Pharmaceutical Employee Admits Scheme To Defraud Military Health Insurance Program
NEWARK, N.J. – A Media, Pennsylvania, man today admitted defrauding TRICARE – a health insurance program for members of the military and their families – by submitting fraudulent claims for medically unnecessary prescriptions, Acting U.S. Attorney William E. Fitzpatrick announced.
Jason Cerge, 41, a pharmaceutical sales representative, pleaded guilty before U.S. District Judge John Michael Vazquez in Newark federal court to an information charging him with conspiracy to commit health care fraud.
According to documents filed in this case and statements made in court:
Cerge admitted that from September 2014 through May 2015, he participated in a scheme to defraud TRICARE by knowingly submitting fraudulent claims for medically unnecessary prescription compounded medications – including scar creams, pain creams, and metabolic supplements – that were marketed by an entity referred to in the information as “Company A.” The conspirators knew that TRICARE reimbursed pharmacies between $2,500 and $18,800 for each of these compounded medications. The conspirators entered into agreements with certain compounding pharmacies nationwide to receive a percentage of the amount reimbursed for each prescription diverted to that pharmacy.
Cerge was recruited into the scheme by Peter Pappas, 45, of Drexel Hill, Pennsylvania. Cerge then recruited a former member of the U.S. military, a conspirator identified in the information as “CC-2,” to approach other members of the military and their families. CC-2 paid cash bribes to TRICARE beneficiaries in exchange for their TRICARE information and agreement to receive medically unnecessary prescription compounded medications.
Cerge placed these TRICARE beneficiaries’ information onto preprinted prescription forms and presented them to a New Jersey physician for a signature. Cerge knew that the physician would immediately sign the prescriptions without examining or speaking with the patients.
Afterwards, the prescriptions were faxed to certain compounding pharmacies associated with Company A who would bill TRICARE for the medication. These compounding pharmacies then paid Company A a percentage of each prescription paid by TRICARE, which was then distributed to Cerge and other members of the conspiracy.
As part of his plea agreement, Cerge must forfeit $12,816.24 in criminal proceeds he received for his role in the scheme and pay restitution of at least $204,198.11.
Cerge faces a statutory maximum term of 10 years in prison and a $250,000 fine, or twice the gross gain or loss from the offense. Sentencing is scheduled for Jan. 30, 2018.
Three other defendants – Peter Pappas, Stephanie Naar, and Julie Andresen – have pleaded guilty to their roles in the scheme and await sentencing.
Acting U.S. Attorney Fitzpatrick credited special agents of the FBI, under the direction of Special Agent in Charge Timothy Gallagher in Newark; and the U.S. Department of Defense, Office of the Inspector General, Defense Criminal Investigative Service, under the direction of Special Agent in Charge Leigh-Alistair Barzey, with the ongoing investigation leading to the guilty plea.
The government is represented by Assistant U.S. Attorney Erica Liu of the United States Attorney’s Office Health Care and Government Fraud Unit in Newark.
The New Jersey U.S. Attorney’s Office reorganized its health care practice in 2010 and created a stand-alone Health Care and Government Fraud Unit to handle both criminal and civil investigations and prosecutions of health care fraud offenses. Since that time, the office has recovered more than $1.36 billion in health care fraud and government fraud settlements, judgments, fines, restitution and forfeiture under the False Claims Act, the Food, Drug and Cosmetic Act and other statutes.
Defense counsel: Scott Godshall Esq., Media, Pennsylvania