United States of America v. CARMINE A. MATTIA, JR. On Appeal from the United States District Court for the…

PRECEDENTIAL
UNITED STATES COURT OF APPEALS
FOR THE THIRD CIRCUIT
_____________
No. 24-2589
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UNITED STATES OF AMERICA,
Appellant
v.
CARMINE A. MATTIA, JR.
_____________
On Appeal from the United States District Court
for the District of New Jersey
(D.C. No. 2:21-cr-00576-001)
District Judge: Honorable Brian R. Martinotti
_____________
Argued: July 8, 2025
Before: RESTREPO, BIBAS and CHUNG, Circuit Judges.
(Filed: October 21, 2025)
Mark E. Coyne
Vikas Khanna
Office of United States Attorney
970 Broad Street

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Room 700
Newark, NJ 07102
Norman Gross
R. David Walk, Jr. [ARGUED]
Office of United States Attorney
Camden Federal Building & Courthouse
401 Market Street
Camden, NJ 08101
Counsel for Appellant
Bruce A. Levy [ARGUED]
Hartmann Doherty Rosa Berman & Bulbulia
830 Morris Turnpike
Suite 304
Short Hills, NJ 07078
Counsel for Appellee
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OPINION OF THE COURT
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RESTREPO, Circuit Judge
Appellee Carmine Mattia was charged in a superseding
indictment (the “Superseding Indictment”) with having
defrauded a pharmacy benefits management company by
causing the submission of fraudulent claims for medically
unnecessary compounded medicines. According to the
Superseding Indictment, Mattia induced an individual
(“Individual-1”) to seek out unnecessary compounded

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medicines and secured, or caused to be secured, a doctor’s
signature on prescriptions for these medicines without a
medical examination or a determination of medical necessity.
The District Court dismissed the Superseding Indictment,
finding that it failed to adequately allege any
misrepresentations or omissions sanctionable by 18 U.S.C.
§ 1347.
The Government now appeals, contending that the
submitted claims contained an implicit misrepresentation by
incorporating fraudulent prescriptions. We agree. Because the
Superseding Indictment adequately alleged a
misrepresentation, and because Mattia’s other arguments
concerning the sufficiency of the Superseding Indictment fail,
we will reverse the District Court’s order granting Mattia’s
motion to dismiss and remand for further consideration
consistent with this opinion.
I. BACKGROUND 1
Appellee Carmine Mattia was an employee of a
telecommunications company (the “Company”) and a union
representative for his fellow employees there. The Company
contracted with a pharmacy benefits management company
(“PBM-1”) that “adjudicated claims for reimbursement from
pharmacies and paid pharmacies for valid claims submitted on
behalf of beneficiaries.” A40. While employed by the
Company, Mattia was also a sales representative for
compounded medications “for a marketing company located in
or around New York and compounding pharmacies.” A42. As
1 The following facts are taken from the Superseding
Indictment and assumed to be true for purposes of assessing
the sufficiency of the Superseding Indictment.

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a sales representative, Mattia was paid a percentage of sales
whenever a compounded medication was billed to a paying
health plan. Compounded medications are “[g]enerally . . .
prescribed by a physician when an FDA-approved drug did not
meet the health needs of a particular patient.” A40–41.
In the Superseding Indictment filed against Mattia, the
Government alleges that Mattia “caused Individual-1,” A42, “a
resident of New Jersey who had drug prescription benefits
through the Company,” A39, “to receive medically
unnecessary compounded medications,” A42. The goal of this
scheme was “to fraudulently obtain money by causing the
submission of Individual-1’s false and fraudulent insurance
claims for compounded prescription medications to the
Company’s health care plan.” A41.
To secure the medically unnecessary compounded
medications, Mattia allegedly “secured and caused to be
secured the signature of Robert Agresti,” a doctor, “on
prescription forms for Individual-1, (a) without Robert Agresti
and Individual-1 having a doctor/patient relationship, (b)
without Robert Agresti determining that Individual-1 had a
medical necessity for the compounded medications selected,
and (c) without Robert Agresti conducting an examination of
Individual-1.” A43. In exchange for seeking these
medications, Mattia allegedly “gave Individual-1 cash and
check payments.” Id. After learning he was the subject of a
criminal investigation, Mattia allegedly told Individual-1 to lie
to investigators and tell them these payments were “for work
that Individual-1 performed on [Mattia’s] kitchen.” A44.
On the basis of these allegations, Mattia was charged
with one count of conspiracy to commit health care fraud
(Count One) and three counts of substantive health care fraud

