A Ventnor firefighter has become the next to fall in NJ’s State health benefits fraud investigation.
Corey Sutor, 37, a Ventnor firefighter from Egg Harbor Township, was accused of submitting fraudulent claims for medically unnecessary prescriptions. He has plead guilty to conspiracy to commit health care fraud before a U.S. District Judge.
From 2015 thru 2016, Sutor compelled others to get expensive, un-needed medications. Sutor and others enjoyed reimbursements adding up to thousands each month. These ill-gotten gains came from NJ State Health Benefit funds, a program that provides medical coverage for municipal and public school employees.
Sutor and others would regularly receive a percentage of monies destined for the compounding pharmacies who created custom, expensive, medical mixtures.
Ventnor firefighter Sutor and others would recruit public employees, many of whom had ‘cadillac’ health plans.
Sutor allegedly offered cash payouts on a regular basis. Sutor convinced them to obtain prescription compounded medications, all without a visit to the doctor.
Sutor would obtain insurance and personal info from the public employee. Sutor would them give that info to others in on the scheme. Sutor and a group of others, would split the monies connected to these fraudulent prescriptions.
In just Sutor’s case, New Jersey (taxpayers) had to pay out over $2 million in fraudulent claims for un-needed & expensive medications for already well paid, public employees.
Sutor pocketed $150,398 for his part in the scheme.
As part of his guilty plea agreement, Sutor will give back the $150, 398. He will also pay a minimum of $2 million in restitution.
Sutor was a firefighter in Ventnor since 2008. His annual salary was $99,760, complete with health care, pension and other benefits. He faces up to 10 years in prison and a $250,000 fine.
Sutor was suspended from the Ventnor Fire Department without pay.
According to documents filed in this case and statements made in court:
Compounded medications are supposed to be specialty medications mixed by a pharmacist to meet the specific medical needs of an individual patient. Although compounded drugs are 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.
Sutor was one of the owners of a company formed to market prescription compounded medications, referred to as Company 1. From May 2015 through February 2016, Sutor and others associated with the company persuaded individuals in New Jersey to obtain very expensive and medically unnecessary compounded medications.
The conspirators learned that certain compound medication prescriptions – including pain, scar, and antifungal creams, as well as vitamin combinations – were reimbursed for thousands of dollars for a one-month supply. The conspirators also learned that the New Jersey State Health Benefits Program, which covers qualified state and local government employees, retirees, and eligible dependents, and the School Employees’ Health Benefits Program, which covers qualified local education employees, retirees, and eligible dependents, would cover compound medication prescriptions.
Sutor and his conspirators entered into an agreement in which Company 1 would receive a percentage of the amounts paid to compounding pharmacies for prescriptions secured by Sutor and his conspirators. Sutor and his conspirators then recruited public employees, offered them hundreds of dollars per month, and persuaded them to agree to obtain prescription compounded medications without any examination by a medical professional. Sutor would obtain insurance and personal information from the public employees and give that information to conspirators. Company 1 then would receive a percentage of the amounts paid on these fraudulent prescriptions, which Sutor and others would divide.
Sutor 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 March 12, 2019.