Two Toms River men admit roles in $50-million health care fraud conspiracy
Two Toms River men and a third from Parkland, Florida plead guilty in Newark Federal Court on Tuesday to their roles in a massive health care fraud conspiracy.
In a released statement, U.S. Attorney Rachael A. Honig announced Tuesday that this conspiracy also included kickback schemes and as such Nicholas Defonte, 73, and Christopher Cirri, 63, of Toms River and Pat Truglia, 53, pleaded guilty.
Investigators learned that Defonte, Cirri and Truglia, in a number of different ways, ventured out with a goal of defrauding health care benefit programs, "by offering, paying, soliciting, and receiving kickbacks and bribes in exchange for completed doctors’ orders for durable medical equipment (DME), namely orthotic braces."
They estimate that the scheming by Defonte, Cirri and Truglia costs approximately $50-million in losses to Medicare, TRICARE, and CHAMPVA.
Attorney Honig also issued the following investigation breakdown of what each of the accused did in their roles within this scheme.
"• 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, in exchange for DME orders, 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."
If convicted on the charge of conspiracy to commit health care fraud Attorney Honig said that the maximum potential penalty is "10 years in prison and a fine of $250,000, or twice the gross profit or loss caused by the offense, whichever is greatest."
The exact number of days and years will come out at sentencing for Cirri, Truglia and Defonte which is scheduled for March 22 of 2022.
The government is represented by Assistant U.S. Attorneys Sean M. Sherman and Ryan L. O’Neill of the Opioid Abuse Prevention & Enforcement and Health Care Fraud Units in Newark, Senior Trial Counsel Barbara Ward of the Asset Recovery and Money Laundering Unit in Newark, and Trial Attorney Darren Halverson of the Criminal Division’s Fraud Section.
Truglia: Bernard M. Cassidy Esq., Fort Lauderdale, Florida.
Cirri: Timothy Anderson Esq., Red Bank, New Jersey.
Defonte: Robert Weir Esq., Little Silver, New Jersey.