TRENTON
- Division of Criminal Justice Director
Vaughn L. McKoy announced that a former
Bergen County certified public accountant
has agreed to pay $325,000 in restitution
after pleading guilty to Health Care Claims
Fraud for inflating and submitting fraudulent
insurance claims for medical services
that were never provided to patients.
According to Director McKoy and Insurance
Fraud Prosecutor Greta Gooden-Brown, Barry
Cohen, 51, Parkland, FL, pleaded guilty
before Bergen County Superior Court Judge
Joseph Conte to Health Care Claims Fraud
(2nd degree). The charge was contained
in a State Grand Jury indictment filed
by the Division of Criminal Justice -
Office of Insurance Fraud Prosecutor on
Sept. 8, 2004. When sentenced on May 13,
Cohen faces up to ten years in state prison
and a fine of up to $150,000.
Insurance Fraud Prosecutor Gooden-Brown
noted that Cohen operated a family-owned
corporation known as Headways, Inc., formerly
located in Bergen County. Headways, which
ceased operations in November, 2000, provided
health care services and therapy to patients
suffering from brain injuries.
At the March 7 guilty plea hearing, Cohen
admitted that between Jan. 15, 1998 and
April 30, 2001, he knowingly submitted
dozens of health care claims to insurance
companies and/or self-funded health benefit
plans for patient therapy and related
treatments by adding additional hours
and/or dates of therapy which were never
provided. An investigation by the Division
of Criminal Justice - Office of Insurance
Fraud Prosecutor determined that Cohen
added more than 4,000 additional hours
of services totaling more than $350,000
to dozens of bills submitted to the insurance
companies for reimbursement or payment.
The insurance companies and health benefits
plans that received the false claims included
Allstate Insurance Company, Horizon Blue
Cross/Blue Shield of New Jersey, State
Farm Insurance Company, Proformance Mutual
Insurance Company, and Key Benefit Administrators,
a third party claims administration company
which administered health insurance for
the Teamsters Union Local 560 Benefit
Fund, as well as the New Jersey Automobile
Full Insurance Underwriting Association.
State Investigator Abraham Aquino, Civil
Investigator Douglas Graham, and Deputy
Attorneys General Nicholas Vasile and
Beth A. Hardy were assigned to the investigation.
DAG Vasile represented the Division of
Criminal Justice - Office of Insurance
Fraud Prosecutor at the guilty plea hearing.
The case was referred to the Office of
Insurance Fraud Proseutor by Horizon Blue
Cross/Blue Shield of New Jersey.
“The
Division of Criminal Justice - Office
of Insurance Fraud Prosecutor is committed
to protecting New Jersey’s citizens
from unscrupulous acts by combating insurance
fraud in whatever form it takes,”
said Insurance Fraud Prosecutor Greta
Gooden Brown. “When health care
providers commit fraud it is particularly
disturbing, because the integrity of the
health care insurance claims process depends
on the trustworthiness of the licensed
professionals involved. As it has in the
past, the Office of the Insurance Fraud
Prosecutor will vigorously investigate
and prosecute this type of criminal activity.”
In 2004, criminal prosecutions by OIFP
resulted in the imposition of jail sentences
totaling 199 years of incarceration -
an increase of over 70% from the prior
record-breaking year. Since its inception
in 1998, the OIFP has screened over 60,000
reports of suspected insurance fraud,
imposed over 4,500 fines totaling more
than $22 million, obtained orders for
over $46 million in civil and criminal
restitution, pursued criminal prosecutions
resulting in the conviction of approximately
840 insurance fraudsters, and sent nearly
300 convicted defendants to jail for more
than 648 years.”
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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