Toms River: Three Confessions to $50M Healthcare Fraud

Source: JerseyShoreOnline.com

Three men have confessed their roles in $50,000,000 fraudulent health care benefit programs and kickback schemes, U.S. Attorney Rachael A. Honig said.

Nicholas Defonte, 73, and Christopher Cirri, 63, both of Toms River, and Pat Truglia, 53, of Parkland, Florida, each pleaded guilty to conspiracy to commit health care fraud.

According to documents and statements made in court, all three played a role in running fraudulent health care benefit programs by offering, paying, soliciting, and receiving kickbacks and bribes in exchange for completed doctors’ orders for durable medical equipment, namely orthotic braces (DME orders):

“Truglia and his conspirators had financial interests in multiple DME companies. The DME companies paid kickbacks to suppliers of DME orders, including Cirri, Defonte, and Truglia, which the DME companies subsequently fraudulently billed to Medicare, TRICARE, CHAMPVA, and other health care benefit programs. Truglia and his conspirators concealed their ownership of the DME companies by using straw owners who were falsely reported to Medicare as the owners of the companies.

“Truglia, Cirri, Defonte, and their conspirators owned and operated multiple call centers through which they obtained DME orders for beneficiaries of Medicare and other federal health care programs. The call centers paid illegal kickbacks and bribes to telemedicine companies to obtain DME orders for these beneficiaries. The telemedicine companies then paid physicians to write medically unnecessary DME orders. The DME orders were provided to DME supply companies owned by Truglia and others in exchange for bribes. The DME supply companies in turn provided the braces to beneficiaries and fraudulently billed the health care programs.

“Cirri, Defonte, and their conspirators had business relationships with call centers through which they obtained prescriptions for compounded medications and other medical products reimbursable by federal and private health care benefit programs. Cirri and Defonte provided these prescriptions for compounded medical prescriptions and other medical products in exchange for kickbacks and bribes from companies that fraudulently billed them to health care programs.”

As a result, all three caused losses to Medicare, TRICARE, and CHAMPVA totaling to about $50,000,000, officials said.

On the charge of conspiracy to commit health care fraud, each have a maximum potential penalty of 10 years in prison and a fine of $250,000, or twice the gross profit or loss caused by the offense, whichever is greatest. Sentencing for all three defendants is scheduled for March 22.

Acting U.S. Attorney Honig credited special agents of the FBI, under the direction of Special Agent in Charge George M. Crouch Jr. in Newark; the Department of Health and Human Services-Office of Inspector General, under the direction of Special Agent in Charge Scott J. Lampert; the U.S. Department of Defense, Office of the Inspector General, Defense Criminal Investigative Service, under the direction of Special Agent in Charge Patrick J. Hegarty; and the U.S. Department of Veterans Affairs, Office of Inspector General, under the direction of Special Agent in Charge Christopher F. Algieri, with the investigation leading to the guilty pleas.

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