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Defendant Admits to Health Care Fraud Conspiracy, Faces 10 Years in Prison
CAMDEN, N.J. – James Wildman, a 44-year-old maintenance worker from Cape May County, New Jersey, has pleaded guilty to defrauding New Jersey state health benefits programs and other insurers out of more than $4 million by submitting fraudulent claims for medically unnecessary prescriptions, U.S. Attorney Craig Carpenito announced.
Wildman, a former employee of the Ocean County school system, pleaded guilty before U.S. District Judge Robert B. Kugler in Camden federal court to an information charging him with conspiracy to commit health care fraud. According to documents filed in this case and statements made in court, Wildman was a recruiter in the conspiracy and persuaded individuals in New Jersey to obtain very expensive and medically unnecessary compounded medications from an out-of-state pharmacy.
Between January 2015 and February 2016, Wildman recruited public employees covered by the Pharmacy Benefits Administrator to fraudulently obtain compounded medications. He secured insurance information from the individuals and passed it along to a conspirator, who had a doctor sign prescriptions without examining the individuals. The prescriptions were faxed to the Compounding Pharmacy, which filled the prescriptions and billed the Pharmacy Benefits Administrator.
The pharmacy then paid one of Wildman’s conspirators a percentage of each prescription filled and paid by the Pharmacy Benefits Administrator, which was then distributed to Wildman and other members of the conspiracy. Wildman paid individuals cash to reward them for obtaining prescriptions. Wildman himself received compounded medications he did not need in order to financially benefit a conspirator.
The Pharmacy Benefits Administrator paid the Compounding Pharmacy more than $50 million for compounded medications mailed to individuals in New Jersey, including $4,879,776 for prescriptions submitted by Wildman and his cohorts. Wildman received $657,040 for his role in the scheme.
Wildman faces a maximum penalty of 10 years in prison and a $250,000 fine, or twice the gross gain or loss from the offense. Sentencing is scheduled for February 25, 2019. As part of his plea agreement, Wildman must forfeit $657,040 in criminal proceeds and pay restitution of at least $4,879,776.
Key Facts
- State: New Jersey
- Category: Fraud & Financial Crimes
- Source: DOJ Press Release â†â€â€
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