Former Pharmaceutical Sales Representative Convicted for Insurance Fraud and Aggravated Identity Theft
BOSTON – A federal jury in Boston convicted an Illinois man yesterday of defrauding insurance companies in relation to a high-priced drug made by Cambridge-based pharmaceutical company Aegerion Pharmaceuticals Inc., and for using the identities of physicians to carry out the fraud.
Mark Moffett, 47, of Springfield, Ill., was convicted of nine counts of wire fraud and six counts of aggravated identity theft. U.S. District Court Judge William G. Young scheduled sentencing for April 9, 2020.
“Mr. Moffett stole doctors’ identities, obtained fraudulent prescriptions, falsified test results, and forged insurance documents in an effort to sell a powerful drug,” said United States Attorney Andrew E. Lelling. “He ignored the serious consequences it could have on patients’ health, caring more about lining his own pockets. Mr. Moffett’s conviction is part of our ongoing effort to hold pharmaceutical companies accountable for violating laws that protect patient safety and the integrity of the health care system.”
“Mark Moffett took matters into his own hands by defrauding Medicare and potentially putting patients’ health at risk for his own financial benefit,” said Joseph R. Bonavolonta, Special Agent in Charge of the Federal Bureau of Investigation, Boston Field Division. “The FBI would like to thank the jury for their swift verdict, and we will continue to vigorously investigate healthcare fraud matters to protect the public’s interest.”
“Greed was at the very core of Mark Moffett’s scheme to defraud our federal healthcare system,” said Phillip M. Coyne, Special Agent in Charge for the U.S. Department of Health & Human Services, Office of Inspector General. “This type of fraud is corrosive, wastes taxpayer funds, and drives up healthcare costs. We will continue to aggressively root out these fraud schemes and bring criminals to justice.”
“The Employee Benefits Security Administration is pleased to have had the opportunity to work collaboratively with our law enforcement partners on this investigation. I commend the exceptional work performed by our investigators and their law enforcement partners. This office will continue to vigorously pursue cases where participants and private sector health benefit plans are victimized by unscrupulous and illegal pharmaceutical sales practices,” said Carol S. Hamilton, Acting Regional Director of the U.S. Department of Labor, Employee Benefits Security Administration, Boston Regional Office
In 2014 and 2015, Moffett, a pharmaceutical sales representative for Aegerion, marketed the company’s cholesterol drug Juxtapid. Juxtapid was approved by the FDA only to treat high cholesterol in patients with a rare genetic disease called homozygous familial hypercholesterolemia (“HoFH”). The FDA approved the drug only to treat HoFH patients because the drug carried serious risks of side effects, including liver damage. The drug’s label included a black box warning.
Moffett nonetheless convinced doctors to prescribe Juxtapid, which costs over $300,000 per year, for patients without HoFH. In order to defraud Medicare and private sector employee health plans into paying for a drug they only covered for FDA-approved uses, Moffett obtained fraudulent prescriptions and falsified numerous documents, including statements of medical necessity and other insurance documents. This included false patient test results, false clinical histories and false diagnoses. Moffett used the identities of several cardiologists to carry out the fraud. He was paid bonuses by Aegerion of up to $11,000 for each prescription of Juxtapid.
The charge of wire fraud provides for a sentence of up to 20 years in prison, three years of supervised release and a fine of $250,000 per count. The charge of aggravated identity theft provides for a mandatory minimum sentence of two years in prison to be serve consecutive to any other sentence imposed. Sentences are imposed by a federal district court judge based upon the U.S. Sentencing Guidelines and other statutory factors.
U.S. Attorney Lelling, FBI Boston SAC Bonavolonta, HSI-OIG SAC Coyne, and DOL-EBSA Acting Regional Director Hamilton made the announcement. Assistant U.S. Attorneys Kriss Basil, of Lelling’s Securities and Financial Fraud Unit, and Rachel Y. Hemani, of Lelling’s Health Care Fraud Unit, are prosecuting the case.