South Jersey doctor pleads guilty to health care fraud conspiracy

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An Atlantic County doctor admitted his role March 29 in a more than $5 million conspiracy to defraud New Jersey state and local health benefits programs and other insurers, which entailed submitting fraudulent claims for medically unnecessary prescriptions.

Brian Sokalsky, of Margate, a doctor of osteopathy with medical practices in Ocean City and Somers Point, pleaded guilty before U.S. District Judge Robert Kugler to a superseding information charging him with one count of conspiring to commit health care fraud.

In June 2020, Sokalsky and two other co-conspirators were charged in a 33-count indictment. The others, Vincent Tornari and Ashley Lyons-Valenti, both pleaded guilty to their roles in the conspiracy earlier this year.

According to court documents and statements, the conspirators learned that certain compound medications reimbursed for up to thousands of dollars for a one-month supply as well as that certain insurance plans – including those for state and local government employees – covered these medications. Compound medications are specialty medications mixed by a pharmacist to meet specific medical needs of a patient. While they are not approved by the U.S. Food and Drug Administration (FDA), they are properly prescribed when a physician determines that an FDA-approved medication does not meet a patient’s health needs.

“Sokalsky agreed to authorize prescriptions for former pharmaceutical sales representative Matthew Tedesco, 47, of Linwood, New Jersey, who pleaded guilty to health care fraud conspiracy in June 2017 and others working with Tedesco. In exchange for authorizing those prescriptions, Tedesco referred approximately 30 patients to Sokalsky’s new medical practice,” according to court documents. “Sokalsky, in turn, billed insurance for patient visits for those people steered to his practice by Tedesco. Sokalsky also authorized prescriptions for the medications for existing patients of his practice, which he did to financially benefit Tedesco and encourage him to refer more patients to his new practice.”

Prosecutors say that Sokalsky authorized medically unnecessary medications, including libido creams for young females and excessive quantities of the medications with maximum numbers of refills.

“When insurance stopped covering certain formulations of the medications, Tedesco informed Sokalsky that he needed to authorize new prescriptions,” court documents say. “Sokalsky did so, often without seeing the individual for a follow-up visit or informing the person of the change in medication.”

During the scheme, more than $5 million was paid out by insurance for the fraudulent prescriptions.

When he is sentenced in August, Sokalsky faces a maximum penalty of 10 years in prison and a $250,000 fine.