Former pharmaceutical sales rep sentenced to prison for insurance fraud and aggravated identity theft

Crime

BOSTON (USDOJ) – An Illinois man was sentenced for defrauding insurance companies in relation to a high-priced drug made by Cambridge-based pharmaceutical company Aegerion Pharmaceuticals Inc., and for using the identities of physicians to carry out the fraud.

Mark Moffett, 49, of Springfield, Ill., was sentenced by U.S. Senior District Court Judge William G. Young to 54 months in prison and three years of supervised release. In December 2019, Moffett was convicted by a federal jury of nine counts of wire fraud and six counts of aggravated identity theft.

“Mr. Moffett exploited his personal relationships with medical staff, stole doctors’ identities, falsified medical documents and deceived insurance companies – all in pursuit of sales bonuses,” said Acting United States Attorney Nathaniel R. Mendell. “His prison sentence is a reminder that those who engage in healthcare fraud schemes, no matter how sophisticated, will pay for their crimes.”

“Today’s sentence holds Mark Moffett accountable for gaming the healthcare system to line his own pockets. He deceived doctors and patients to boost sales of this powerful drug, and defrauded Medicare in the process. Fraud of this magnitude will not be tolerated because it drives up healthcare costs for all of us,” said Joseph R. Bonavolonta, Special Agent in Charge of the Federal Bureau of Investigation, Boston Division.

“Today’s sentence shows that fraudsters like Mark Moffett who try to enrich themselves at the expense of federal health care programs and the well-being of beneficiaries will be held accountable for their greed-fueled schemes. Such scams threaten patient health, waste taxpayer funds, and drive-up healthcare costs for all of us,” said Phillip M. Coyne, Special Agent in Charge for the U.S. Department of Health & Human Services, Office of Inspector General. “Working closely with our law enforcement partners, we will continue to aggressively root out health care fraud and bring criminals to justice.”

“Working with our law enforcement partners, the Employee Benefits Security Administration continues to investigate and vigorously pursue cases in which participants and private sector health benefit plans are victimized by unscrupulous and illegal pharmaceutical sales practices,” said Carol S. Hamilton, Regional Director of the U.S. Department of Labor, Employee Benefits Security Administration, Boston Regional Office.

In 2014 and 2015, Moffett, a pharmaceutical sales representative for Aegerion, marketed the company’s cholesterol drug Juxtapid. Juxtapid was approved by the FDA only to treat high cholesterol in patients with a rare genetic disease called homozygous familial hypercholesterolemia (HoFH). The FDA approved the drug only to treat HoFH patients because the drug carried serious risks of side effects, including liver damage. The drug’s label included a black box warning.

Moffett nonetheless convinced doctors to prescribe Juxtapid, which costs over $300,000 per year, for patients without HoFH. In order to defraud Medicare and private sector employee health plans into paying for a drug they only covered for FDA-approved uses, Moffett obtained fraudulent prescriptions and falsified numerous documents, including statements of medical necessity and other insurance documents. This included false patient test results, false clinical histories and false diagnoses. Moffett used the identities of several cardiologists to carry out the fraud. He was paid bonuses by Aegerion of up to $11,000 for each prescription of Juxtapid.

Acting United States Attorney Mendell, FBI Boston SAC Bonavolonta, HSI-OIG SAC Coyne and DOL-EBSA Regional Director Hamilton made the announcement. Assistant U.S. Attorneys Kriss Basil, of Mendell’s Securities and Financial Fraud Unit, and Rachel Y. Hemani, of Mendell’s Health Care Fraud Unit, prosecuted the case.

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