Three Individuals Charged, Fourth Admits Guilt in $6 Million Health Care Fraud Conspiracy Targeting State Health Benefits Programs
CAMDEN, N.J. – A federal grand jury has returned a 33-count indictment charging 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 by submitting fraudulent claims for medically unnecessary prescriptions, U.S. Attorney Craig Carpenito announced today. A fourth individual, a Mt. Laurel, New Jersey, doctor, pleaded guilty to signing four false prescriptions for patients he never met.
Brian Sokalsky, D.O., 42, of Margate, New Jersey, and Vincent Tornari, 46, of Linwood, New Jersey, 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, New Jersey, 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.
The cases are assigned to U.S. District Judge Robert B. Kugler in Camden. The indicted defendants are expected to appear today by videoconference before U.S. Magistrate Judge Joel Schneider.
According to the indictment:
Compounded medications are specialty medications mixed by a pharmacist to meet the specific medical needs of an individual patient. Although compounded drugs are not approved by the Food and Drug Administration (FDA), they are properly prescribed when a physician determines that an FDA-approved medication does not meet the health needs of a particular patient, such as if a patient is allergic to a dye or other ingredient.
The conspirators recruited individuals in New Jersey to obtain very expensive and medically unnecessary compounded medications from a Louisiana pharmacy, identified in the indictment as “Compounding Pharmacy 1,” and a Pennsylvania pharmacy, identified in the indictment as “Compounding Pharmacy 2.” The conspirators learned that certain compound medication prescriptions – including pain, scar, antifungal, and libido creams, as well as vitamin combinations – 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, including teachers, firefighters, municipal police officers, and state troopers, had insurance coverage for these particular compound medications. An entity referred to in the indictment as the “Pharmacy Benefits Administrator” provided pharmacy benefit management services for the State Health Benefits Program, which covers qualified state and local government employees, retirees, and eligible dependents, the School Employees’ Health Benefits Program, which covers qualified local education employees, retirees, and eligible dependents, and other insurance plans. 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.
In the first charged conspiracy, Matthew Tedesco, who previously pleaded guilty to conspiracy to commit health care fraud, 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 obtained 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 often tipped him off that they were coming. Sokalsky prescribed Compounding Pharmacy 1 medications for the patients, including medications that patients did not need or discuss with him. Sokalsky profited by billing insurance for over 30 new patients.
The completed prescriptions were faxed to Compounding Pharmacy 1, which 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.
The indictment charges Sokalsky and Tornari with a similar scheme to write fraudulent prescriptions 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, often after letting Sokalsky know that they were coming. Sokalsky wrote Compounding Pharmacy 2 prescriptions that the patients did not need or discuss with Sokalsky, sometimes without even seeing the patients. These prescriptions cost insurers over $500,000.
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 commission payments. Lyons-Valenti persuaded her workers and subordinates at her medical office to receive Compounding Pharmacy 2 prescription medications that they did not need, often without giving them a medical examination or recording the prescriptions in their medical records. Lyons-Valenti wrote Compounding Pharmacy 2 prescriptions for which insurance paid over $1.25 million and received over $90,000 in kickbacks in return.
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 examined the patient’s medical records, conducted a face-to-face examination of the patient, and 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.
The health care fraud and wire fraud conspiracy count with which defendants Sokalsky and Tornari are charged carries a maximum potential penalty of 20 years in prison and a $250,000 fine, or twice the gain or loss from the offense. Each wire fraud count carries a maximum potential penalty of 20 years in prison and a $250,000 fine, or twice the gain or loss from the offense. Each health care fraud count carries a maximum penalty of 10 years in prison and a $250,000 fine, or twice the gross gain or loss from the offense. The honest services conspiracy count and the false statement counts each carry a maximum penalty of five years in prison and a $250,000 fine, or twice the gross gain or loss from the offense. The witness tampering charge carries a maximum penalty of 20 years in prison and a $250,000 fine, or twice the gross gain or loss from the offense
Also today, Michael Goldis, D.O., 64, who had a medical practice in Stratford, New Jersey, pleaded guilty by videoconference before Judge Kugler 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 examined the patient’s medical records, conducted a face-to-face examination of the patient, and 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 Goldis signed at Zappala’s request.
Goldis was previously charged in an indictment with conspiracy to commit health care fraud and other offenses with Steven Monaco, Daniel Oswari, and Aaron Jones. Oswari pleaded guilty in December 2019 to fraud and kickback charges. The indictment remains pending against Monaco and Jones.
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 Nov. 6, 2020.
U.S. Attorney Carpenito credited agents of the FBI’s Atlantic City Resident Agency, under the direction of Acting Special Agent in Charge Douglas Korneski in Newark; IRS – Criminal Investigation, under the direction of Special Agent in Charge Michael Montanez in Newark; and the U.S. Department of Labor, Office of Inspector General, New York Region, under the direction of Special Agent in Charge Michael C. Mikulka, with the investigation leading to the indictment and guilty plea. He also thanked the Division of Pensions and Financial Transactions in the State Attorney General’s Office, under the direction of Attorney General Gurbir S. Grewal and Division Chief Aimee Nason, for its assistance in the investigation.
The government is represented by Assistant U.S. Attorneys R. David Walk, Jr. and Christina O. Hud of the U.S. Attorney’s Office in Camden.
The charges and allegations contained in the indictment and the indictment against Monaco and Jones are merely accusations, and the defendants are presumed innocent unless and until proven guilty.