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Three Individuals Charged in New Jersey for Alleged Involvement in $6 Million Health Care Fraud Conspiracy

thermometer-headache-pain-pills-139398-300x200Three individuals were indicted in New Jersey on Thursday for their alleged involvement in a $6 million prescription fraud scheme that targeted state healthcare plans in South Jersey.

The U.S. Attorney’s Office for the District of New Jersey announced a 33-count indictment against Dr. Brian Sokalsky, 42, of Margate; Vincent Tornari, 46, of Linwood; and Ashley Lyons-Valenti, 63, of Swedesboro, for their role in conspiracy schemes to receive kickback payments for medically unnecessary compounded medications. It is unclear if they have acquired legal representation.

The first two defendants were charged with multiple counts of conspiracy to commit health care fraud and wire fraud. The third defendant was charged with wire fraud and five counts of making false statements; she was additionally charged with obstruction of justice for allegedly tampering with a federal grand jury witness. A fourth conspirator, Dr. Michael Goldis of Stratford, pleaded guilty to four counts of making false statements for writing fraudulent prescriptions for patients he never met.

According to the indictment, the defendants are accused of recruiting patients in New Jersey to obtain expensive and medically unnecessary compounded medications from pharmacies in Louisiana and Pennsylvania. Compounded drugs are non-FDA-approved specialty medications mixed by a pharmacist to meet the specific needs of a patient.

The alleged fraud scheme centered on billing state and local government employees—police officers, firefighters, state troopers, teachers—covered by the state health benefits program for compounded drugs. The conspirators purportedly discovered that certain compound medication prescriptions, such as vitamin combinations and creams for pain, scars, and libido, were reimbursed for thousands of dollars for just a one-month supply.

The accused doctor reportedly had an arrangement with Matthew Tedesco of Northfield, who is awaiting sentencing after pleading guilty to conspiracy to commit health care fraud. The conspirator from Northfield allegedly sent new patients to the defendant’s medical practice. The doctor would then prescribe them compounded drugs from the Louisiana pharmacy. The state paid the pharmacy over $5 million for compounded medications he prescribed, according to the indictment. The doctor profited by billing insurance for over 30 new patients, while the conspirator received a percentage of the money the pharmacy received for the prescriptions, sources indicate.

The first two defendants had a similar arrangement with the Pennsylvania pharmacy, officials allege. The indictment claims the defendant from Linwood received 50 percent of the insurance payments the pharmacy got for prescriptions the doctor wrote. He hired an individual identified as Mark Bruno to find patients who would agree to receive medication from the pharmacy in exchange for cash payments. The hired individual sent the patients to the doctor, who gave them prescriptions for drugs they didn’t need, sometimes without even seeing them. The prescriptions cost insurers over $500,000, according to officials.

The third scheme involved the Linwood and Sedesboro defendants. The former allegedly hired the latter’s boyfriend to find patients and paid the boyfriend commissions for each prescription the female defendant wrote for the Pennsylvania pharmacy. She allegedly received half of the commission payments her boyfriend received from the Linwood defendant.

The female defendant is also accused of persuading individuals who work at her medical office to receive prescription medications from the Pennsylvania pharmacy that they did not need, often without performing a medical examination or recording the prescriptions in their medical records, officials said. The scheme cost insurance companies over $1.25 million. She received over $90,000 in kickbacks.

She was additionally charged with witness tampering for allegedly making false and misleading statements to a co-worker who was a witness in the investigation. She called and texted the witness before and after they spoke to the FBI, and before the witness was scheduled to testify in court, sources indicate.

In total, the three defendants allegedly defrauded the state health benefits program and other insurers out of more than $6 million by prescribing compound drugs.

Anyone under investigation for health care fraud should immediately consult an attorney. A good attorney can come up with a defense strategy that will result in the best possible outcome for your case.

South Florida Fraud Attorney

Are you accused of committing health care fraud in South Florida? Contact Brian Silber, P.A. for a free initial consultation with one of South Florida’s most experienced fraud defense attorneys.

Source: 6.25.20 three individuals charged in $6 million health care fraud conspiracy.pdf

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