The basics:

• N.J. cases tied to national DOJ health care fraud takedown
• Over a dozen physicians, pharmacies reach settlements
• Schemes involve false claims, kickbacks, unneeded treatment

More than a dozen physicians and pharmacies in New Jersey reached settlements with federal authorities to resolve allegations they defrauded Medicare, Medicaid, TRICARE and private health insurers.

According to the U.S. Attorney’s Office for the District of New Jersey, the accused participated in schemes such as submitting reimbursements for drugs, devices and tests that patients didn’t need or were never sold, as well as receiving kickbacks to drive phony prescriptions.

The June 30 announcement includes pharmacies in Camden, Jersey City, Newark and Elizabeth, along with Newark Beth Israel Medical Center and a dental group, authorities said.

The settlements are also part of a larger crackdown on health care fraud by the Department of Justice that resulted in criminal charges against 324 licensed medical professionals across the U.S. Altogether, the defendants are alleged to have participated in various schemes that resulted in over $14.6 billion in losses, authorities said.

In New Jersey, the U.S. Attorney’s Office said the following individuals were charged and entered settlements:

Alan Vaughan, 56, United Kingdom

Charged with conspiracy to violate the federal anti-kickback statute in connection with a scheme to generate referrals for durable medical equipment and cancer genetic tests. As alleged in the indictment:

• Vaughan paid kickbacks to several marketers in exchange for personal health and insurance information about Medicare beneficiaries; transmitted that information to telemedicine companies; and then received kickbacks from genetic testing laboratories as well as durable medical equipment supply companies for each applicable item for which Medicare provided reimbursement
• To conceal the scheme, Vaughan and his co-conspirators received millions of dollars in kickbacks through a shell company in New Zealand
• As a result of the scheme, Vaughan and his co-conspirators caused a loss to Medicare of more than $80 million

Taejin Kim, 43, River Vale

Charged by information with conspiracy to commit health care fraud in connection with a scheme to submit false and fraudulent claims to Amtrak’s health care plan for services that never provided and medically unnecessary. Amtrak paid approximately $2.25 million on these claims.

Nestor Jaime, 36, Pine Brook

Charged by indictment with health care fraud in connection with a scheme to submit fraudulent prescription drug claims to Medicare.

As alleged in the indictment, pharmacy owner Jaime engaged in a scheme to submit fraudulent claims for a high-reimbursement medication that was never dispensed; and for which the pharmacy never received any prescriptions from the purported beneficiaries’ health care providers for the medication.

Medicare paid Jaime’s pharmacy $2.51 million for these false and fraudulent claims.

These predatory schemes prioritize profits over patients, and the District of New Jersey is fiercely committed to rooting out this fraud and ensuring those responsible face justice.
– acting U.S. Attorney Alina Habba

Newark Beth Israel Medical Center, Newark

Agreed to pay $250,000 to resolve allegations that from Jan. 1, 2018, through Dec. 31, 2019, doctors working in NBIMC’s Heart Transplant Program failed to adequately disclose to patients and their family members material medical information about patients’ conditions. The United States contends that this conduct resulted in NBIMC performing medically unnecessary treatment on these patients.

“Newark Beth Israel Medical Center (NBI) is dedicated to providing the highest quality care to its patients in a safe and ethical manner,” a RWJBarnabas Health representative told NJBIZ.

“The U.S. Department of Justice and the U.S. Attorney’s Office for the District of New Jersey (Government) and NBI reached a settlement agreement on claims related to the NBI heart transplant program from 2018. This civil settlement is not in any way an admission of wrongdoing or liability on the part of NBI,” the representative continued. “As stated in the settlement agreement, NBI denies the allegations (by the Government) and did not provide unnecessary medical treatment to patients. Furthermore, this matter is completely unrelated to the any of the actions announced by the Government in its omnibus press release.”

Excel Pharmacy Inc., Jersey City

Agreed to pay $3 million to resolve allegations that from Jan. 2, 2015, through Jan. 25, 2022, it caused the submission of claims for reimbursement to the Medicare Part D Program and the New Jersey Medicaid Program for drugs never dispensed to beneficiaries.

QuickRx LLC, Elizabeth

Agreed to pay $962,821 to resolve allegations that from Jan. 7, 2015, through Jan. 24, 2022, it caused the submission of claims for reimbursement to the Medicare Part D Program and the New Jersey Medicaid Program for drugs never dispensed to beneficiaries.

Camden Discount Pharmacy, Camden

Agreed to pay $310,000 to resolve allegations that from Jan. 2, 2015, through Jan. 24, 2022, it caused the submission of claims for reimbursement to the Medicare Part D Program and the New Jersey Medicaid Program for drugs never dispensed to beneficiaries.

Rachit Drug Inc., Newark

Agreed to pay $225,000 to resolve allegations that, from Jan. 2, 2015, through Jan. 25, 2022, it caused the submission of claims for reimbursement to the Medicare Part D Program and the New Jersey Medicaid Program for drugs never dispensed to beneficiaries.

Premier Dental Holdings Inc.

Agreed to pay $540,000 to resolve allegations that from Jan. 1, 2021 through July 31, 2023, it submitted or caused the submission of claims for reimbursement to the Medicare Part D Program and the New Jersey Medicaid Program for:

• Services performed by providers who were not credentialed with NJ FamilyCare or the applicable managed care organization, but billed for by using the National Provider Identifiers of dentists who did not perform the services but had the necessary credentials; or
• Services performed and billed by uncredentialed providers at the time the service was rendered

In a statement, acting U.S. Attorney Alina Habba said, “These predatory schemes prioritize profits over patients, and the District of New Jersey is fiercely committed to rooting out this fraud and ensuring those responsible face justice.”

U.S. Attorney General Pamela Bondi added, “This record-setting Health Care Fraud Takedown delivers justice to criminal actors who prey upon our most vulnerable citizens and steal from hardworking American taxpayers. Make no mistake — this administration will not tolerate criminals who line their pockets with taxpayer dollars while endangering the health and safety of our communities.”

Editor’s note: This story was updated at 5:04 p.m. EST July 1, 2025, to remove a reference to Newark Beth Israel pharmacy, which was not among those named. Additionally, the story was updated to include a statement from RWJBarnabas Health.