TRENTON – Acting Attorney General John Hoffman and the Office of the Insurance Fraud Prosecutor announced that a Monmouth County woman pleaded guilty today for submitting fraudulent healthcare claims that totaled more than $500,000 to her insurer over a two-year span.

Donna Dzienisewski, 40, of Middletown, pleaded guilty to second-degree health care claims fraud before Judge Anthony J. Mellaci Jr. The charge was contained in a state grand jury indictment in April. Judge Mellaci scheduled sentencing for February 6, 2015. Under the plea agreement, the state will recommend that Dzienisewski be sentenced to five years in prison and that she be ordered to pay restitution in the amount of $10,000. In addition, a civil consent judgment will be entered against her in the amount of $50,000, which means the State could still seek financial penalties from Dzienisewski up to that amount.
 
“Dzienisewski made concerted and repeated efforts to swindle her insurer over a two-year span and the multitude of her crimes have rightfully landed her in prison,” said Acting Attorney General Hoffman. “On more than 100 occasions, she submitted fraudulent claims for medical procedures that had never taken place. These egregious crimes netted her an exorbitant sum, which could have been much more had she not been caught.”

In pleading guilty, Dzienisewski admitted that between March 18, 2011 and March 12, 2013, she submitted 107 claims to Horizon Blue Cross Blue Shield of New Jersey that gave the false impression that she incurred approximately $502,740 in total reimbursable expenses for health care services. Dzienisewski never actually visited the doctor on 101 of those occasions and incurred no medical expenses at all on those occasions. She incurred only approximately $2,640 in medical expenses for the remaining six claims, even though she altered the six medical invoices corresponding to these claims to show falsely that she incurred a total of $8,640 in medical expenses. In total, Dzienisewski deposited $141,126 into her bank account as a result of her fraudulent activity.

“The 107 medical invoices that she submitted grossly overstated the costs and frequency with which such procedures would be ordinarily performed,” said Acting Insurance Fraud Prosecutor Ron Chillemi. “Fraud of this magnitude negatively impacts all corners of the health care insurance industry in New Jersey. Stopping and punishing one fraudster should dissuade others from attempting such a scam.”

Deputy Attorney General T.J. Harker and Detectives Wendy Berg and Matthew Armstrong coordinated the investigation. Analyst Kelly Celenza provided substantial assistance in the financial analysis of the investigation. Acting Insurance Fraud Prosecutor Chillemi thanked Horizon Blue Cross Blue Shield of New Jersey for referring the matter.

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