TRENTON
- Attorney General Peter C. Harvey announced
that a Hudson County businessman has been
sentenced to nine years in State Prison
for submitting more than 400 fraudulent
health insurance claims totaling more
than $300,000 in illegal payments.
According to Vaughn L. McKoy, Director,
Division of Criminal Justice and Insurance
Fraud Prosecutor Greta Gooden-Brown, James
Clark, 49, Mountain Road, Union City,
Hudson County, was sentenced by Essex
County Superior Court Judge Michael A.
Petrolle to nine years in State Prison
and ordered to pay a $5,000 fine. Clark
was sentenced on April 1 after being found
guilty on charges of theft by deception
and Health Care Claims Fraud after aFeb.
10 jury trial.
Insurance Fraud Prosecutor Gooden-Brown
said that the Essex County jury found
that between Dec. 1, 1996 and Sept. 11,
1998, Clark, as president of Home Health
Care Center, Inc., located on First Street,
Hoboken, Hudson County, misrepresented
to Horizon Blue Cross/Blue Shield (which
administers health care claims for the
State Health Benefits Program) that Home
Health Care was licensed to supply, dispense,
and sell prescription medications which
were delivered to patients and was entitled
to payment or reimbursement from the State
Health Benefits Plans for the cost of
the medications. Home Health Care Center
was in business to deliver prescription
medications from pharmacies to person’s
homes and was not licensed to dispense
or otherwise sell prescription medications.
Clark was neither a medical service provider
nor a licensed pharmacist.
An investigation by the Office of Insurance
Fraud Prosecutor determined that Clark
submitted more than 400 fraudulent insurance
claims for various medications -- approximately
330 of which may have been for medications
that were never dispensed and never delivered
to patients. The total amount of the fraudulent
billings submitted by Clark to the State
Health Benefits Program was in excess
of $365,000, of which more than $343,000
was paid.
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 cases. State
Investigators David Hiestand and Natalie
Brotherston and Deputy Attorneys General
Steven B. Farman and Joan Burke were assigned
to the investigation. The case was referred
by Horizon Blue Cross/Blue Shield to the
Office of the Insurance Fraud Prosecutor
for investigation.
“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.”
www.NJInsuranceFraud.org
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