Five Individuals Responsible for Over $15M in Health Care Fraud Arrested, Three Members of South Jersey Oxycodone Ring Plead Guilty
The largest health care fraud and opioid enforcement action ever taken by the Justice Department resulted in three guilty pleas and five arrests in New Jersey involving a South Jersey-Philadelphia drug trafficking ring that sold over 1,100 oxycodone pills and multiple individuals who used phony claims to steal millions from state and private insurers, U.S. Attorney Craig Carpenito announced today.
The national takedown targeted over 601 charged defendants across 58 federal districts, including more than 165 doctors, nurses and other licensed medical professionals, for their alleged participation in health care fraud schemes involving approximately $2 billion in false billings. Of those charged, over 162 defendants, including 76 doctors, were charged for their roles in prescribing and distributing opioids and other dangerous narcotics.
As part of the national takedown, the New Jersey U.S. Attorney’s Office filed five separate cases this week charging four defendants with conspiracy to commit health care fraud and three defendants with conspiracy to distribute oxycodone.
Robert Agresti, 61, a doctor from Essex Fells, New Jersey, and Brian Catanzarite, 42, a former gym owner from Cedar Grove, New Jersey, pleaded guilty on June 26, 2018 to their roles in separate conspiracies to attain phony compounded medication prescriptions on behalf of companies that marketed those products.
Enver Kalaba, 36, a Metropolitan Transportation Authority (MTA) bus driver from Old Bridge, New Jersey, pleaded guilty June 27, 2018 to a similar scheme targeting his employer.
Tiffany Marsh, 40, a medical billing company owner from West Orange, New Jersey, and Keasam Johnson, 34, a telecommunications company employee from East Orange, New Jersey, were arrested on June 26, 2018 for their alleged roles in a conspiracy to collect insurance reimbursements for chiropractic services that were never rendered.
Anthony Pepe III, 40, of Cherry Hill, New Jersey, an anesthesiology technologist for a Philadelphia hospital, along with Daniel Watson, 39, of Bellmawr, New Jersey, and Prussia Hing, 35, of Philadelphia, were arrested on June 26, 2018 for their alleged roles in an oxycodone distribution ring.
Officials say Agresti admitted that from November 2014 through September 2017, he participated in a scheme to defraud health insurance plans, including New Jersey state and local employee health benefit programs, by prescribing medically unnecessary compounded prescriptions on behalf of a company that marketed those products. He was paid $300 in cash for every prescription he authorized for compounded medication, regardless of medical necessity. Agresti signed the prescriptions brought to him by other conspirators without examining or speaking with the patients. Multiple health benefit programs paid more than $8.9 million as a result of Agresti’s phony prescriptions.
According to authorities, Catanzarite admitted that from March 2015 through January 2017, he conspired to defraud New Jersey state benefit programs. Catanzarite was recruited by one of his former gym members to become a sales representative of a company that marketed compounded medications. The marketing company received a percentage of every prescription that its sales representatives steered toward a particular compounding pharmacy.
To maximize his profit, Catanzarite convinced state beneficiaries to obtain compounded medications regardless of their medical necessity. On several occasions, Catanzarite even paid an advanced nurse practitioner, introduced to him by the marketing company, or used a telemedicine service that was paid for by the marketing company, to fraudulently obtain compounded medication prescriptions. Altogether, Catanzarite caused losses of at least $3.5 million and personally made over $1.1 million from the scheme.
Kalaba admitted that from April 2016 through August 2017, he conspired to defraud the MTA’s health benefits plan using fraudulent claims for medically unnecessary compounded medications. Kalaba was recruited into the scheme by another former MTA bus driver, Christopher Frusci. Both Frusci and Kalaba acted as sales representatives of a company that marketed compounded medications. He paid MTA beneficiaries monthly cash bribes, including $100 per phony prescription. To ensure physicians prescribed compounded medications regardless of medical necessity, Kalaba referred MTA beneficiaries to telemedicine physicians who were paid by the marketing company or its affiliates. Altogether, Kalaba caused losses of $2.9 million and made $138,629 from the scheme.
Marsh, the owner and operator of TJB Medical Billing Consultants LLC, provided medical billing to two New Jersey chiropractors. Johnson worked as a supervisor in the New Jersey office of a large telecommunications company.
Marsh used her access to the billing software at the chiropractor offices to generate false claims for out-of-network chiropractic services that were never performed. The claims were made pursuant to an agreement between Marsh and Johnson, who recruited other employees to allow false claims to be made in their names in exchange for a portion of the proceeds. From June 2016 through November 2017, Marsh submitted approximately 800 fraudulent claims seeking approximately $850,000 in reimbursements, which resulted in the payment of approximately $333,000 for chiropractic services that were never rendered.
Pepe, Watson, and Hing between January 2018 and May 2018, Pepe, Watson, and Hing engaged in a conspiracy which resulted in the trafficking of 1,180 oxycodone pills – 680 of which were unadulterated oxycodone and 500 of which were pressed pills mixed with hydrocodone, codeine, and methylphenidate. As part of the investigation, law enforcement observed eight controlled purchases, three of which were carried out by the defendants – including Pepe dressed in his work scrubs – in front of the Philadelphia hospital where Pepe was employed.
According to authorities, Agresti, Kalaba, Catanzarite, Marsh and Johnson each face a potential 10 years in prison and a $250,000 fine, or twice the gross gain or loss from the offense. Sentencing for Agresti, Catanzarite, and Kalaba is scheduled for Oct. 30, 2018. Pepe, Watson, and Hing each face a potential 20 years in prison and a $1 million fine.
The charges and allegations against Marsh, Johnson, Pepe, Watson, and Hing are merely accusations, and they are considered innocent unless and until proven guilty.