Old Bridge Man, MTA Bus Driver Admits To $2.9M Healthcare Fraud

OLD BRIDGE, NJ — A man who lives in Old Bridge Township and drives a bus for the New York City MTA pleaded guilty this week to participating in an elaborate healthcare fraud ring that tricked the MTA's health insurance plan into paying out millions in bogus claims.

Enver Kalaba, 36, of Old Bridge, pleaded guilty yesterday, June 27. He admitted that from April 2016 through August 2017, he conspired to defraud the MTA’s health benefits plan by filing fraudulent claims for medically unnecessary compounded medications.

Kalaba acted as a middle man, a sales agent pushing scar creams, pain creams and metabolic supplements, all of which federal agents say were bogus and medically unnecessary.

Other New York City MTA employees are suspected of participating in the health care fraud scheme as well, and they are currently being sought, federal agents said.

You can read the entire complaint against Kalaba here: http://content.govdelivery.com...

Kalaba was recruited into the scheme by another former MTA bus driver, Christopher Frusci. Both Frusci and Kalaba acted as sales representatives of a company that marketed compounded medications.

Kalaba paid MTA beneficiaries monthly cash bribes, including $100 per phony prescription. To ensure physicians prescribed compounded medications regardless of medical necessity, Kalaba referred MTA beneficiaries to telemedicine physicians who were paid by the marketing company or its affiliates. Those telemedicine doctors almost always approved the request for the drugs, prosecutors say.

Altogether, Kalaba caused losses of $2.9 million and made $138,629 from the scheme, federal prosecutors said. The MTA's health insurance plan was not named in the complaint.

In general, "compounding" is a practice in which a licensed pharmacist combines, mixes or alters ingredients of a drug to create a medication tailored to the needs of an individual patient. Pharmacies engaging in the practice are referred to as "compounding pharmacies." Telemedicine allows health care providers, such as physicians, to treat patients without the need for an in-person visit, either talking to the patient over the phone or internet.

Kalaba was arrested in a wide-ranging, cross-country FBI investigation into healthcare fraud. Incredibly, he was arrested alongside 601 people across the United States — including more than 165 doctors and nurses — all charged with health care fraud schemes involving approximately $2 billion in false billings. Of those charged, over 162 defendants, including 76 doctors, were charged for their roles in prescribing and distributing opioids and other dangerous narcotics.

In New Jersey, here's who else was arrested:

Robert Agresti, 61, a doctor from Essex Fells

Brian Catanzarite, 42, a former gym owner from Cedar Grove: Both pleaded guilty this Tuesday, June 26, to their roles in separate conspiracies to attain phony compounded medication prescriptions on behalf of companies that marketed those products.

Tiffany Marsh, 40, a medical billing company owner from West Orange

Keasam Johnson, 34, a telecommunications company employee from East Orange: Both were arrested on June 26 for their alleged roles in a conspiracy to collect insurance reimbursements for chiropractic services that were never rendered.

Anthony Pepe III, 40, of Cherry Hill, an anesthesiology technologist for a Philadelphia hospital

Daniel Watson, 39, of Bellmawr

Prussia Hing, 35, of Philadelphia: All three were arrested on June 26, 2018 for their alleged roles in an oxycodone distribution ring.

Kalaba is facing a potential 10 years in prison. He will be sentenced Oct. 30.

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