New Jersey Healthcare fraud by doctor and sales representative duo posing as uncle and nephew

New Jersey Healthcare fraud by doctor and sales representative duo posing as uncle and nephew

Another healthcare racket carried out by those involved in the medical profession was disclosed by US Attorney Craig Carpenito. The racket consisted of cheating major healthcare benefits as well as health insurance providers of large bills of medical claims. The total sum amounted to almost two and a half million dollars. Such bills were of the prescriptions for medications that were not even essential for the patients.

Forty-year-old Keith Ritson was one of the main culprits of the crime. Another culprit was Frank Alario, a sixty-three-year-old man. They were also charged with committing financial frauds through electronic means. Also, they were charged with illegally gaining the personal information of patients that could identify the patients individually. They were also accused of falsifying their statements in matters concerning the health of people and making large amounts of money through illegal ways.

Rober B. Kugler was assigned the case as a judge. He was a US District judge. The final verdict was to be on the 10th of September, 2020.

Compound medications are made by licensed pharmacists for the particular needs of individual patients.  These medications are unique concoctions of different medications in certain proportions. The Food and Drug Administration does not approve of these medications. They are specifically developed when the existing drugs are considered to be not sufficient to cater to the needs of some patients. It can also be developed if there are problems with the patient such as allergy.

The scheme consisted of hiring people to get medications and compounds that were high in prices. The main pharmacy from where they obtained these was Louisiana Pharmacy, Central Rexall Drugs Inc. The medication consisted of creams for various purposes such as a scar, anti-fungal, pain, libido, and vitamins. The schemers realized that such medications would be compensated in large sums of money by health care and insurance institutions. So they focused on these medications specifically.

Certain civil employees in the New Jersey state have facilities of health insurance. The schemers took advantage of this. The State Health Benefits Program is supported by an institution through services related to pharmacy benefit handling. This institution was called Pharmacy Benefits Administrator. Under these services, various civil workers, education workers, workers who are retired as well as some who fulfill certain criteria are served. The institution indemnified the bills of prescription and then claimed the amount from the State of New Jersey or other insurance providers.

Ritson gathered people who were beneficiaries of the Pharmacy Benefits Administrator. These people could be prescribed compound medications by Alario. Alario authorized these prescriptions without any personal consultations with the patients. He made these prescriptions, not for the welfare of the patient’s health, but just to fill his own pockets. He even made claims that he did the consultations to the Central Rexall’s offices. He claimed that he made face to face communications with the patients. All these false claims were made to ensure that there would be no doubts regarding the authenticity of the prescriptions. The conspiring duo made a list of all the patients of Alario with the specific type of insurance coverage. This insurance would cover prescriptions of high priced compound medications. The whole plot was designed to rip off the Pharmacy Benefits Administrator.  These prescriptions were used to claim reimbursements from the Pharmacy Benefits Administrator. The institution paid more than two and a half million dollars because of the scheme. Ritson got a certain proportion of the payments that Central Rexall got through reimbursements. Alario received a commission from the scheme in the forms of different facilities of food and fun. These were the sorts of selfish gains that the two conspirators schemed so greatly for.

Furthermore, the duo was also involved in gathering very personal information about the patients and their health, in an unlawful manner. They abused this information for illegal gains to themselves. Ritson, in fact, did not have the right to this information at all as he was not employed at the clinic where Alario worked. Besides that, they misused a lot of office property like medical records, computers, and fax machines for gaining very private insurance information about many of the patients. The insurance of some only covered certain medications. So they conducted these illegal searches to find more information about their insurances. They would go into great lengths to calculate the insurance probabilities of patients. Additionally, Ritson also stationed himself in the examination rooms of Alario during consultations. He did this in order to promote compound medications. He purported to be Alario’s nephew on these occasions. He used these times inside the rooms to gain information about the patients.

Healthcare fraud together with wire fraud charges can land a person in prison for a maximum of twenty years. Wire frauds can also result in twenty years in prison at the most. The charges of illegally gathering personal information can result in a maximum of five years in prison. Illegally gaining money can result in ten years of imprisonment. All of these charges can also result in a fine amounting to a quarter of a million dollars. Depending on the value of the loss to the party or the gain to the fraud, the fine can go higher.

U.S. Attorney Carpenito gave appreciation for the works of the different agencies and offices involved in the inspection of the case. FBI’s Atlantic City Resident Agency, under the direction of Special Agent in Charge George M. Crouch Jr. in Newark; the U.S. Department of Labor, Office of Inspector General, New York Region, under the direction of Special Agent in Charge Michael C. Mikulka, IRS – Criminal Investigation, under the direction of Special Agent in Charge Michael Montanez in Newark were among them. Credit was also given to the Division of Pensions and Financial Transactions in the State Attorney General’s Office. The office was under the direction of Division Chief Aimee Nason and Attorney General Gurbir S. Grewal.

The prosecution was conducted by Assistant U.S. Attorneys R. David Walk Jr. and Christina O. Hud of the U.S. Attorney’s Office in Camden.

It is very difficult to navigate the intricacies of the modern world. Systems are in place everywhere that have certain procedures and rules that need to be followed in order to gain services. Fraud cases are delicate matters that usually span numerous systems and networks. Figuring out the best solution to such matters requires special legal assistance to win through. People who are in such fixes should seek genuine legal assistance. The Healthcare Fraud Group is here for any person or organization that is charged or defrauded in such cases. We provide comprehensive assistance through simple communication along with the blend of academics as well as experienced background. We ensure your case is represented in the most favorable manner in the court of law. Please feel free to contact us at 888-402-4054 for free consultations.

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