A 38-year-old Phillipsburg lady has admitted her function in an insurance scams plan that bilked public and personal health prepares out of at least$8.8 million by filling fake prescriptions for intensified medicines. Christine Myers swiped practically $1.5 million in the plan to get insurance coverage reimbursements for phony prescriptions and faces up to a years in prison, according to a news release.
The previous co-owner of a New Jersey marketing company last week pleaded guilty to conspiracy to dedicate healthcare fraud through video conference prior to U.S. District Judge John Michael Vazquez.
“Myers confessed that she and others sought to defraud insurance companies by recruiting the very individuals who take pleasure in that protection, offering them money allurements to get medications they didn’t need,” U.S. Attorney Craig Carpenito said in a news release. “Her conviction must serve as an alerting to those who would exploit their health protection for financial gain.”
As part of her plea offer, Myers needs to quit the$1.475 million she netted in the plan and pay restitution of at least$ 8.8 million. Sentencing is
scheduled for Dec. 1.
Here’s how the scheme worked according to court records and statement: Pharmacists mix intensified medications for patients when a doctor identifies a Food and Drug Administration-approved medication would not work, for example, if a patient is allergic to dye in a prescription. Particular insurance coverage strategies pay “expensive reimbursement rates” for some intensified medications, including scar and wound creams and metabolic supplements and vitamins.
Those associated with the plan found this and from February 2015 until February 2017 they developed a sophisticated system to send phony prescriptions for compounded medicine to pubic and personal insurance coverage strategies.
Myers developed a marketing business and hired sales agents to target individuals who had insurance plans that covered intensified medications. The sales associates got those people to get prescriptions for the medications, even if they did not require them, typically by paying them cash. They were then directed to send out the prescriptions to specific telemedicine companies, which Myers’ company or its affiliates paid.
The prescriptions were filled by certain compounding pharmacies, which Myers’ business conspired with. The drug stores would be repaid by the insurance coverage plans and pay Myers’ business a portion of the repayment. Myers then filched a portion of the payment and paid her sales rep a commission.
2 of the sales agents– Christopher Frusci and Enver Kalaba– are former Metropolitan Transport Authority employees. Since the MTA’s health insurance covered intensified medications, Frusci and Kalaba targeted employees at the company and paid them cash kickbacks for each compounded prescription they sent.
Frusci and Kalaba currently both pleaded guilty to conspiracy to dedicate health care scams. Frusci is waiting for sentencing.
On Feb. 7, 2019, Kalaba was sentenced to 20 months in federal prison and one year of monitored release. He needs to give up the $138,630 he made in the plan and pay back $2.9 million in restitution.
“Christine Myers treated medical insurance plans as a car to line her own pockets when she participated in a fancy plan that led to defrauding insurance companies out of a minimum of $8.8 million,” stated Joe Denahan, the FBI Newark Acting Special Agent in Charge. “The FBI, in combination with our police partners, will continue to investigate and haul into court crooks who defraud the system and cheat the American taxpayer.”
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