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10th guilty pleas in shore prescription benefits fraud case

Another pharmaceutical representative pleaded guilty in a far-reaching prescription $50 million-plus fraud case that includes several Atlantic County towns.
Michael Neopolitan, 49, of Willow Grove, Pennsylvania, admitted defrauding New Jersey state health benefits programs and other insurers out of millions of dollars by submitting fraudulent claims for medically unnecessary prescriptions, acting U.S. Attorney William E. Fitzpatrick and New Jersey Attorney General Christopher S. Porrino announced.
From January 2015 through April 2016, Neopolitan recruited individuals in New Jersey to obtain very expensive and medically unnecessary compounded medications from an out-of-state pharmacy, identified in federal documents only as “Compounding Pharmacy.”
The conspirators learned that certain compound medication prescriptions – including pain, scar, antifungal, and libido creams, as well as vitamin combinations – were reimbursed for thousands of dollars for a one-month supply.
The unnamed “Pharmacy Benefits Administrator” provided pharmacy benefit management services for the State Health Benefits Program, which covers qualified state and local government employees, retirees, and eligible dependents, and the School Employees’ Health Benefits Program, which covers qualified local education employees, retirees, and eligible dependents. The Pharmacy Benefits Administrator would pay prescription drug claims and then bill the state.
Once he had recruited an employee covered by the Pharmacy Benefits Administrator, Neopolitan would obtain the employee’s insurance information and fill out a Compounding Pharmacy prescription form. He would select the compounded medications that paid the most without regard to their medical necessity.
Neopolitan would then get the prescriptions signed by doctors who never evaluated whether the patients had a medical necessity for the compounded medication. The prescriptions were then faxed to Compounding Pharmacy, which filled the prescriptions and billed the Pharmacy Benefits Administrator.
Neopolitan must forfeit $198,617.14 in criminal and pay restitution of at least $762,519.74.
He faces as much as10 years in prison when he is sentenced Jan. 12.
Nine other conspirators have pleaded guilty, including Margate Dr. John Gaffney and Atlantic City Firefighter Michael Pepper.

 

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