Ocean City schools maintenance worker latest to plead in insurance fraud scheme

An Ocean City schools maintenance worker is the latest to admit to health insurance fraud in a far-reaching multimillion dollar scheme.
James Wildman, 44, of Marmora, made more than $650,000 as a recruiter who persuaded public workers to get expensive, medically unnecessary compounded medications that insurers then reimbursed for thousands of dollars per monthly supply, U.S. Attorney Craig Carpenito said Tuesday.
Wildman was part of the conspiracy from January 2015 through February 2016, according to the complaint.
He resigned from his position with the Ocean City School District last month, an agenda from that time shows.
Teachers, firefighters, police officers and state troopers were targeted as recruits due to their high-dollar insurance converage.
Wildman and conspirators working under him recruited public employees covered by the Pharmacy Benefits Administrator to fraudulently obtain compounded medications from the Compounding Pharmacy without any evaluation by a medical professional that they were medically necessary, the complaint said. Wildman secured insurance information from the individuals and passed it along to a conspirator, who had a doctor sign prescriptions without examining the individuals. The prescriptions were faxed to the Compounding Pharmacy, which filled the prescriptions and billed the Pharmacy Benefits Administrator.
The pharmacy then paid one of Wildman’s conspirators a percentage of each prescription filled and paid by the Pharmacy Benefits Administrator, which was then distributed to Wildman and other members of the conspiracy. Wildman paid individuals cash to reward them for obtaining prescriptions. Wildman himself received compounded medications he did not need in order to financially benefit a conspirator.
More than $50 million was paid out by the Pharmacy Benefits Adminitrator for compounded medications mailed to individuals in state. Of that, $4,879,776 had allegedly been tied to Wildman and his cohorts.
Wildman received $657,040 for his role in the scheme.
He faces a maximum of 10 years in prison and a $250,000 fine, or twice the gross gain or loss from the offense. Sentencing is scheduled for Feb. 25, but that may just be a hold date. Sentencings for admitted co-conspirators have had numerous delays. None has been sentenced yet.
As part of his plea agreement, Wildman must forfeit $657,040 in criminal proceeds and pay restitution of at least $4,879,776.
Defense attorney Mark Roddy said he could not comment on the case.

Others who have pleaded

Dr. John Gaffney, 55, of Linwood: Margate doctor must forfeit $25,000. Cost: $24.9 million

Michael Sher, 40, of Northfield: Margate firefighter must forfeit $1.7 million. Cost: tbd at sentencing

Mike Pepper, 45, of Northfield: Atlantic City firefighter must forfeit $113,627.54. Cost: $719,000

Richard Erick McAllister, 42, of Ocean City: Pleasantville High School English teacher must forfeit $456,806.23. Cost: $3.4 million

Shawn Sypherd, 46, of Marmora: Middle Township Middle School social studies teacher must forfeit $354,264.06. Cost: $2.4 million

Michael Pilate, 39, of Williamstown: Pleasantville schools counselor must forfeit $392,684.20. Cost: $3.5 million

Matthew Tedesco, 42, of Linwood: Pharmaceutical representative must forfeit $11.1 million. Cost: $28.7 million

Nicholas Tedesco, 44, of Linwood: local candy retailer must forfeit $782,766.56. Cost: $2 million

Tara LaMonaca, 43, of Linwood: Pharmaceutical representative must forfeit $89,855.13. Cost: $530,527

William Hunter, 43, of Sewell: Salesman must forfeit $245,020.08. Cost: $1.3 million

Michael Neopolitan, 49, of Willow Grove, Pa.: Pharmaceutical representative must forfeit $198,617.14. Cost: $762,519

Judd Holt, 42, of Marlton: Pharmaceutical representative must forfeit $95,574.49. Cost: $769,762

George Gavras, 36, of Moorestown: Pharmaceutical representative must forfeit $204,002.02. Cost: $679,368.53

Steven Urbanski, 37, of Marlton: Pharmaceutical representative must forfeit $113,600. Cost: $250,000

Thomas Hodnett, 41, of Voorhees: Pharmaceutical representative must forfeit $270,000. Cost: $1.5 million

Robert Bessey, 43, of Philadelphia: Pharmaceutical representative must forfeit $485,540.09. Cost: $2.7 million

Richard Zappala, 45, of Northfield: Pharmaceutical representative must forfeit $1.5 million. Cost: $4.3 million

Andrew Gerstel, 39, of Galloway Township: Pharmaceutical representative must forfeit $184,389.05. Cost: $483,946

Timothy Frazier, 42, of Galloway Township: Commercial construction estimator must forfeit $145,425. Cost: $801,119

Robert Madonna, 36, of Florida: Former Margate mortgage consultant must forfeit $179,370. Cost: $2.1 million.

Kristie Abbott Masucci, 36, of Cedar Run: Pharmaceutical representative must forfeit amount to be determined at sentencing. Cost: $1.88 million.

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