New Jersey man pleads guilty to role in HIPAA health care fraud scheme
A Bayville man, who was once employed as a pharmaceutical sales representative, is facing a possible 10-years in prison for his role in an elaborate health care fraud scheme that featured several HIPAA violations.
For a two year period from 2014 to 2016, Keith Ritson, 42, was employed as a pharmaceutical sales representative whose specialty was compound prescription medications among other medicines, according to U.S. Attorney Vikas Khanna.
During that time frame he and four others made strides in developing their scheme in trying to take advantage of a perceived loophole with certain insurance plans that had pharmacy benefit management services covering compound medications from Central Rexall Drugs Inc., located in Louisiana.
Attorney Khanna said that these conspirators, Ritson included, found out that "the pharmacy benefits administrator paid prescription drug claims and then billed the state of New Jersey and other insurance plans for the amounts paid. The conspirators identified that certain compound medication prescriptions would reimburse by insurance for thousands of dollars on a monthly basis."
Ritson played a big role in this scheme as after getting a cut of what Central Rexall got for the prescriptions he arranged, he is accused of getting people who had that type of insurance plan to receive the compound medications even if they didn't need them, he collected compound medication prescriptions for himself that weren't necessary, according to Attorney Khanna, and then went a step further by going to the office of a Dr. Frank Alario to further try and recruit patients.
His route and business did not include Dr. Alario, but, even with that in mind, Ritson still went to this doctors office with with Dr. Alario's permission was allowed to access medical offices, medical files, and patient information -- which is also illegal -- and then Ritson went to the office during and after business hours to look up patient information and files in the office and on the computers and specially mark files of people who would be in need of compound medications.
Ritson allegedly went a step further by being in the room with Dr. Alaria and his patients and used the confidential forms these people filled out to fill out prescription forms Dr. Alario authorized and then Ritson would get a cut of the prescriptions filled out and bought at a pharmacy.
Ritson was eventually arrested and charged and has now pleaded guilty according to Attorney Khanna to one count of conspiracy to commit health care fraud and one count of conspiring to wrongfully disclose and obtain patients’ individually identifiable health information in violation of the criminal provisions of the Health Insurance Portability and Accountability Act (HIPAA) and earlier this month to conspiring to wrongfully disclose patients’ individually identifiable health information.
His inside conspirators who worked as executives of Central Rexall -- Christopher Kyle Johnston, 43, of Mandeville, Louisiana, Trent Brockmeier, 60, of Pigeon Forge, Tennessee, and Christopher Casseri, 54, of Baton Rouge, Louisiana – were charged in 2020, according to Attorney Khanna with health care and wire fraud and other offenses but those charges are pending, while Hayley Taff, 39, of Hammond, Louisiana, pleaded guilty to health care fraud conspiracy.
Attorney Khana said that Ritson faces a maximum penalty of 10 years in prison and a $250,000 fine on the health care fraud conspiracy count, and a maximum penalty of one year in prison and a $50,000 fine on the criminal HIPAA conspiracy count.
The government is represented in this case "by Assistant U.S. Attorney Christina O. Hud of the Criminal Division; R. David Walk, Jr., Chief of the Opioid Abuse Prevention and Enforcement Unit; Assistant U.S. Attorney Daniel A. Friedman of the Criminal Division; and Assistant U.S. Attorney Barbara Ward, Senior Trial Counsel of the Asset Recovery and Money Laundering Unit."
Defense counsel: Eric Kanefsky Esq. and Greg Mullens Esq., Newark.