Ocean City schools maintenance worker latest to plead in insurance fraud scheme
An Ocean City schools maintenance worker is the latest to admit to health insurance fraud in a far-reaching multimillion dollar scheme.
James Wildman, 44, of Marmora, made more than $650,000 as a recruiter who persuaded public workers to get expensive, medically unnecessary compounded medications that insurers then reimbursed for thousands of dollars per monthly supply, U.S. Attorney Craig Carpenito said Tuesday.
Wildman was part of the conspiracy from January 2015 through February 2016, according to the complaint.
He resigned from his position with the Ocean City School District last month, an agenda from that time shows.
Teachers, firefighters, police officers and state troopers were targeted as recruits due to their high-dollar insurance converage.
Wildman and conspirators working under him recruited public employees 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, the complaint said. Wildman secured insurance information from the individuals and passed it along to a conspirator, who had a doctor sign prescriptions without examining the individuals. The prescriptions were faxed to the Compounding Pharmacy, which filled the prescriptions and billed the Pharmacy Benefits Administrator.
The pharmacy then paid one of Wildman’s conspirators a percentage of each prescription filled and paid by the Pharmacy Benefits Administrator, which was then distributed to Wildman and other members of the conspiracy. Wildman paid individuals cash to reward them for obtaining prescriptions. Wildman himself received compounded medications he did not need in order to financially benefit a conspirator.
More than $50 million was paid out by the Pharmacy Benefits Adminitrator for compounded medications mailed to individuals in state. Of that, $4,879,776 had allegedly been tied to Wildman and his cohorts.
Wildman received $657,040 for his role in the scheme.
He faces a maximum of 10 years in prison and a $250,000 fine, or twice the gross gain or loss from the offense. Sentencing is scheduled for Feb. 25, but that may just be a hold date. Sentencings for admitted co-conspirators have had numerous delays. None has been sentenced yet.
As part of his plea agreement, Wildman must forfeit $657,040 in criminal proceeds and pay restitution of at least $4,879,776.
Defense attorney Mark Roddy said he could not comment on the case.