TRENTON
- Vaughn L. McKoy, Director, Division
of Criminal Justice, announced that an
Essex County man has pleaded guilty for
his role in a $1.2 million conspiracy
to commit Health Care Claims Fraud and
theft by deception as part of a broad-based
chiropractic and automobile insurance
fraud scheme.
According to Insurance Fraud Prosecutor
Greta Gooden-Brown, Carl Love, Jr., 47,
Northfield Avenue, West Orange, Essex
County, pleaded guilty before Essex County
Superior Court Judge Paul J. Vichness
to third degree conspiracy and fourth
degree possession of a weapon by a convicted
felon. A third degree crime carries a
sentence of up to five years in state
prison and a fine of up to $15,000, while
a fourth degree crime is punishable by
up to 18 months in state prison and a
fine of up to $10,000. Love may also face
civil insurance fraud fines pursuant to
the civil Insurance Fraud Prevention Act.
Love is scheduled to appear before Judge
Vichness on April 25 for sentencing.
Insurance Fraud Prosecutor Gooden-Brown
noted that Love, along with four other
defendants, was charged via a State Grand
Jury indictment returned on Nov. 17, 2003.
The indictment alleged that the defendants
devised an insurance fraud scam geared
to steer patients to a chiropractic business
operated by Dr. Lisa Tsilionis, 42, and
her former husband, Dr. George Tsilionis,
44, formerly of South Woodside Avenue,
Bergenfield, Bergen County. The indictment
charged the Tsilionis’ with conspiracy,
Health Care Claims Fraud, theft by deception,
financial facilitation of criminal activity
(money laundering), and misconduct by
a corporate official. Also charged was
Rudolph Hora, 37, South Orange Avenue,
Newark, and/or North 17th Street in East
Orange. Hora was charged with aiding in
the conspiracy.
The indictment alleged that between Feb.
9, 1996 and March 31, 1999, Love, the
president and owner/operator of two corporations
doing business as the Love Courier, Inc.
and Essex Shuttle, Inc., used the transportation
company’s to funnel patients to
the Tsilionis’ chiropractic office
(Allied Trauma) located in East Orange.
In so doing, it is alleged that the Tsilionis’
increased the number of patients and the
amount of PIP claims submitted to insurance
companies for payment of various medical,
diagnostic, and chiropractic treatments.
Based in part on Love’s assistance
in directing patients to Allied Trauma,
it is charged that the Tsilionis’
fraudulently billed 30 different insurance
companies more than $1.2 million in PIP
claims. The claims sought payment for
chiropractic services and electric diagnostic
tests known as Somatosensory Evoked Potentials
(SSEP) - chiropractic procedures that
are frequently used to diagnose injuries
in connection with automobile accidents.
It is alleged that the insurance companies
paid more than $435,000 on the claims
submitted by the Tsilionis’ and
Allied Trauma.
In pleading guilty, Love admitted that
he was paid by Dr. George Tsilionis and
Dr. Lisa Tsilionis to direct patients
to Allied Trauma for treatment so that
the false PIP claims could be submitted
to the various automobile insurance companies
-- in essence, Love admitted being a runner
for Allied Trauma. Love’s corporations
ceased operation following the execution
of search warrants by investigators assigned
to the Office of the Insurance Fraud Prosecutor.
Additionally, Love’s corporate bank
accounts were frozen and forfeited to
the State. A lien was also filed on Love’s
West Orang home. Love subsequently filed
for bankruptcy.
The investigation was conducted by the
Division
of Criminal Justice - Office
of the Insurance Fraud Prosecutor
which investigates and prosecutes civil
and criminal insurance fraud crime. State
Investigator Kristen Marcus, Special State
Investigator Jeremy Rabe, Civil Investigator
Julia Ferreira, and Deputy Attorney General
Steven B. Farman were assigned to the
investigation.
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