NJ Man Admits Role In $4M Health Insurance Fraud Scheme: Feds

FRANKLINVILLE, NJ - A Gloucester County man admitted last week to submitting fraudulent claims for medically unnecessary prescriptions, including oxycodone, costing his employer’s health insurance plan out of more than $4 million, federal authorities said.

Christopher Gualtieri, 50, of Franklinville, pleaded guilty before U.S. District Judge Robert B. Kugler to one count of an indictment charging him with conspiracy to commit health care and mail fraud and one count charging him with obtaining oxycodone through fraud, Attorney for the United States Vikas Khanna said in a statement.

After learning that certain compound medications - specialty medications mixed by a pharmacist to meet an individual patient’s needs - were reimbursed by his health insurance plan for up to thousands of dollars for a one-month supply, Gualtieri recruited co-workers to agree to receive medically unnecessary compounded medications for themselves and their family members, According to documents filed in the case and statements made in court.

Gualtieri and two co-conspirators prompted the pharmacy benefits administrator to pay the compounding pharmacies more than $4 million for compounded medications through the scheme, federal officials said, with Gualtieri receiving a portion of the amount paid by the pharmacy benefits administrator to the compounding pharmacies.

Gualtieri also admitted to paying cash to his conspirators for their participation in the scheme.

When questioned by special agents of the FBI, Gualtieri falsely denied recruiting others to receive compounded medications and falsely denied paying cash to others for their participation in the scheme.

The charge of conspiracy to commit health care and mail fraud is punishable by a maximum potential penalty of 20 years in prison; the charge of obtaining drugs by fraud is punishable by a maximum potential penalty of four years in prison. Both counts are also punishable by a fine of up to $250,000, or twice the gross gain or gross loss from the offense, whichever is greatest.

Sentencing is scheduled for Oct. 18, 2023.