Mark Moffett, a former pharmaceutical sales representative for Aegerion Pharmaceuticals Inc., was recently sentenced to 54 months in prison and three years of supervised release for defrauding insurance companies.
Background
In his work with Aegerion, Moffett marketed the company’s cholesterol drug, Juxtapid. Juxtapid was FDA-approved for treating high cholesterol in patients with homozygous familial hypercholesterolemia (HoFH), a rare genetic disease. The FDA approved the drug only to treat patients with HoFH due to the significant risk of side effects, including liver damage, and the drug’s label included a black box warning.
However, despite the risks and limited FDA approval, Moffett convinced physicians to prescribe Juxtapid for patients without HoFH, to the tune of more than $300,000 per year per prescription. For his part, Moffett was paid up to $11,000 in bonus pay for each prescription of Juxtapid.
To defraud Medicare and private health insurance plans into paying for a drug they only covered for FDA-approved uses, Moffett obtained fraudulent prescriptions and falsified documents – including statements of medical necessity and other insurance documents. The falsified documents included false patient test results, false clinical histories, and false diagnoses. Moffett used the identities of several cardiologists to propagate his fraudulent activities.
During his sentencing, Moffett told the judge that he believed the drug benefitted every patient who took it. Even if that were the case, United States District Judge William Young said that was “no excuse” for forging doctors’ names to defraud insurance companies – “who do you think you are?” he asked.
Moffett Attempted Multiple Delay Tactics
Moffett was convicted of nine counts of wire fraud and six counts of aggravated identity theft in December 2019. His sentencing was initially scheduled for April 9, 2020. However, due to the COVID-19 pandemic, the sentencing was delayed four times. In September 2021, Moffett asked for a fifth delay as his “compromised immune system” and unvaccinated status regarding COVID-19 presents a health concern for him. However, Judge Young denied that request.
Reactions
“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.”