A pharmaceutical sales representative from New Jersey has pleaded guilty to his role in a health care fraud scheme and a conspiracy to wrongfully disclose patients’ protected health information.
CAMDEN, N.J. – Keith Ritson, 42, of Bayville, New Jersey, pleaded guilty on October 19, 2022, before U.S. District Judge Robert B. Kugler in Camden to a superseding information charging him with 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).
According to documents filed in this case and statements made in court, Ritson was a pharmaceutical sales representative who promoted compound prescription medications and other medications from 2014 to 2016. Compound medications are specialty medications mixed by a pharmacist to meet the specific medical needs of an individual patient. Although not approved by the Food and Drug Administration (FDA), they are properly prescribed when a physician determines that an FDA-approved medication does not meet the health needs of a particular patient, such as if a patient is allergic to a dye or other ingredient.
Ritson and his conspirators discovered that certain insurance plans with pharmacy benefit management services – including plans for state and local government employees and eligible dependents – covered compound medications from a Louisiana pharmacy, Central Rexall Drugs, Inc. (Central Rexall). 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 received a percentage of the amount that Central Rexall received from the pharmacy benefits administrator for the prescriptions he arranged. Ritson recruited individuals with insurance plans that covered the compound medications to receive the medications, regardless of their medical need for them. Ritson himself also received medically unnecessary compound medication prescriptions.
As a pharmaceutical sales representative not associated with Alario’s medical practices, Ritson was not permitted to access and obtain patients’ individually identifiable health information and protected health information. As part of the criminal HIPAA scheme, Alario permitted Ritson to have significant access to his medical offices, medical files, and patient information. Ritson was present in the office both during and outside normal business hours and had access to areas of the office restricted to staff, including areas with patient files and office computers. Ritson looked up patients’ information in files and on office computers to determine if they had insurance that covered the compound medications. Ritson then would earmark files in advance so that Alario knew to whom to prescribe the medications. Ritson also joined Alario in patient exam rooms during appointments, which gave patients the impression that Ritson was employed by or affiliated with the medical practices. Ritson used patients’ confidential information to fill out prescription forms that Alario authorized, and then Ritson received commissions on those prescriptions.
Alario pleaded guilty on October 7, 2022, to conspiring to wrongfully disclose patients’ individually identifiable health information. He is scheduled to be sentenced on February 7, 2023.
This case was investigated by the Federal Bureau of Investigation and the Office of Inspector General, Health and Human Services. Assistant U.S. Attorney Vikas Khanna of the U.S. Attorney’s Office for the District of New Jersey prosecuted the case.
The charges against Ritson carry a maximum penalty of 10 years in prison and a fine of $250,000. Ritson is scheduled to be sentenced on March 15, 2023.
Related Federal Cases
- Steven Monaco, Health Care Fraud, New Jersey 2023 · Pennsylvania
- Physician and Sales Rep, Health Benefits Fraud, NJ 2024 · Louisiana
- Philip R. Selliniger, Healthcare Fraud, New Jersey 2024 · Alabama
- Hayley Taff, Healthcare Fraud Scheme, LA 2024 · Pennsylvania
- New Jersey Man Pleads Guilty to Child Pornography Conspiracy · Washington
Key Facts
- State: New Jersey
- Category: Fraud & Financial Crimes
- Source: DOJ Press Release â†â€â€
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