TRENTON
- Division of Criminal Justice Director
Vaughn L. McKoy announced that a former
Bergen County certified public accountant
has been ordered to pay more than $433,000
after pleading guilty to Health Care Claims
Fraud for inflating and submitting fraudulent
insurance claims for medical services
that were never provided to patients.
According to Director McKoy and Insurance
Fraud Prosecutor Greta Gooden-Brown, Barry
Cohen, 51, Parkland, FL, was ordered by
Bergen County Superior Court Judge Joseph
Conte to pay $328,000 in restitution and
a $105,000 civil fine. In addition, Cohen
was sentenced to three years probation.
On March 7, Cohen pleaded guilty to Health
Care Claims Fraud, a charge which was
contained in a State Grand Jury indictment
filed by the Division of Criminal Justice
- Office of Insurance Fraud Prosecutor
on Sept. 8, 2004.
Insurance Fraud Prosecutor Gooden-Brown
noted that Cohen operated a family-owned
corporation known as Headways, Inc., formerly
located in Bergen County. Headways, which
ceased operations in November, 2000, provided
health care services and therapy to patients
suffering from brain injuries.
At the guilty plea hearing, Cohen admitted
that between Jan. 15, 1998 and April 30,
2001, he knowingly submitted dozens of
health care claims to insurance companies
and/or self-funded health benefit plans
for patient therapy and related treatments
by adding additional hours and/or dates
of therapy which were never provided.
An investigation by the Division of Criminal
Justice - Office of Insurance Fraud Prosecutor
determined that Cohen added more than
4,000 additional hours of services totaling
more than $350,000 to dozens of bills
submitted to the insurance companies for
reimbursement or payment.
The
insurance companies and health benefits
plans that received the false claims included
Allstate Insurance Company, Horizon Blue
Cross/Blue Shield of New Jersey, State
Farm Insurance Company, Proformance Mutual
Insurance Company, and Key Benefit Administrators,
a third party claims administration company
which administered health insurance for
the Teamsters Union Local 560 Benefit
Fund, as well as the New Jersey Automobile
Full Insurance Underwriting Association.
State Investigator Abraham Aquino, Civil
Investigator Douglas Graham, and Deputy
Attorneys General Nicholas Vasile were
assigned to the investigation. DAG Vasile
represented the Division of Criminal Justice
- Office of Insurance Fraud Prosecutor
at the sentencing on June 24. The case
was referred to the Office of Insurance
Fraud Prosecutor by Horizon Blue Cross/Blue
Shield of New Jersey.
“The
Division of Criminal Justice - Office
of Insurance Fraud Prosecutor is committed
to protecting New Jersey’s citizens
from unscrupulous acts by combating insurance
fraud in whatever form it takes,”
said Insurance Fraud Prosecutor Greta
Gooden-Brown. “When health care
providers commit fraud it is particularly
disturbing, because the integrity of the
health care insurance claims process depends
on the trustworthiness of the licensed
professionals involved. As it has in the
past, the Office of the Insurance Fraud
Prosecutor will vigorously investigate
and prosecute this type of criminal activity.”
Noting that some important cases have
begun with anonymous tips from the public,
Prosecutor Brown emphasized that individuals
can make a difference. “We need
people’s information, not their
identities. People who are concerned about
insurance cheating and have any information
about a fraud can call our toll-free hotline
at 1-877-55-FRAUD, or
visit our Web site at www.NJInsurancefraud.org
.”
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