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(Counts Two, Three, and Four). Mattia was also charged with
witness tampering and obstruction, but those counts are not at
issue in this appeal.
Before the District Court, Mattia moved to dismiss
Counts One through Four of the Superseding Indictment.
Mattia primarily contended that these counts failed to identify
any misstatement or omission and were unconstitutionally
vague as applied because they used the term “medically
unnecessary.” The District Court agreed with Mattia, finding
that the Superseding Indictment did not allege:
(1) any misrepresentation or false or fraudulent
statement or omission by Defendant;
(2) how the ‘false and fraudulent insurance
claims’ were ‘caused’ to be submitted to the
Health Plan and who submitted those claims; or
(3) what, if any, false or fraudulent statements or
misrepresentations appeared (or fraudulent
omissions did not appear) on the ‘false and
fraudulent insurance claims’ that were
purportedly submitted to the Health Plan, nor
who made those statements, misrepresentations,
or omissions.
A14. Specifically, the District Court found that:
[T]o the extent the Government contends health
care fraud was sufficiently alleged because there
was a false statement in the prescriptions
themselves and/or the claims submitted to the
Health Plan (or even a false implicit statement)

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stating that the prescriptions were ‘medically
necessary’ for Individual-1, that fact is not
alleged in the Superseding Indictment.
A17. The District Court found that Mattia was “[n]otably
missing” from the chain of events whereby “the doctor writes
the script for the prescription and then the doctor or the
pharmacy . . . submits a claim to the PBM, which subsequently
submits a claim . . . to the insurance company for adjudication.”
A18. Accordingly, the District Court granted Mattia’s motion
to dismiss the Superseding Indictment. The Government now
appeals.
II. DISCUSSION 2
A. Standard of Review
“The ‘sufficiency of an indictment to charge an offense
is a legal question subject to plenary review.’” United States
v. Yusuf, 536 F.3d 178, 184 (3d Cir. 2008) (quoting United
States v. Conley, 37 F.3d 970, 975 n.9 (3d Cir. 1994)). A
court’s determination of the sufficiency of an indictment “must
be based on whether the facts alleged in the indictment, if
accepted as entirely true, state the elements of an offense and
could result in a guilty verdict.” United States v. Bergrin, 650
F.3d 257, 268 (3d Cir. 2011).
Federal indictments are governed by Federal Rule of
Criminal Procedure 7(c), which requires only a “plain, concise,
and definite written statement of the essential facts constituting
the offense charged[.]” Fed. R. Crim. P. 7(c)(1). “An
2 The District Court had jurisdiction under 18 U.S.C. § 3231.
We have jurisdiction under 18 U.S.C. § 3731.

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indictment is generally deemed sufficient if it: (1) contains the
elements of the offense intended to be charged, (2) sufficiently
apprises the defendant of what he must be prepared to meet,
and (3) allows the defendant to show with accuracy to what
extent he may plead a former acquittal or conviction in the
event of a subsequent prosecution.” United States v. Rankin,
870 F.2d 109, 112 (3d Cir. 1989) (quoting Russell v. United
States, 369 U.S. 749, 763–64 (1962)) (cleaned up).
Section 1347, the underlying health care fraud statute,
prohibits “knowingly and willfully execut[ing], or attempt[ing]
to execute, a scheme or artifice—(1) to defraud any health care
benefit program; or (2) to obtain, by means of false or
fraudulent pretenses, representations, or promises, any of the
money or property owned by, or under the custody or control
of, any health care benefit program, in connection with the
delivery of or payment for health care benefits, items, or
services[.]” 18 U.S.C. § 1347(a).
B. Sufficiency of the Superseding Indictment
Mattia contends that the Superseding Indictment failed
to state an offense and failed to apprise him of what he must be
prepared to meet at trial for three main reasons: (1) it fell short
of adequately alleging a misrepresentation; (2) it used vague
and undefined terminology; and (3) it lacked requisite
specificity regarding Mattia’s knowledge of and interactions
with Dr. Agresti. None of these arguments are availing.
i. Misrepresentations
The Government contends that the Superseding
Indictment fairly “identifies the misrepresentations at the heart
of the fraudulent scheme: that the prescriptions for Individual-

