TRENTON – Attorney General Gurbir S. Grewal and the Office of the Insurance Fraud Prosecutor announced today that a Licensed Clinical Social Worker in Bergen County has been charged with second-degree health care claims fraud for allegedly billing the Medicaid program for mental health rehabilitation services never provided to at-risk children and adolescents under her professional care through a state-run program.
Gloria Andrade, 56, of Teaneck, was also charged with Medicaid fraud (3rd degree), theft by deception (3rd degree), and falsifying records (4th degree) in an indictment handed up by a state grand jury in Trenton on Monday.
Andrade, who was employed full-time as a social services specialist with the Township of Teaneck, allegedly submitted the fraudulent Medicaid claims while working a secondary job as a solo practitioner providing in-home counseling and therapy to children, adolescents, and their families in the NJ Department of Children and Families’ Intensive In-Community Services program (IICS).
“Licensed health care providers who commit Medicaid fraud are a disgrace to their professions,” said Attorney General Grewal. “They are not only stealing from the New Jersey taxpayers who fund the Medicaid program, they are depriving much-needed services to individuals and families who cannot afford health insurance.”
“Medicaid is a state and federal partnership to help the needy and we will not allow it to be raided by greedy criminals masquerading as health care providers,” said Acting Insurance Fraud Prosecutor Tracy M. Thompson. “As this indictment shows, we will vigorously investigate and prosecute any provider caught stealing from this vital funding source, as this defendant allegedly did.”
IICS providers must document services rendered on Service Delivery Encounter Documents forms. These forms document the day and time IICS providers performed the services and are attested by the recipient's parent or guardian.
Between 2012 and 2016 Andrade allegedly sought reimbursement from Medicaid for 49 IICS services never rendered.
Andrade allegedly billed, and was paid for, "conflict" claims for services that could not have been rendered because at the time of the purported services, Andrade was either working at her full-time job as Teaneck's Social Services Specialist, or because the minors she purportedly provided services to were in school.
Andrade also allegedly billed Medicaid for "overlap" services that could not have been rendered; claiming she provided IICS counseling on the same date, at the same time, to two or more beneficiaries at different locations.
Deputy Attorney General Fernando Maldonado presented the case to the Grand Jury. Detective Laura Parisi coordinated the investigation with assistance from Analyst Elizabeth O’Brien
Acting Insurance Fraud Prosecutor Thompson noted that some important cases have started with anonymous tips. People who are concerned about insurance cheating and have information about a 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.
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