BAYVILLE – A former pharmaceutical sales representative from Ocean County has admitted to managing a health care scheme and wrongfully obtaining patients’ personal health information, officials said.
Keith Ritson, 42, of Bayville, pleaded guilty to the charges of 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).
Ritson was a pharmaceutical sales representative from 2014 to 2016 who promoted compound prescription medications and other medications.
According to officials, 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.”
During this time, Ritson and his conspirators found out that certain insurance plans with pharmacy benefit management services will cover compound medications from a Louisiana pharmacy called Central Rexall Drugs, Inc. (Central Rexall). They realized that certain prescriptions would be reimbursed 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. Subsequently, Ritson recruited people with the appropriate insurance plans that covered the medications, regardless of the medical need, in order to benefit from them.
Additionally, Ritson himself received unnecessary prescriptions and also choose patients from the medical practices of Dr. Frank Alario who had insurance plans that covered the medications.
As a pharmaceutical sales representative, Ritson was not associated with Alario’s medical practices and was not permitted to access patients’ health information, officials said.
Alario also allowed Ritson to have access to his medical offices, medical files, and patient information. Ritson was in the office during normal and after business hours and had access to areas of the office restricted to staff. This included with patient files and office computers, officials said.
As a result, Ritson searched patients’ information in files and on computers to determine if they had insurance that covered the compound medications. He would then labelthese filed so Alario could prescribe the medications.
In addition, Ritson was in patient exam rooms with Alario during appointments allowing patients to believe Ritson was an employee. He would use patients’ information to fill out prescription forms and Alario would authorize them. Ritson then received commissions on those prescriptions.
On October 7, Alario pleaded guilty to conspiring to wrongfully disclose patients’ individually identifiable health information.
Three former executives of Central Rexall, Christopher Kyle Johnston, 43, of Mandeville, Louisiana; Trent Brockmeier, 60, of Pigeon Forge, Tennessee; and Christopher Casseri, 54, of Baton Rouge, Louisiana, were charged on September 17, 2020, in a 24-count indictment with health care and wire fraud and other offenses. The charges against them remain pending.
A fourth former pharmacy executive, Hayley Taff, 39, of Hammond, Louisiana, pleaded guilty to health care fraud conspiracy on August 12, 2020. The charges and allegations contained in the indictment against Johnston, Brockmeier and Casseri are merely accusations, and they are presumed innocent unless and until proven guilty.
Ritson faces a maximum penalty of 10 years in prison and a $250,000 fine on the health care fraud conspiracy count, and a maximum penalty of one year in prison and a $50,000 fine on the criminal HIPAA conspiracy count. Sentencing is scheduled for February 21, 2023.
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