Former Pharmacy Owner Pleads Guilty to Health Care Fraud
Jennifer Caloia Will Pay Insurance Companies, State and Federal Governments, in Settlement of Criminal and Civil Liability
SYRACUSE, NEW YORK – Jennifer Caloia, age 56, a licensed pharmacist who owned and operated Dougherty Pharmacy in Morrisville, New York, from 1998 to 2015, pled guilty today in federal court in Utica to one felony count of health care fraud, announced Acting United States Attorney Antoinette T. Bacon; Thomas F. Relford, Special Agent in Charge of the Albany Field Office of the Federal Bureau of Investigation (FBI); Scott J. Lampert, Special Agent in Charge of the New York Regional Office of the U.S. Department of Health and Human Services, Office of Inspector General; Ralph D. Tortora III, Regional Director, New York Attorney General’s Medicaid Fraud Control Unit, Syracuse Office; Carol S. Hamilton, Regional Director, U.S. Department of Labor Employee Benefits Security Administration (DOL EBSA); and Superintendent Linda A. Lacewell, New York State Department of Financial Services.
In pleading guilty, Jennifer Caloia admitted that between 2011 and 2015, she defrauded public and private health insurance programs by submitting false and fraudulent claims for prescription drugs that the pharmacy did not dispense. Caloia also admitted that customers submitting prescriptions for medications had their health insurance providers billed for more expensive drugs than those prescribed. To facilitate this scheme, the defendant changed the names of some of the prescription drugs in the software she used to communicate with insurance companies and to print drug labels, which allowed her to submit her fraudulent claims while providing the customer with the appropriate labels and instructions. Caloia further admitted that she personally obtained $110,431.02 in unrecovered proceeds in connection with her health care fraud scheme. She no longer owns or operates Dougherty Pharmacy.
Sentencing is scheduled for February 24, 2021 in federal court in Utica, at which time Caloia faces up to ten years in prison; a fine of up to $250,000; and a term of supervised release of up to 3 years. A defendant’s sentence is imposed by a judge based on the particular statute the defendant is charged with violating, the U.S. Sentencing Guidelines and other factors. In her plea agreement, Caloia has agreed to pay restitution in the amount of $110,431.02 to the public and private insurers affected by her fraud scheme.
In separately negotiated civil settlements with the Civil Division of the United States Attorney’s Office for the Northern District of New York and the New York State Attorney General’s Office, Caloia and her company agreed to pay $92,308.76 related to her submission of false claims to public insurers such as Medicare and Medicaid. The civil settlement resolves a whistleblower lawsuit filed under the qui tam provisions of the federal and New York False Claims Acts, which allow private persons, knowns as “relators,” to file civil actions on behalf of the government and share in any recovery. The relator in this case will receive $19,332.76 of the settlement proceeds. The federal civil case is docketed with the United States District Court for the Northern District of New York under number 6:17-cv-92 (BKS/ATB).
This case was investigated by the Federal Bureau of Investigation (FBI); the U.S. Department of Health and Human Services, Office of Inspector General; the U.S. Drug Enforcement Administration (DEA), the U.S. Department of Labor-Employee Benefits Security Administration (DOL EBSA), New York Attorney General’s Medicaid Fraud Control Unit; and the New York State Department of Financial Services, and it is being prosecuted by Assistant U.S. Attorney Michael F. Perry. The civil investigation is being handled by Assistant United States Attorney John Hoggan and Special Assistant Attorney General Paul Berry.