State prosecutors in Camden court recently announced that the New Jersey woman charged with prescription fraud and healthcare fraud has already admitted to the offenses. The defendant filed a guilty plea for conspiring to commit healthcare insurance fraud against the government and private health insurers through the issuance of impractical prescriptions for drugs that have no reasonable medical purposes.
Tara Lamonaca, a 43 years old pharmaceutical representative from Linwood, filed a guilty plea to an accusation directed at her for being part of a large scale scheme to commit healthcare fraud against health insurers by issuing claims for reimbursements of prescriptions that were written without any reasonable medical purpose.
Based on the investigations conducted by the prosecution and the defendant’s statements, Lamonaca is one of the conspirators that participated in a large-scale scheme that involved other pharmaceutical representatives and individuals, some of whom have already pleaded guilty earlier. The defendant was found out to have actively sourced out New Jersey residents to instruct them to take part in the conspiracy by going to an unidentified pharmacy, referred to in the indictment as the “compounding pharmacy” and acquire costly and unreasonable specially mixed or modified medications. These individuals who took Lamonaca’s offer were from different job fields, some of whom are teachers, firefighters, etc. Lamonaca had directed the recruited conspirators to obtain a month’s supply of specific costly mixed medications, including pain and scar creams, antifungal ointments, and mixed vitamin supplements, which were compensated by insurers, amounting to a loss of more than a thousand dollars of funding.
The recruited individuals are aware that the mixed medications are paid for by an unidentified individual, only known as the pharmacy benefits administrator. This unidentified personage was said to have management connections with government-funded healthcare programs, specifically the State Health Benefits Program and the School Employees’ Health Benefits Program. The conspirators only knew that this person used the prescriptions for the compound medications and reimbursed them using the two programs mentioned above. The State Health Benefits Program provides health insurance coverage to government employees, retirees, and their dependents. On the other hand, the School Employees’ Health Benefits Program provides benefits to employees and retirees working in the education industry and their qualified dependents.
The unidentified pharmacy benefits administrator serves as the one who directed the scheme, while Lamonaca and other recruited collaborators are the ones who do the dirty work of acquiring the prescriptions for mixed medications and getting them filled up in the unnamed collaborator pharmacy. In usual operation, the defendant would acquire the details of the insurance coverage of the accomplices, forward the information to another collaborator who will issue the prescriptions, and convince a possible accomplice physician to approve the prescriptions without seeing the actual patients. These fraudulent prescriptions were forwarded to the collaborator pharmacy, which issued the compounded medications, and then reimbursed by the pharmacy benefits administrator. The collaborators would then each get a share of the proceeds they got from the insurance programs. According to evidence gathered, the collaborator pharmacy has acquired more than $50 million from the pharmacy benefits administrator as payment for its services in distributing the compounded drugs to the accomplices, including the prescriptions issued by Lamonaca and her recruits. Lamonaca admitted that she had amassed more than $80,000 in the conspiracy.
If proven guilty of the allegations, the defendant will be facing a 10-year federal detainment and a quarter million fines. The defendant also agreed to the forfeiture of the money she had gained from the conspiracy and paid compensations for damages as decided during the sentencing.
It is worrying that multiple medical professionals and civilians have willingly participated in a prescription fraud and healthcare fraud conspiracy, in exchange for financial gain. Lamonaca and her cohorts had allowed that pharmacy benefits administrator to make use of them as his pawns in committing multimillion fraudulent reimbursements to healthcare insurers, unaware of how their actions have negatively impacted the funding for the healthcare services that were supposed to help the real beneficiaries. Moreover, the unreasonable compounded medications can also endanger the patients’ lives, particularly because their own health was never assessed, and they were only used by the fraudsters as insurance information sources.
The Healthcare Fraud Group is steadfast on its commitment to help our clients who have concerns related to prescription and healthcare fraud. If you or anyone you know is somehow involved in the same conspiracy as above, either as a victim, a witness or an unwilling or falsely accused conspirator, we are willing to provide you with our assistance. Our competent team of defense lawyers has proven expertise in handling legal disputes related to healthcare fraud. Reach out to us now at 888-402-454 and discuss your situation with one of our lawyers.