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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