NJ Man Gets 3.5 Years for $4M Health Fraud

Gloucester County Man Sentenced to 42 Months in Prison for Healthcare Fraud.Photo byMorristown Minute

Christopher Gualtieri defrauded employer's health plan with fraudulent claims for unnecessary medications.

NEW JERSEY - Christopher Gualtieri, 51, of Franklinville, New Jersey, was sentenced to 42 months in prison for defrauding his employer’s health insurance plan out of over $4 million.

The sentence was imposed by U.S. District Judge Christine P. O’Hearn in Camden federal court, as announced by Attorney for the United States Vikas Khanna. Gualtieri had previously pleaded guilty to charges of conspiracy to commit health care and mail fraud, as well as obtaining oxycodone through fraud.

The scheme involved the fraudulent submission of claims for compounded medications, which are custom-made by pharmacists for specific medical needs that FDA-approved drugs cannot address.

Gualtieri and his accomplices exploited the high reimbursement rates for these medications by recruiting co-workers covered by the employer's health insurance plan. They convinced these individuals to receive medically unnecessary compounded medications, then submitted fraudulent prescriptions to compounding pharmacies. The pharmacies filled these prescriptions and billed the health insurance plan’s pharmacy benefits administrator, which paid out more than $4 million.

Gualtieri received a share of these payments and compensated his co-conspirators in cash for their participation. When questioned by the FBI, he falsely denied his involvement in recruiting others and compensating them.

In addition to the healthcare fraud, Gualtieri was involved in filling fraudulent prescriptions for oxycodone for himself and a family member. Along with the prison term, Gualtieri was sentenced to three years of supervised release and ordered to pay $5.4 million in restitution.

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