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1 were medically necessary based on a legitimate examination
conducted by a doctor.” Appellant’s Br. at 14. Specifically,
the Government argues that the prescriptions obtained for
Individual-1 “conveyed false representations that the
medications were legitimately needed based on a bona fide
examination by a doctor.” Id. “Because PBM-1 only paid for
‘valid claims,’ the allegations taken together permit an
inference that, at the very least, the conspirators made implicit
representations to PBM-1 that the medications for Individual-
1 were medically necessary based on a legitimate doctor’s
evaluation and examination.” Id. at 16.
In response, Mattia argues that the Superseding
Indictment fails to allege any “false or fraudulent pretenses,
representations, or promises” as required to sustain a health
care fraud charge. Appellee’s Br. at 11 (quoting 18 U.S.C.
§ 1347(a)). To Mattia, the Government’s argument improperly
relies on the undefined term “valid claims,” reaching outside
the four corners of the indictment to assert that a “valid claim”
is only one based on a “legitimate doctor’s evaluation and
examination” that a medication is medically necessary. Id. at
17.
Mattia is incorrect: we do not need to reach outside the
four corners of the Superseding Indictment to find that the
government alleged an implicit fraudulent misrepresentation.
As an initial matter, we join the Fifth and Eleventh Circuits in
recognizing that implicit misrepresentations can give rise to
valid charges under Section 1347. See United States v.
Anderson, 980 F.3d 423, 429 (5th Cir. 2020) (“We conclude
that an implicit misrepresentation theory of health care fraud is
valid.”); United States v. Gonzalez, 834 F.3d 1206, 1214 (11th
Cir. 2016) (“A person makes a false claim if the treatments that
were billed were ‘not medically necessary[ ] or were not

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delivered to the patients.’” (quoting United States v. Medina,
485 F.3d 1291, 1304 (11th Cir. 2007))). We have long
recognized that implicit misrepresentations are cognizable in
other fraud contexts, and we see no justification in the text of
Section 1347(a) to stray from this approach. See, e.g., United
States v. Ferriero, 866 F.3d 107, 120 (3d Cir. 2017) (“Express
falsehoods lie at fraud’s core, but a fraudulent representation
need not be fraudulent on its face, nor must it necessarily
involve affirmative misrepresentation.” (cleaned up)).
Here, the District Court concluded that there was no
implicit misrepresentation alleged in the Superseding
Indictment because there was no alleged “false implicit
statement” contained “in the prescriptions themselves and/or
the claims submitted to the Health Plan . . . that the
prescriptions were ‘medically necessary’ for Individual-1.”
A17. This was error.
In reviewing its sufficiency, “we review the indictment
using a common sense construction.” United States v. Hodge,
211 F.3d 74, 76 (3d Cir. 2000). A common-sense reading of
the Superseding Indictment makes it clear that the claims
submitted to PBM-1 incorporated Dr. Agresti’s prescriptions
and that those prescriptions contained implicit
misrepresentations.
The Superseding Indictment adequately alleges that a
prescription is a required component of a claim submitted to
PBM-1. The Superseding Indictment describes the
compounded medications as “compounded prescription
medications,” suggesting that a prescription is required for
them to be dispensed. A41. And the Superseding Indictment
states that Mattia was paid “a percentage of the adjudication or
reimbursement amount for each prescription for compounded

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medication that [Mattia] caused to be billed to a paying health
plan.” A42. This phrasing—that “prescriptions” were “billed
to a paying health plan”—suggests that the prescriptions
played an integral part of the claims submitted to PBM-1. Id.
A common-sense reading of the Superseding
Indictment also makes it clear that the government alleged that
these prescriptions, signed by Dr. Agresti, carried implicit
misrepresentations. Viewed through this common-sense lens,
the Superseding Indictment sufficiently alleges that a valid
prescription for compounded medications must be based on a
physician’s medical assessment of the “health needs of a
particular patient.” A40–41 (alleging that “[g]enerally,
compounded drugs were prescribed by a physician when an
FDA-approved drug did not meet the health needs of a
particular patient,” and that “[c]ompounded drugs could also
be prescribed when a patient could not consume a medication
by traditional means”). Even the word “prescription” itself, if
ascribed a common-sense definition, suggests a level of
validity based on a doctor’s determination that a particular drug
is needed by a patient. See United States v. Smith, 573 F.3d
639, 651 (8th Cir. 2009) (“[T]he word prescription . . . in
common parlance, means only a bona fide order—i.e.,
directions for the preparation and administration of a medicine,
remedy, or drug for a real patient who actually needs it after
some sort of examination or consultation by a licensed
doctor[.]” (quoting United States v. Nazir, 211 F. Supp. 2d
1372, 1375 (S.D. Fla. 2002))). By alleging that Dr. Agresti’s
prescriptions were issued “(a) without Robert Agresti and
Individual-1 having a doctor/patient relationship, (b) without
Robert Agresti determining that Individual-1 had a medical
necessity for the compounded medications selected, and (c)
without Robert Agresti conducting an examination of

