TRENTON
- Attorney General Peter C. Harvey announced
that program director and administrator
of a Camden County outpatient mental health
clinic have been ordered to perform community
service for inflating more than $13,000
worth of patient billings submitted to
the Medicaid Program. The Medicaid Program
is funded by the state and federal governments
and provides health care services and
prescription drugs to persons who may
not otherwise be able to afford such services
and medicines.
According to Vaughn L. McKoy, Director,
Division of Criminal Justice and Insurance
Fraud Prosecutor Greta Gooden-Brown, Patrick
Traynor, 61, Woodland Road, Abington,
PA and Maria Carmen Cruz, 39, Red Lion
Road, Phila., PA, were each sentenced
by Camden County Superior Court Judge
Irvin J. Snyder to three years probation
and ordered to perform 150 hours of community
service. Additionally, Judge Snyder barred
Traynor and Cruz from participating in
the Medicaid Program for five years.
Insurance Fraud Prosecutor Gooden Brown
noted that Traynor, the Program Director
of the New Hopes of New Jersey mental
health clinic located at 328 Market St.,
Camden, and Cruz, employed as the clinic
administrator, were indicted by a State
Grand Jury on March 13 on charges of Medicaid
Fraud. Both Traynor and Cruz pleaded guilty
to the Medicaid Fraud charges. In pleading
guilty, Traynor admitted that from March
through June, 1999, at the direction of
the owners of New Hopes, he prepared fraudulent
patient progress notes for counseling
sessions which never occurred. At her
guilty plea hearing, Cruz admitted that
from May through October, 1999, to submitting
more than $13,000 in fraudulent invoices
to the Medicaid Program for payment for
mental health counseling and psychological
services which were never provided.
Cruz also admitted that she prepared and
filed false billings with Medicaid for
mental health counseling services purportedly
provided to family members during group
sessions. In fact, no such sessions were
provided as family members were treated
in single sessions. Additionally, Medicaid
regulations prohibit billing for multiple
family members. Cruz also billed for mental
health counseling sessions rendered to
children when no such services were provided.
The investigation was conducted by the
Division of Criminal Justice - Office
of Insurance Fraud Prosecutor's Medicaid
Fraud Section. State Investigator Joseph
Jaruszewski and Deputy Attorneys General
Joie Piderit and William Hoyman coordinated
the investigation. DAG Hoyman represented
the Division of Criminal Justice - Office
of Insurance Fraud Prosecutor at the sentencing.
"The
Medicaid Program is funded through tax
dollars and is in place to provide health
care and related services to persons who
may not otherwise have access to such
services," Insurance Fraud Prosecutor
Gooden Brown said. "When service
providers steal from the Medicaid Program,
they are stealing from each and every
New Jersey taxpayer and denying badly
needed health care services to those who
are least able to afford them. The Office
of Insurance Fraud Prosecutor will continue
to investigate and prosecute these cases."
Insurance Fraud Prosecutor Gooden Brown
noted that the Office of Insurance Fraud
Prosecutor realized a 143 percent increase
in indictments; a 91 percent increase
in defendants charged; a 79 percent increase
in convictions (trial convictions and
guilty pleas); and a 80 percent increase
in civil sanctions in 2002. The Office
of Insurance Fraud Prosecutor charged
225 defendants in 2002, versus 118 defendants
in 2001. Additionally, the Office of Insurance
Fraud Prosecutor imposed sanctions in
3,723 civil fraud cases in 2002, compared
to 2,063 civil sanctions obtained in 2001.
The Office of Insurance Fraud Prosecutor
collected $20.6 million in penalties in
2002, up from $15.8 million in 2001.
Noting that some important cases have
begun with anonymous tips from the public,
Insurance Fraud Prosecutor Gooden Brown
encouraged anyone with information about
insurance fraud to contact the Division
of Criminal Justice - Office of Insurance
Fraud Prosecutor's toll-free hotline at
1-877-55-FRAUD, or to visit the insurance
fraud web site at www.NJInsurancefraud.org
.
Housed in the Department of Law and Public
Safety's Division of Criminal Justice
and reporting to the Attorney General,
the Office of the Insurance Fraud Prosecutor
was established by the Automobile Insurance
Cost Reduction Act of 1998 (AICRA). The
Office is the centralized state agency
that investigates and prosecutes civil
and criminal insurance fraud, as well
as Medicaid fraud. Criminal convictions
for insurance fraud can result in fines
and imprisonment. Civil penalties can
include substantial fines and referral
for revocation or suspension of professional
licenses.
