Ocean County pharmaceutical rep latest to plead in health care fraud case
An Ocean County pharmaceutical representative is the latest to plead guilty in a multi-million dollar scheme to defraud health benefits.
Kristie Abbott Masucci, 36, of Cedar Run, admitted to conspiracy to commit health care fraud Monday.
Firefighters, teachers and a doctor are among the 20 who already pleaded guilty in the scheme that took advantage of benefits afforded state and local government and education employees. Thousands of dollars were made in reimbursements for monthly supplies of compound medications that were prescribed for profit rather than necessity.
As a recruiter in the conspiracy from January 2015 through February 2016, Masucci made $388,608, U.S. Attorney Craig Carpenito said.
She and those working under her recruited public employees and other individuals covered by the Pharmacy Benefits Administrator to fraudulently obtain compounded medications from the Compounding Pharmacy without any evaluation by a medical professional that they were medically necessary. In return, the pharmacy paid one of Masucci’s conspirators a percentage of each prescription filled and paid by the Pharmacy Benefits Administrator, which was then distributed to Masucci and other members of the conspiracy.
Masucci’s conspirators would then cause the prescriptions to be signed by a doctor who never evaluated whether the patients had a medical necessity for the compounded medication. The prescriptions were then faxed to the Compounding Pharmacy, which filled the prescriptions and billed the Pharmacy Benefits Administrator.
According to the information, the Pharmacy Benefits Administrator paid the Compounding Pharmacy more than $50 million for compounded medications mailed to individuals in New Jersey, including $1.88 million for prescriptions submitted by Masucci and her cohorts.
Masucci faces a maximum as long as 10 years in prison and a $250,000 fine, or twice the gross gain or loss from the offense. Sentencing is scheduled for Feb. 5.
As part of her plea agreement, Masucci must forfeit her criminal proceeds and pay restitution in an amount to be determined at sentencing.