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Individual-1,” the Superseding Indictment sufficiently alleged
that these prescriptions were not bona fide orders and therefore
contained an implicit misrepresentation.3 A43.
Because the Superseding Indictment sufficiently
alleged that Dr. Agresti’s prescriptions contained implicit
misrepresentations, and that these implicit misrepresentations
were incorporated into the claims submitted to PBM-1, the
District Court erred in concluding that the Superseding
Indictment did not sufficiently allege a misrepresentation.
More specificity or detail concerning these misrepresentations
was not required for the Superseding Indictment to clear Rule
7(c)(1)’s low bar.
ii. Vagueness
Mattia also contends that the Superseding Indictment
fails to apprise him of what he needs to meet at trial because it
used the terms “medically unnecessary,” “doctor/patient
relationship,” and “valid claims,” which Mattia argues are
undefined and vague. Appellee’s Br. at 11–14. The District
Court, in assessing the sufficiency of the indictment, was
troubled by the Superseding Indictment’s use of the term
“medically unnecessary,” finding that “there is unquestionably
no singular or static definition for ‘medically unnecessary,’
3 That it was not Mattia himself directly making these
misrepresentations is of no consequence: “[i]f conspirators
have a plan which calls for some conspirators to perpetrate the
crime and others to provide support, the supporters are as guilty
as the perpetrators.” Salinas v. United States, 522 U.S. 52, 64
(1997).

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rendering it a vague term, which can have different meanings
depending on context.” A17.
We do not share these concerns. Because “criminal
indictments are to be read as a whole and interpreted in a
common sense manner,” United States v. Lee, 359 F.3d 194,
209 (3d Cir. 2004) (cleaned up), the mere fact that a term “can
have different meanings depending on context,” A17, does not
render it unusable in an indictment. Here, a fair, holistic, and
common-sense interpretation of the terms in the context in
which they are used in the Superseding Indictment fairly
apprises Mattia of what he needs to meet at trial.4
iii. Allegations Concerning Dr. Agresti
Mattia contends that the Superseding Indictment was
insufficient because it “is silent regarding when and under what
circumstances Dr. Agresti signed [Individual-1’s]
prescriptions.” Appellee’s Br. at 14–15. But this level of
specificity is not required by Rule 7(c), which merely requires
“a plain, concise, and definite written statement of the essential
facts constituting the offense charged[.]” Fed. R. Crim. P.
7(c)(1); see also United States v. Resendiz-Ponce, 549 U.S.
102, 110 (2007) (“While detailed allegations might well have
been required under common-law pleading rules, they surely
are not contemplated by Rule 7(c)(1).” (citation omitted)). The
4 The District Court suggested that the Superseding Indictment
was unconstitutionally vague, but did not rule on this aspect of
Mattia’s motion. Though we hold that the Superseding
Indictment fairly apprises Mattia of what he needs to meet at
trial despite its use of the term “medically unnecessary,” we
leave the issue of unconstitutional vagueness to the District
Court to address in the first instance.

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Superseding Indictment described the essential facts of
Mattia’s alleged scheme, and therefore complies with Rule
7(c), even though it did not detail the specific timing and
circumstances of Dr. Agresti’s participation in it. United States
v. Stevenson, 832 F.3d 412, 424 (3d Cir. 2016) (generally,
indictments are sufficient when they track statutory language).
Mattia also argues that the Superseding Indictment
failed to allege that Mattia “knew that there was no doctor
patient relationship” between Individual-1 and Dr. Agresti,
“knew that the medications were not needed,” or “knew that
there was no physical examination.” Appellee’s Br. at 22.
Without those allegations, Mattia argues that the Superseding
Indictment fails to allege that he “knew there was a conspiracy
or scheme to defraud as alleged and knowingly joined a
conspiracy or knowingly participated in the alleged scheme.”
Id. at 23.
This argument also fails. The Superseding Indictment
plainly stated that Mattia “did knowingly and intentionally
conspire and agree with others to knowingly and willfully
execute a scheme and artifice to defraud a health care benefit
program,” A41, and that he “did knowingly and willfully
execute and attempt to execute a scheme and artifice to defraud
a health care benefit program,” A45. The Superseding
Indictment went into further detail concerning Mattia’s
knowledge of the scheme’s fraudulent nature, alleging among
other things that he “gave Individual-1 cash and check
payments to induce Individual-1 to obtain medically
unnecessary compounded medications,” A43, payments which
Mattia “well knew . . . were illicit payments to induce
Individual-1 to obtain medically unnecessary prescriptions,”
A44. These allegations are sufficient to allege that Mattia

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knowingly participated in a conspiracy and scheme to defraud
PBM-1. Stevenson, 832 F.3d at 424.
III. CONCLUSION
For the reasons set forth above, we will reverse the
District Court’s order granting Mattia’s motion to dismiss and
remand for further consideration consistent with this opinion.

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