TRENTON
- Attorney General Peter C. Harvey announced
that an Ocean County woman has been ordered
by the Ocean County Superior Court to
pay more than $19,000 in restitution for
her involvement in a scheme to obtain
reimbursements from Horizon Blue Cross/Blue
Shield for prescription drugs that were
never paid for or received.
According to Vaughn L. McKoy, Director,
Division of Criminal Justice and Insurance
Fraud Prosecutor Greta Gooden Brown, Ruth
Schwartz, 55, Tuscany Drive, Jackson Township,
was sentenced by Ocean County Superior
Court Judge James N. Citta to three years
probation and ordered to pay $19,569 in
restitution to Horizon Blue Cross/Blue
Shield and to pay a $5,000 civil insurance
fraud fine pursuant to the Insurance Fraud
Prevention Act.
Insurance Fraud Prosecutor Gooden Brown
noted that Schwartz was charged via a
State Grand Jury indictment with Health
Care Claims Fraud and theft by deception.
Schwartz pleaded guilty before Judge Citta
on June 16, admitting that she submitted
121 prescriptions to 26 pharmacies for
various prescription drugs. The prescriptions
were submitted under Schwartz' husband's
prescription plan.
The investigation by the Division of Criminal
Justice - Office of Insurance Fraud Prosecutor
determined that while Schwartz never picked
up or paid for the prescriptions, the
pharmacies automatically submitted electronic
claims to Horizon Blue Cross/Blue Shield
for payment. Horizon Blue Cross/Blue Shield
processed the electronic claims as though
the prescriptions were valid and reimbursed
Schwartz $19,569.
The investigation was conducted by the
Division of Criminal Justice - Office
of Insurance Fraud Prosecutor and coordinated
by State Investigator Peter Pfeifer, Civil
Investigator Michael Troso and Supervising
Deputy Attorney General Lewis Korngut.
SDAG Korngut represented the Division
of Criminal Justice - Office of Insurance
Fraud Prosecutor at the sentencing. The
case was referred to the Division of Criminal
Justice - Office of Insurance Fraud Prosecutor
by the Horizon Blue Cross/Blue Shield
Special Investigations Unit.
"This
case represents a blatant theft from an
employer sponsored health insurance plan,"
said Insurance Fraud Prosecutor Gooden
Brown. "Given that health insurance
costs continue to skyrocket and that some
people cannot afford basic health insurance,
thefts of this nature are particularly
troubling. The Office of Insurance Fraud
Prosecutor will continue to investigate
and aggressively prosecute these cases."
Insurance Fraud Prosecutor Gooden Brown
noted that the Office of Insurance Fraud
Prosecutor realized a 143 percent increase
in indictments; a 91 percent increase
in defendants charged; a 79 percent increase
in convictions (trial convictions and
guilty pleas); and a 60 percent increase
in civil sanctions in 2002. The Office
of Insurance Fraud Prosecutor charged
225 defendants in 2002, versus 118 defendants
in 2001. Additionally, the Office of Insurance
Fraud Prosecutor imposed sanctions in
3,723 civil fraud cases in 2002, compared
to 2,063 civil sanctions obtained in 2001.
The Office of Insurance Fraud Prosecutor
collected $20.6 million in penalties in
2002, up from $15.8 million in 2001.
Noting that some important cases have
begun with anonymous tips from the public,
Insurance Fraud Prosecutor Gooden Brown
encouraged anyone with information about
insurance fraud to contact the Division
of Criminal Justice - Office of Insurance
Fraud Prosecutor's toll-free hotline at
1-877-55-FRAUD, or to visit the
insurance fraud web site at www.NJInsurancefraud.org
.
Housed in the Department of Law and Public
Safety's Division of Criminal Justice
and reporting to the Attorney General,
the Office of the Insurance Fraud Prosecutor
was established by the Automobile Insurance
Cost Reduction Act of 1998 (AICRA). The
Office is the centralized state agency
that investigates and prosecutes civil
and criminal insurance fraud, as well
as Medicaid fraud. Criminal convictions
for insurance fraud can result in fines
and imprisonment. Civil penalties can
include substantial fines and referral
for revocation or suspension of professional
licenses.
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