U.S. Attorney for the District of New Jersey: Gloucester County Man Admits Healthcare Fraud

CAMDEN, New Jersey, June 13 -- The office of the U.S. Attorney for the District of New Jersey issued the following news release on June 12, 2023:

A Gloucester County, New Jersey, man today admitted 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 announced.

Christopher Gualtieri, 50, of Franklinville, New Jersey, 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.

According to documents filed in this case and statements made in court:

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.

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. 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. 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. 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. 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.

The charge of conspiracy to commit health care and mail fraud is punishable by a maximum potential penalty of 20 years in prison; the charge of obtaining drugs by fraud is punishable by a maximum potential penalty of four years in prison. Both counts are also punishable by a fine of up to $250,000, or twice the gross gain or gross loss from the offense, whichever is greatest. Sentencing is scheduled for Oct. 18, 2023.

Attorney for the United States Khanna credited agents of the FBI, Philadelphia Field Office, Health Care Fraud Task Force, under the direction of Special Agent in Charge Jacqueline Maguire; task force members from the Pennsylvania Attorney General's Office, Department of Health and Human Services - Office of Inspector General; the Philadelphia Police Department; and diversion investigators of the Drug Enforcement Administration, New Jersey Division, Camden Resident Office, under the direction of Special Agent in Charge Cheryl Ortiz, with the investigation leading to today's guilty plea. Attorney for the United States Khanna also thanked U.S. Postal Service - Office of Inspector General, for its assistance in the investigation.

The government is represented by Assistant U.S. Attorney Jeffrey Bender of the U.S. Attorney's Office in Camden.

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Original text here: https://www.justice.gov/usao-nj/pr/gloucester-county-man-admits-healthcare-fraud