WEST ORANGE, NJ - Robert and William Carlucci, twin brothers and former owners of West Orange Pharmacy located at 443 Main St., pled guilty to conspiring to commit health-care fraud after defrauding patients, Medicaid and insurance companies over a 15-year period and reaping $1.5 million in illegal profits.
The announcement came today from U.S. Attorney Paul J. Fishman and the Department of Justice, United States Attorney's Office, District of New Jersey. The brothers, who both reside in Florham Park, pled guilty before US Magistrate Judge Michael A. Hammer. Charges were separated out for each brother.
According to court transcripts "Robert Carlucci, William Carlucci, and another conspirator (identified as “L.S.” in the charging documents" utilized several different schemes to cheat customers and steal from insurance companies of the $1.5 million.
One scheme was called "Trade-Quick," which underfilled prescriptions. The letters in "Trade-Quick" each corresponded to a number, “T” for “1” through “K” for “0.” A two-letter code was entered into the West Orange Pharmacy computer system to indicate what percentage of the prescription they intended to fill.
“QK” showed that a prescription for 90 dosages would be filled with 60 dosages - the “Q” stood for the number “6” and the “K” stood for the number “0.” After the presecription was underfilled, the Carlucci brothers and "L.S." billed Medicaid and other insurance provided for the full prescription.
The conspirators would substitute generic drugs for brand names and not inform the patients. They then billed their providers for the brand name amount. To do this, they entered the prescribing physicians' phone numbers into their computer system as a code to remind themselves they were using this particular scheme.
Another scheme the pharmacists used was to fill outstanding refills on a prescription without the knowledge of the patient, and then bill their Medicaid or insurance providers. They would enter a dot (“.”) into the pharmacy computer system to indicate that they were utilizing this particular scheme.
If the pharmacists lost money on a prescription, they searched for additional costs in their files that could be passed on to Medicaid or their insurance provider. They would enter the code "COV" into the pharmacy computer to indicate this scheme.
Prescription drugs were purchased from non-licensed wholesalers at a substantial discount to the drugs’ wholesale price. The pharmacists then dispensed these discounted drugs to patients and Medicaid or their insurance providers for the full cost.
According to the statement published by the US District Attorney's Office
"The sentence for the health care fraud conspiracy charge is punishablle by a maximum potential penalty of 10 years in prison and a fine of $250,000 or twice the gross gain or loss from the scheme. As part of their guilty pleas, the defendants are agreeing to pay restitution of $1.5 million. Additionally, Robert Carlucci is forfeiting $849,568 and William Carlucci is forfeiting $558,717. Sentencing for both is scheduled for Nov. 12, 2013.
Sentencing for both is scheduled for Nov. 12, 2013."
"U.S. Attorney Fishman thanked special agents of the DEA, under the direction of Special Agent in Charge Carl Kotowski; and special agents of the Food & Drug Administration’s Office of Criminal Investigations, under the direction of Mark Dragonetti, with the investigation leading to today’s guilty pleas. He also thanked the Elizabeth, Clinton, Toms River, West Orange, and Marlboro Police Departments, along with the Essex County Sheriff’s Department for their work on this case."
Assistant U.S. Attorney Rahul Agarwal of the U.S. Attorney’s Office Criminal Division represented the government. There was no word at this time on the government's case against "L.S."
Editor's Note: This Article was updated at 4:27 pm.