NEWARK, N.J. – An Old Bridge, New Jersey, man was sentenced today to 20 months in prison for his role in a large scheme to defraud the Metropolitan Transit Authority’s health benefits plan of more than $2.8 million for the billing of medically unnecessary compounded prescriptions, U.S. Attorney Craig Carpenito announced.
Enver Kalaba, 37, a bus driver with the MTA, previously pleaded guilty before U.S. District Judge John Michael Vazquez to an information charging him with conspiracy to commit health care fraud. Judge Vazquez imposed the sentence today in Newark federal court.
According to documents filed in this case and statements made in court:
Kalaba admitted that as early as April 2016 through August 2017 he participated in a scheme to defraud the MTA’s health benefits plan, a privately funded health plan, by knowingly causing the billing of fraudulent claims for medically unnecessary prescription compounded medications, such as scar creams, pain creams, and metabolic supplements. Kalaba was recruited into the scheme by another former MTA bus driver, Christopher Frusci, 34, of Staten Island, New York. Both Frusci and Kalaba were “sales representatives” of Company A, a New Jersey marketing company of compounded prescriptions.
Kalaba and Frusci targeted MTA employees because the MTA’s health benefits’ plan covered compounded medications. To convince MTA beneficiaries to obtain medically unnecessary compounded prescriptions, Kalaba paid them monthly cash bribes of approximately $100 per prescription. To ensure physicians prescribed compounded medications regardless of medical necessity, Kalaba referred MTA beneficiaries to telemedicine physicians who were paid by Company A and its affiliates.
Kalaba was also sentenced to one year of supervised release, and must forfeit $138,630 in criminal proceeds he received for his role in the scheme and pay restitution of $2.9 million.
On March 2, 2018, Frusci pleaded guilty before Judge Vazquez for his role in the scheme and is scheduled for sentencing on March 27, 2019.
U.S. Attorney Carpenito credited special agents of the FBI, under the direction of Special Agent in Charge Gregory W. Ehrie in Newark; the U.S. Department of Defense, Defense Criminal Investigative Service, under the direction of Special Agent in Charge Leigh-Alistair Barzey; and the Office of the Inspector General, Metropolitan Transportation Authority, under the direction of Inspector General Barry Kluger, with the ongoing investigation leading to today’s sentencing.
The government is represented by Assistant U.S. Attorney Erica Liu of the United States Attorney’s Office.
Defense counsel: Robert G. Stahl Esq., Westfield, New Jersey