September 11, 2018

CT sues over $11M drug-billing fraud

PHOTO | Contributed
PHOTO | Contributed
State Attorney General George Jepsen.

Connecticut is suing a Florida compounding pharmacy and at least 13 current or former state workers who participated in a pharmacy-benefit billing kickback scheme that state prosecutors claim cost taxpayers some $11 million in drug overcharges.

Attorney General George P. Jepsen announced Tuesday his office is suing the co-defendants under the state's False Claims Act for three times the $10.9 million in losses it claims to have suffered from the fraud.

"The fraud we are alleging in this lawsuit is simply egregious," Jepsen said, adding the state's overarching benefit-fraud investigation is ongoing.

This latest action stems from a request from state Comptroller Kevin Lembo, whose office administers the state Pharmacy Benefit Plan and who has publicly complained about irregularities and abuses he claims contribute to escalating costs to the state and participants.

This is the second lawsuit relating to compound drug billing fraud that was initiated as a result of the state's investigation. The state's probe into compounded pharmaceutical manufacturers and pharmacy providers is ongoing.
In Feb., Jepsen sued a Fairfield County physician and her husband, who was employed at UConn staffer, to recover $1 million in alleged overbillings to the state's pharmacy benefit plan. The pair also face criminal charges related to that scheme, authorities say.

"Today's action," Lembo said in the same statement, "should send a clear-cut message: When you defraud the state's health plan, you will get caught and you will face consequences."

According to Jepsen, Assured Rx, of Clearwater, Fla., has a nonresident Connecticut license to operate in the state. Assured Rx, he said, conspired with Nicholas Maulucci, of Simsbury, a retired state corrections department staffer, and Maulucci's ex-wife, Lisette Martinez, of Springfield, to perpetrate the fraud.

Compounded pharmaceuticals differ from mass-made drugs in that they typically are made-to-order, based on doctors' prescripted dosing and patients' medical histories. Compound drugs are not approved by the U.S. Food and Drug Administration and, thus, tend to cost "significantly more than FDA-approved brand name and generic drugs,'' Jepsen said in a statement.
State investigators allege that Assured Rx paid the Mauluccis kickbacks for their own compound drug prescriptions and those enrolled in the state's pharmacy benefit plan whom they recruited into the scheme. In turn, they said, these other individuals paid the Mauluccis in the manner of a classic pyramid scheme.

The kickbacks were allegedly paid out of reimbursements Assured Rx received from the state for dispensing the compound drug products.

The Mauluccis formed NLM LLC, a Florida limited liability company, for the alleged purpose of funneling the kickback payments, investigators said.

The state alleges the pharmacy benefit plan fraudulently paid $394,403 for prescriptions for Nicholas Maulucci, and $442,477 for prescriptions for Lisette Martinez. The Mauluccis and NLM allegedly received $2.7 million in compensation for their role in the scheme. The Mauluccis in turn used a portion of those funds to pay kickbacks to the other individuals they recruited into the scheme.
The additional defendants, all but one retired corrections-department staffers, are:

  • Carol Boardman-Scruse, of Bloomfield, an employee of the state Department of Developmental Services, is alleged to have cost the pharmacy benefit plan $317,791 in prescriptions for herself and a family member, and was allegedly paid $27,500 for her role in the scheme.
  • Ricardo Collazo, of Bloomfield, is alleged to have cost the state $615,366 in prescriptions for himself and a family member, and was allegedly paid $24,600 for his role.
  • James Corcoran, of Wethersfield, is alleged to have cost the state total of $231,850 in prescriptions for himself, and was allegedly paid $12,000 for his role.
  • Benjamin Franco, of East Haven, and his spouse, Jill Franco, allegedly cost the state $524,542 in prescriptions for themselves and a family member, and Jill Franco was allegedly paid $27,700 for their role.
  • Paul Germano, of Berlin, is alleged to have cost the state $241,437 in prescriptions for himself and family members, and was allegedly paid $19,000 for his role.
  • Edward Heller, of Enfield, is alleged to have cost the state $282,229 in prescriptions for himself and a family member, and was allegedly paid $17,500 for his role.
  • Joseph Heller, of Enfield, is alleged to have cost the state $377,345 in prescriptions for himself and family members, and was allegedly paid $15,500 for his role .
  • Francis Mancini, of Southwick, Mass., and his spouse, Sarah Mancini, are alleged to have cost the state $525,307 in prescriptions for themselves, and were allegedly paid a total of $47,400 for their role.
  • Todd Sokolowski, of Stafford Springs, is alleged to have cost the state $380,304 in prescriptions for himself and a family member, and was allegedly paid $16,900 for his role.
  • Todd Vining, of Enfield, is alleged to have cost the state $561,643 in prescriptions for himself and a family member, and was allegedly paid $17,800 for his role.
  • Joyce Wright, of East Longmeadow, Mass., is alleged to have cost the state $270,578 in prescriptions for herself, and was allegedly paid $14,000 for her role.
Comments
Free E-Newsletters

Sign up now for our daily and weekly
e-newsletters! Click Here

 
Today's Poll Does your company use social media to recruit for open positions?<>
ADVERTISEMENTS
Most Popular on Facebook
Copyright 2017 New England Business Media