CAMDEN – A Stafford Township woman is facing prison time and stiff fines for her role in a conspiracy to defraud the state health benefits program.
Kristie Masucci, 36, faces up to 10 years in prison and a $250,000 fine after pleading guilty to health care fraud conspiracy charges.
She pleaded guilty before U.S. District Judge Robert B. Kugler in Camden federal court to a charge of conspiracy to commit health care fraud. She’s scheduled for sentencing Feb. 5, 2019.
She was part of an elaborate scheme that defrauded state health benefits plan, for which she received a $388,608 kickback. From January 2015 through February 2016, she and others persuaded individuals part of the state health benefits program to submit medically unnecessary prescriptions for compound medications – medications not FDA approved but mixed by pharmacists for a specific patient need. These mixtures often cost thousands of dollars for a one-month supply.
Masucci and others worked with an out-of-state pharmacy to fill these prescriptions. Doctors signed off on the scripts without evaluating patient need. The pharmacy would then pay Masucci or a co-conspirator a percentage.
The federal investigation revealed that the Pharmacy Benefits Administrator paid this pharmacy more than $50 million for compounded medications mailed to New Jersey residents. According to the U.S. Attorney’s Office, District of New Jersey office, $1.88 million of those claims were submitted by Masucci and her cohorts.
As part of her plea deal, Masucci must forfeit her criminal proceeds and pay restitution, an amount to be determined at sentencing.