An Old Bridge man was sentenced on Feb. 7 to 20 months in prison for his role in a large scheme to defraud the Metropolitan Transit Authority’s (MTA) health benefits plan of more than $2.8 million for the billing of medically unnecessary compounded prescriptions.
Enver Kalaba, 37, a bus driver with the MTA, previously pleaded guilty before U.S. District Judge John Michael Vazquez to an information charging him with conspiracy to commit health care fraud, according to information provided by U.S. Attorney Craig Carpenito.
According to documents filed in this case and statements made in court, Kalaba admitted that as early as April 2016 through August 2017 he participated in a scheme to defraud the MTA’s health benefits plan, a privately funded health plan, by knowingly causing the billing of fraudulent claims for medically unnecessary prescription compounded medications, such as scar creams, pain creams, and metabolic supplements. Kalaba was recruited into the scheme by another former MTA bus driver, Christopher Frusci, 34, of Staten Island. Both Frusci and Kalaba were “sales representatives” of Company A, a New Jersey marketing company of compounded prescriptions, according to the statement.
Kalaba and Frusci targeted MTA employees because the MTA’s health benefits’ plan covered compounded medications. To convince MTA beneficiaries to obtain medically unnecessary compounded prescriptions, Kalaba paid them monthly cash bribes of approximately $100 per prescription. To ensure physicians prescribed compounded medications regardless of medical necessity, Kalaba referred MTA beneficiaries to telemedicine physicians who were paid by Company A and its affiliates, according to the statement.
Kalaba was also sentenced to one year of supervised release, and must forfeit $138,630 in criminal proceeds he received for his role in the scheme and pay restitution of $2.9 million.
On March 2, 2018, Frusci pleaded guilty before Vazquez for his role in the scheme and is scheduled for sentencing on March 27.
