Crispin Abarientos, M.D., of Middletown, Connecticut, pleaded guilty to one count of health care fraud in Hartford federal court. According to court statements, Abarientos was a physician that operated out of Middlesex Rheumatology and submitted false claims to Medicaid regarding the use of the drug Remicade on behalf of his patients.
Remicade is primarily used to treat rheumatoid arthritis, and is a drug that was commonly prescribed to Middlesex Rheumatology patients. When Medicaid patients are treated with Remicade the prescribing physician is required to submit claims to their local Medicaid facility, in this case Connecticut Medicaid, on their behalf. Medicaid then pays a partnered pharmacy for the requested drugs, which are then delivered to the prescribing doctor’s facility.
While this was a procedure that Abarientos regularly followed for many of his patients, he admitted to submitting claims to Medicaid for large quantities of the drug that were never intended to be distributed to his patients. He would then submit claims to insurers for reimbursement of the drugs, profiting from the scheme without any out-of-pocket expenses. In total, Abarientos was able to obtain around $895,000 worth of Remicade, which were never distributed to his patients for treatment.
In an effort to cover-up the scheme, Abarientos also falsified documents that made it look like his patients were being treated with Remicade. After pleading guilty to one count of health care fraud, Abarientos faces up to 10 years in prison. He is scheduled to be sentenced for his charges on October 30th, 2019.
This investigation was performed by the Federal Bureau of Investigation, the US Department of Health and Human Services, and the Medicaid Fraud Control Unit.
To learn more about Medicaid fraud or similar types of fraud, visit the Jeff Newman Law Whistleblower Help Center and blog!