TRENTON
- Attorney General Peter C. Harvey announced
that the Division of Criminal Justice
- Office of Insurance Fraud Prosecutor
has charged the operators of a Passaic
County medical practice with submitting
$34,000 in fraudulent billings to insurance
companies for medical services never provided
to patients.
"Insurance fraud is among our top
priorities," said Attorney General
Harvey. "We have dedicated significant
resources to investigating and prosecuting
insurance fraud - particularly insurance
fraud involving licensed medical professionals.
And, we're fighting insurance fraud on
three fronts: criminal prosecution, civil
sanctions and forfeiture of the licenses
of professionals who engage in insurance
fraud. We've used that triple threat to
make the Office of Insurance Fraud Prosecutor
one of the nation's foremost fraud fighting
agencies."
According to Vaughn L. McKoy, Director,
Division of Criminal Justice and Insurance
Fraud Prosecutor Greta Gooden Brown, Alphonso
Smith, 65, Westwood Drive, Woodbury, Gloucester
County, and Daniel Catanzaro, 44, Cartersville,
Georgia, were each charged via a State
Grand Jury indictment with one count of
Health Care Claims Fraud (2nd degree),
attempted theft by deception (3rd degree),
and theft by deception (3rd degree). If
convicted on all charges, the defendants
face up to 20 years in state prison and
a fine of up to $180,000. Additionally,
the defendants face possible civil insurance
fraud fines pursuant to the Insurance
Fraud Prevention Act. Smith and Catanzaro
will be ordered to appear in Passaic County
Superior Court for arraignment and bail.
Insurance Fraud Prosecutor Gooden Brown
noted that the State Grand Jury indictment
alleges that Smith, a licensed medical
doctor, and Catanzaro, a licensed chiropractor,
operated the Quality Care Physicians,
d/b/a Physicians Plus, medical practice
in Wayne, Passaic County. The investigation
determined that Smith founded the medical
practice and was the medical director
and sole shareholder, while Catanzaro
ran the facility on a day-to-day basis.
The indictment charges that from July,
1997 through March, 1999, Smith and Catanzaro
submitted more than $34,000 in fraudulent
and/or inflated bills to insurance companies.
It is charged that the fraudulent billings
sought reimbursement for more expensive
injected anesthesia when, in fact, the
services administered to patients were
less expensive non-invasive electrical
stimulation therapy. Smith and Catanzaro
submitted the fraudulent health and automobile
insurance claims to several insurance
companies, including Oxford Health Care,
New Jersey Manufacturers Insurance Company,
United Health Care, and Allstate Insurance
Company.
The investigation and audit conducted
by the Division of Criminal Justice -
Office of Insurance Fraud Prosecutor determined
that Smith and Catanzaro submitted at
least 92 fraudulent billings seeking more
than $36,000 in insurance reimbursements.
Both Smith and Catanzaro have been suspended
from the practice of medicine in New Jersey
by the Board of Medical Examiners.
State Investigator Robyn Greene, Civil
Investigator Janet Domino and Deputy Attorney
General Dennis J. Kwasnik were assigned
to the investigation. DAG Kwasnik represented
the Division of Criminal Justice - Office
of Insurance Fraud Prosecutor before the
State Grand Jury. The indictment was handed
up to Mercer County Superior Court Judge
Linda R. Feinberg, the Assignment Judge
in charge of the State Grand Jury, on
Dec. 17.
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.
