|TRENTON – Acting Attorney General John J. Hoffman and the Office of the Insurance Fraud Prosecutor (OIFP) announced that a licensed professional counselor who worked with children with autism was indicted today on more than 40 criminal counts related to her alleged submission of reimbursement claims to Medicaid for in-home counseling and therapy services she did not provide.
Stephanie Fleming, 38, of Lyndhurst, Bergen County, was named in a 43-count state grand jury indictment. The indictment charges multiple counts of second-degree health care claims fraud, third-degree Medicaid fraud, and fourth degree forgery. It also charges a single count of second-degree theft by deception because Fleming received actual Medicaid reimbursement totaling more than $9,000.
The indictment alleges that, between March 1, 2012 and July 1of this year, Fleming fraudulently submitted Medicaid documentation seeking reimbursement for full counseling and therapy “encounter” sessions with children that she either did not conduct at all, or that she began but failed to complete.
“Although any attempt to defraud government health care programs is unlawful and cannot be tolerated, it is particularly deplorable that this defendant allegedly billed for services provided to children with autism that she did not provide,” said Acting Attorney General John J. Hoffman. “This kind of callous program abuse costs us all.”
“Every dollar lost to alleged Medicaid fraud is one less dollar available to help some of the most vulnerable citizens of our state. We are committed to identifying this type of fraud and ensuring that those who engage in it are held accountable,” said Acting Insurance Fraud Prosecutor Ronald Chillemi.
According to an OIFP investigation, the conduct alleged in the indictment took place while Fleming was working for an in-home service and Medicaid provider in Morris County that provides eligible beneficiary families with therapy and counseling services in their homes.
The company’s client base is primarily youth with autism, and the objective of the in-home counseling and therapy sessions is to improve –or stabilize – the children’s level of functioning within the home, in school and in the community.
The indictment alleges that Fleming fraudulently billed for a total of 21 full counseling and therapy sessions that did not take place. The phantom sessions were ostensibly provided to a total of nine beneficiaries, and Fleming sought reimbursement for them in the total amount of $6,328.
The indictment also charges that Fleming fraudulently billed for 10 full counseling and therapy sessions that were actually partial sessions. The partial sessions were provided to a total of seven beneficiaries, and Fleming allegedly sought reimbursement for those in the total amount of $2,712.
The indictment’s theft by deception count goes to Fleming’s actual receipt of payment from New Jersey’s Medicaid program in the total amount of $9,045. In addition, the indictment charges Fleming with multiple counts of forgery for allegedly forging or falsifying the signatures of Medicaid beneficiary parents or guardians on treatment encounter forms required as part of Medicaid reimbursement documentation.
The charges announced today are merely accusations, and the defendant is presumed innocent until proven guilty in a court of law.
Each of the second-degree crimes charged in today’s indictment carry a sentence of five-to-10 years in state prison and a criminal fine of up to $150,000. Each of the third-degree crimes charged carries a sentence of not more than three years in state prison and a criminal fine of up to $25,000. Each of the fourth degree crimes charged in the indictment carry a sentence of not more than 18 months in state prison and a maximum criminal fine of $10,000.
Deputy Attorney General Peter Sepulveda presented the Fleming case to the grand jury. Detective Laura Parisi conducted the investigation.
Acting Insurance Fraud Prosecutor Chillemi noted that important cases have started with anonymous tips. People concerned about insurance cheating who have information about fraud can report it anonymously by calling the toll-free hotline at 1-877-55-FRAUD, or visiting the Web site at www.NJInsurancefraud.org. State regulations permit a reward to be paid to an eligible person who provides information that leads to an arrest, prosecution and conviction for insurance fraud.