South Jersey Woman Admits Role In $50 Million Drug Fraud: Police

A South Jersey woman has admitted to helping defraud New Jersey state health benefits programs and other insurers out of over $50 million by submitting fraudulent claims for medically unnecessary prescriptions, U.S. Attorney Craig Carpenito and New Jersey Attorney General Gurbir S. Grewal announced.

Tara Lamonaca, 43, of Linwood, pleaded guilty to an information charging her with conspiracy to commit health care fraud. She faces a maximum penalty of 10 years in prison and a $250,000 fine, or twice the gross gain or loss from the offense. She must pay about $89,855.13 for her role in the scheme. Sentencing is scheduled for July 19.

She is the 19th person to plead guilty in connection with this scheme. Others include Richard McAllister, a 42-year-old Pleasantville school teacher from Ocean City; William Hunter, 43, a salesman from Sewell; Michael Sher, a firefighter from Northfield; Nicholas Tedesco, a retail director for a local candy company, and his brother Matthew, an alleged leader of the conspiracy; Middle Township school teacher Shawn Sypherd, 46, of Marmora; sales representatives Andrew Gerstel, 32, of Galloway; 36-year-old George Gavras, of Moorestown; and 42-year-old Judd Holt, of Marlton.

John Gaffney, Robert Bessey, Michael Pepper, Thomas Hodnett, Steven Urbanski, Judd Holt, Richard Zappala, Timothy Frazier and Michael Neopolitan have also already pleaded guilty to their roles in this conspiracy and await sentencing. The conspiracy revolved around the unnecessary prescriptions of compounded medications.

Compounded medications are supposed to be specialty medications mixed by a pharmacist to meet the specific medical needs of an individual patient, according to documents filed in the case and statements made in court. They aren't approved by the Federal Drug Administration (FDA), but when an FDA-approved medication don't meet the health needs of a patient, the doctor is permitted to prescribe a compounded medication.

From January of 2015 through April of 2016, Lamonaca was among a group of conspirators who persuaded patients to obtain very expensive and medically unnecessary compounded medications from an out-of-state pharmacy, identified in the information as the "Compounding Pharmacy," according to authorities.

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, authorities said. They also discovered 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 information 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, and the School Employees' Health Benefits Program, which covers qualified local education employees, retirees, and eligible dependents.

The pharmacy paid one of their conspirators a percentage of each prescription filled and paid by the Pharmacy Benefits Administrator, which was then distributed to members of the conspiracy. Lamonaca admitted obtaining insurance information from those individuals and gave it to another conspirator, who completed the prescriptions and had a doctor sign them without examining the individuals. The prescriptions were faxed to the Compounding Pharmacy, which filled the prescriptions and billed the Pharmacy Benefits Administrator.

According to the information, the Pharmacy Benefits Administrator paid Compounding Pharmacy over $50 million for compounded medications mailed to individuals in New Jersey, including $530,527.01 for prescriptions submitted by Lamonaca and her cohorts.

Patch file photo