-Valenti who persuaded his patients to acquire compounded medication. Lyons-Valenti further advised her workers to receive Compounding Pharmacy 2. In addition to that, it is well established that Tornari, in this case, that involved Lyons-Valenti’s boyfriend paid kickbacks for the prescriptions made by this pharmacy. Therefore, this is another scheme that involves the alleged culprits of healthcare fraud.

Apart from this case, the prevalence of such cases in the court of law is well documented. On the other hand, it is well established that such cases, among all the other cases that fall under the bracket of healthcare fraud, often have severe punishment in terms of jail times or even twice the gain from the scheme. This is seen in the cases presented in court in the previous years. One of these cases includes the one that involved Michael Goldis a 64-year-old who had a medical practice at Stratford, New Jersey.

According to Goldis’ case, the defendant, Goldis, signed 4 prescriptions for individuals who were not his patients. However, in this case, it is well established that these actions were provoked by Richard Zappala, who also pled guilty for committing several counts of healthcare fraud. Additionally, Glodis outlined that the patients that he had prescribed the medication for were four. On the other hand, he admitted that he received some kickback cash from Zappala for the prescriptions. These kickback payments summed up to $4,700. Regardless of the alleged amount gained through this scheme, the pharmacy that Goldis worked was summoned to pay a sum of $1 million.

Additionally, Goldis was also found guilty of other counts of healthcare fraud acts. However, these counts involved other individuals including Aaron Jones, Steven Monaco, and Daniel Oswari. Al these cases were charged in court and all the alleged culprits were sentenced in court. However, some of these cases still stand in court awaiting the final judgment. From this case, it is well established that healthcare fraud has enormous consequences. On the other hand, the commonness of these cases is also shaded light upon. This is evident from the different cases as heard in court. This means that the cases provide the basis of the importance that the law enforcement agencies have been putting on healthcare fraud cases. Also, these cases show that healthcare fraud is a common crime in modern-day society and also that most of the cases heard have been receiving severe punishment in the court of law.

Carpenito, a US attorney, also outlined the hard work by the FBI agents on bringing the above-mentioned culprits to justice. Also, IRS – Criminal Investigation assisted in bringing forth the details on the case for the prosecution. It is therefore evident that several law enforcement agencies in the US have come forth to fight healthcare fraud in America. From all these cases, it is well established that the alleged culprits either faced or are bound to face harsh sentences. First, Goldis has a potential of five years in prison on each count presented in the case. Also, he is bound to pay a fine of $250,000 in addition to the jail sentence. Apart from that, it is well established that he is bound to pay twice the gross loss or gain from the scheme. From the possible penalties, it is well established that such cases have severe penalties.

In addition to that, it is well established that the cases presented in the courts of law on healthcare fraud, especially those of such nature have been rampant and also have been receiving enormous attention in the previous years. Therefore, healthcare specialists that are involved in such cases have great potential of landing in hot soup. They, therefore, have to seek all the relevant assistance to escape most of the damage that is associated with such cases, including long term imprisonment and also greater fines. Seeking legal assistance is one of the main strategies that healthcare specialists should consider. The Healthcare Fraud Group stands to assist any healthcare providers that fall victim to such a situation. Our main aim is to ensure that you are effectively represented in the court of law. Contact us at 888-402-4054 for free consultations.

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