Three Individuals Charged, Fourth Admits Guilt in $6 Million Health Care Fraud
Federal officials announced that a federal grand jury has charged three individuals, including a doctor and an advanced practice nurse, with defrauding New Jersey state health benefits programs and other insurers out of more than $6 million.
A fourth individual, a Mt. Laurel, doctor, pleaded guilty to signing four false prescriptions for patients he never met.
Brian Sokalsky, D.O., 42, of Margate, and Vincent Tornari, 46, of Linwood, were charged with conspiracy to commit health care fraud and wire fraud.
Sokalsky was charged with a second conspiracy to commit health care fraud and wire fraud.
Ashley Lyons-Valenti, 63, of Swedesboro, and Tornari were charged with a third conspiracy to bribe Lyons-Valenti and deprive her patients and employer of her honest services.
Sokalsky and Tornari also were each charged with individual acts of health care fraud and wire fraud, and Lyons-Valenti was charged with individual acts of wire fraud and five false statement counts.
Lyons-Valenti was also charged with obstruction of justice for tampering with a grand jury witness.
According to the indictment:
The conspirators recruited individuals in New Jersey to obtain very expensive and medically unnecessary compounded medications from a Louisiana pharmacy, identified as “Compounding Pharmacy 1,” and a Pennsylvania pharmacy, identified as “Compounding Pharmacy 2.”
The conspirators learned that certain compound medication prescriptions were reimbursed for thousands of dollars for a one-month supply.
The conspirators also learned that some New Jersey state and local government and education employees had insurance coverage for these particular compound medications.
An entity referred to as the “Pharmacy Benefits Administrator” provided pharmacy benefit management services for the State Health Benefits Program. The Pharmacy Benefits Administrator would pay prescription drug claims and then bill the State of New Jersey or the other insurance plans for the amounts paid.
First Charged Conspiracy
In the first charged conspiracy, Matthew Tedesco had an arrangement with Sokalsky – if Tedesco sent new patients to Sokalsky’s medical practice, Sokalsky would prescribe Compounding Pharmacy 1 medications for the patients.
Tedesco received a percentage of the amount that Compounding Pharmacy 1 received for prescriptions sent to them by Tedesco and his associates.
Tedesco and his conspirators recruited public employees and others covered by the Pharmacy Benefits Administrator to agree, in exchange for money, to obtain compounded medications from Compounding Pharmacy 1.
Tedesco sent the recruited individuals to Sokalsky and then Sokalsky prescribed Compounding Pharmacy 1 medications for the patients. Sokalsky profited by billing insurance for over 30 new patients.
The completed prescriptions were faxed to Compounding Pharmacy 1, which then filled the prescriptions and billed the Pharmacy Benefits Administrator.
The Pharmacy Benefits Administrator paid Compounding Pharmacy 1 over $5 million for compounded medications prescribed by Sokalsky.
Second Charged Conspiracy
The indictment charges Sokalsky and Tornari with a similar scheme for Compounding Pharmacy 2.
Tornari’s company had an agreement with Compounding Pharmacy 2 to receive 50 percent of the insurance payment for prescriptions they arranged.
Tornari then hired Mark Bruno to find patients who would agree to receive Compounding Pharmacy 2 medications in exchange for cash payments.
Bruno pleaded guilty in 2019 to conspiracy to commit health care fraud for his participation in the scheme.
Tornari had Sokalsky agree to write Compounding Pharmacy 2 prescriptions for new patients sent to him. Bruno found patients and sent them to Sokalsky who then wrote Compounding Pharmacy 2 prescriptions that the patients did not need or discuss with him. These prescriptions cost insurers over $500,000.
Third Charged Conspiracy
In a third charged scheme, Tornari hired Lyons-Valenti’s boyfriend and agreed to pay him commissions on each Compounding Pharmacy 2 prescription that Lyons-Valenti wrote.
Lyons-Valenti then started writing Compounding Pharmacy 2 prescriptions and Tornari paid commissions to the boyfriend, who gave Lyons-Valenti half of the payments. Lyons-Valenti persuaded her workers and subordinates at her medical office to receive Compounding Pharmacy 2 prescription medications that they did not need.
Lyons-Valenti wrote Compounding Pharmacy 2 prescriptions for which insurance paid over $1.25 million and received over $90,000 in kickbacks in return.
Fourth Charged Conspiracy
In a fourth scheme, Lyons-Valenti signed five Compounding Pharmacy 1 prescriptions for Judd Holt, who previously pleaded guilty to conspiracy to commit health care fraud for his role in the scheme.
On each of the five prescriptions, Lyons-Valenti falsely stated that she had determined that the prescribed medications were medically necessary, when in fact she had never met or examined any of the five patients.
Lyons-Valenti also was charged with witness tampering for making false and misleading statements to a co-worker who was a federal grand jury witness.
Lyons-Valenti called and texted the witness before and after the witness talked to the FBI and before the witness was scheduled to testify in the grand jury.
Lyons-Valenti told the witness to tell the FBI that Lyons-Valenti had examined the witness before prescribing medications for the witness, which was false.
Lyons-Valenti also falsely told the witness that Lyons-Valenti had never received any money for writing the prescriptions.
Additionally, Michael Goldis, D.O., 64, who had a medical practice in Stratford, pleaded guilty by videoconference to four counts of making false statements relating to health care matters.
According to admissions made in court, Goldis signed four prescriptions for individuals who were not his patients at the request of Richard Zappala, who previously pleaded guilty to conspiracy to commit health care fraud.
On each of the four prescriptions, Goldis falsely certified that he had determined that the prescribed medications were medically necessary, when in fact Goldis had never met or examined any of the four patients.
Goldis admitted that he received $1,000 checks on the same days he signed two of the prescriptions and received a total of $4,700 from Zappala. The Pharmacy Benefits Administrator paid approximately $1 million for prescriptions that Goldis signed at Zappala’s request.
Goldis faces a maximum penalty on each count of five years in prison and a $250,000 fine, or twice the gross gain or loss from the offense. Sentencing is scheduled for November 6.