United States Attorney for the District of New Jersey philip selinger announced on January 5 that two North Jersey brothers have been sentenced for their roles in a multimillion-dollar scheme to defraud public and private health benefit programs.
John Cafari, 61, of Cedar Grove, and Christopher Cafari, 57, of Little Falls, each pleaded guilty to conspiracy to commit health care fraud.
The brothers worked as sales representatives for marketing companies and pharmacies. This system allows certain insurance plans to offer exorbitant reimbursement rates for complex drugs (specialty drugs compounded by pharmacists to meet a patient's specific medical needs, such as scar creams, wound creams, and metabolic supplements and vitamins). It was based on the fact that they were paying. .
According to case documents and court statements released by prosecutors, “From November 2014 to July 2016, John Cafari participated in a conspiracy to submit fraudulent prescriptions for compounded drugs to public and private insurance plans. “I did it.” “Christopher Cafari participated in the conspiracy from November 2014 to September 2017.”
Prosecutors argued that the brothers targeted individuals with insurance plans that covered these combination drugs.
“They then convinced these individuals to obtain prescriptions for compounded drugs, often by giving them cash, regardless of medical necessity,” according to prosecutors. “Defendants made payments to a New Jersey-based physician to obtain prescriptions for compounded drugs for some of the recruits.”
Christopher Cafari was sentenced on January 3 to 27 months in prison for his role in a welfare program that defrauded the patient of $7.89 million in medically unnecessary prescription claims. The next day, on January 4, his brother John Cafari was sentenced to 17 months in prison for defrauding welfare programs out of at least $5.3 million.
Both men were sentenced to three years of supervised release.
“By their own admission, these defendants defrauded publicly and privately funded insurance plans of millions of dollars and fraudulently reimbursed compounded drugs.” Jha said. “We will work with our partners to prosecute those who take advantage of our health care system to generate illicit income.”
“Government agencies and insurance companies are enacting stricter regulations and policies to prevent fraud,” said James Dennehy, FBI Special Agent in Charge in Newark. “It also affects patients who have a much harder time getting the medical care they desperately need. The Cuffari brothers are just a small cog in a very frustrating criminal ring, but we will not hesitate to judge them all.”
