TRENTON
- Attorney General Peter C. Harvey announced
that an Essex County doctor and his niece
have pleaded guilty to multiple counts
of insurance fraud, including submitting
more than $48,000 in insurance claims
for services that were never provided
to patients.
According to Vaughn L. McKoy, Director,
Division of Criminal Justice, and Insurance
Fraud Prosecutor Greta Gooden-Brown, Dr.
LeClerc Adisson, 58, Walter Place, Irvington,
Essex County, and his niece, Lunic Adisson,
34, same address, pleaded guilty before
Essex County Superior Court Judge Paul
J. Vichness to criminal charges contained
in a criminal Accusation and two separate
indictments.
In pleading guilty to a charge of theft
by deception contained in a State Grand
Jury indictment, Dr. Adisson, the former
owner of Laguardia Primary Health Care,
108 South Munn Ave., East Orange, Dantor
Medical Supply and Clara Medical Services,
and Lunic Adisson (niece) admitted that
from April, 1997 through December, 2000,
they improperly treated and referred patients
to the various Adisson-owned facilities.
As a result of those actions, Adisson
inflated claims for services and medical
supplies that were not prescribed by a
treating chiropractic physician and then
sought payment for those services and
supplies that were not provided to patients.
The investigation determined that $48,273
in fraudulent bills were submitted to
several insurance companies including
Zurich Insurance Group, Century Insurance
Company, New Jersey Manufacturers Insurance
Company, Progressive Insurance Company,
MDA Insurance Company, Liberty Mutual
Insurance Company, Keystone Insurance
Company, Prudential Insurance Company,
Clarendon Insurance Company, and State
Farm Insurance Company.
In pleading guilty to charges of Health
Care Claims Fraud and Criminal Use of
Runners as contained in the Accusation,
Adisson admitted that between February,
2000 and September, 2001, he and another
chiropractor (not named as a defendant)
submitted false auto insurance Personal
Injury Protection (PIP) claims to Parkway
Insurance. Adisson admitted that he employed
a “runner” to procure additional
patients in order to beef-up the submission
of insurance claims. In using a “runner”
and in recklessly using the other chiropractor’s
false treatment notes, Adisson was able
to increase the amount of claims submitted
to insurance companies. Additionally,
Adisson admitting that referrals for MRI
services came from an outside medical
chiropractor and that he paid a “runner”
$100 for each MRI scan and $300 for every
patient referred to his practice by the
outside chiropractor for treatment. Parkway
Insurance Company was billed $19,494 for
treatments never provided to patients.
Insurance Fraud Prosecutor Gooden-Brown
said that Lunic Adisson pleaded guilty
to an unrelated charge of simulating a
motor vehicle insurance identification
card contained in a June 27, 2003 Essex
County Grand Jury indictment. The indictment
charged that Adisson produced and supplied
a motor vehicle insurance identification
card to an Irvington, Essex County, police
officer in order to regain possession
of her impounded vehicle. The charge arose
from a separate investigation conducted
by the Office of the Insurance Fraud Prosecutor
regarding fake motor vehicle insurance
identification cards.
The Adissons are scheduled to be sentenced
by Judge Vichness on April 18. Second-degree
crimes carry sentences of up ten years
in state prison and a fine of up to $150,000,
while third degree crimes carry sentences
of up to five years in state prison and
a fine of up to $15,000. A fourth degree
crime carries a sentence of up to 18 months
in state prison and a fine of up to $10,000.
Additionally, Dr. Adisson and Lunic Adisson
could face civil insurance fraud fines
pursuant to the civil Insurance Fraud
Prevention Act. The guilty pleas involving
Dr. Adisson will be referred to the Board
of Medical Examiners which licenses medical
doctors in New Jersey.
State Investigators Anne Hayes and Anthony
Abarno, Civil Investigator Errol English,
and Deputy Attorneys General Lewis Korngut,
Richard Queen, and Andrew Fried were assigned
to the investigation. DAsG Korngut and
Fried represented the Division
of Criminal Justice - Office
of Insurance Fraud Prosecutor at the
guilty plea hearing. The Newark Police
Department assisted in the investigation.
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