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For Immediate Release:  
For Further Information Contact:
February 10, 2005

Office of The Attorney General
- Peter C. Harvey, Attorney General
Division of Criminal Justice
- Vaughn L. McKoy, Director

Office of the Insurance Fraud Prosecutor
- Greta Gooden Brown, Insurance Fraud Prosecutor

 

Rachel Sacharow
609-984-1936

 
 

Hudson County Man Convicted of $300,000 Insurance Fraud and Theft

TRENTON - Attorney General Peter C. Harvey announced that a Hudson County businessman was convicted by an Essex County jury today for submitting more and collecting upon more than 400 fraudulent health insurance claims worth more than $300,000.

According to Vaughn McKoy, Director of the Division of Criminal Justice, and Insurance Fraud Prosecutor Greta Gooden-Brown, James Clark, 49, Mountain Road, Union City, Hudson County, was found guilty by the Essex County jury following a trial before Essex County Superior Court Judge Michael A. Petrolle. Clark was convicted of crimes alleged in a State Grand Jury filed by the Division of Criminal Justice - Office of Insurance Fraud Prosecutor on July 16, 2003. The indictment charged Clark with two counts of theft by deception and one count of Health Care Claims Fraud (all 2nd degree). When sentenced on April 1, Clark faces up to 30 years in state prison and a fine of up to $450,000. Clark may also face civil insurance fraud fines pursuant to the civil Insurance Fraud Prevention Act.

Fraud Prosecutor Greta Gooden Brown noted that Clark was the president of Home Health Care Center, Inc., First Street, Hoboken, Hudson County, as well as the Director of the now defunct Medical Care Management, Inc., d/b/a Mile Square Medical Group, formerly located on Harbor Boulevard in Weehawken, Hudson County. Home Health Care Center is a business that delivers prescription medications from pharmacies to person’s homes. Home Health Care is not licensed to dispense or otherwise sell prescription medications.

The Essex County jury found that between Dec. 1, 1996 and Sept. 11, 1998, Clark, who is neither a medical service provider nor a licensed pharmacist, misrepresented to Horizon Blue Cross/Blue Shield that Home Health Care was licensed to supply, dispense, and sell prescription medications which were delivered to patients of Mile Square Medical Group and was therefore entitled to payment or reimbursement from the State Health Benefits Plans for the cost of the medications.

An investigation by the Division of Criminal Justice determined that Clark submitted as many as approximately 400 fraudulent insurance claims for various medications, some of which were for medications that were never dispensed and never delivered to the patients. The total amount of fraudulent billings submitted by Clark to Horizon Blue Cross/Blue Shield and/or the State Health Benefits Program was in excess of $365,000, of which Horizon paid more than $343,000. Many prescriptions HHC sold were grossly inflated over and above the customary price in the billings to the State Health Benefits Program.

State Investigator David Hiestand and Deputy Attorney General Steven B. Farman were assigned to the investigation. DAG Farman represented the Division of Criminal Justice - Office of the Insurance Fraud Prosecutor at the trial. State Investigator Natalie Brotherston and DAG Joan Burke assisted with the trial. The case was referred to the Division of Criminal Justice - Office of Insurance Fraud Prosecutor by Horizon Blue Cross/Blue Shield.

“Part of the reason health care and prescription insurance is not available to many people is because of the added expense of insurance fraud,” Fraud Prosecutor Gooden-Brown said. “In this case the amount of the fraud was shocking in that health care claims were submitted for medications not provided and for costs grossly inflated.”

Noting that some important cases have begun with anonymous tips from the public, Prosecutor Brown emphasized that individuals can make a difference. “We need people’s information, not their identities. People who are concerned about insurance cheating and have any information about a fraud can call our toll-free hotline at 1-877-55-FRAUD, or visit our Web site at www.NJInsurancefraud.org .”

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