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NJ Man Pleads Guilty in $4 Million Health Insurance Fraud Scheme Involving Prescriptions

Nicole Rosenthal of reports that according to Vikas Khanna, Attorney for the United States, 50-year-old Christopher Gaultieri of Franklinville, NJ has pleaded guilty last month in connection to a scheme involving submitting fraudulent claims for “medically unnecessary prescriptions, including oxycodone,” ultimately costing his employer’s health insurance plan over $4 million.

Rosenthal highlights the following:

  • “After learning that certain compound medications - specialty medications mixed by a pharmacist to meet an individual patient’s needs - were reimbursed by his health insurance plan for up to thousands of dollars for a one-month supply, Gualtieri recruited co-workers to agree to receive medically unnecessary compounded medications for themselves and their family members, According to documents filed in the case and statements made in court.”

  • “Gualtieri and two co-conspirators prompted the pharmacy benefits administrator to pay the compounding pharmacies more than $4 million for compounded medications through the scheme, federal officials said, with Gualtieri receiving a portion of the amount paid by the pharmacy benefits administrator to the compounding pharmacies.”

  • “Gualtieri also 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.”

Gaultieri is charged with one count of conspiracy to commit health care fraud and mail fraud (punishable by a maximum 20-year prison sentence), and one count of obtaining oxycodone through fraud (punishable by a maximum 4-year prison sentence). These charges 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.

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