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TRENTON
- Attorney General Anne Milgram and Criminal
Justice Director Gregory A. Paw announced
that a Mercer County neurologist has been
sentenced for conspiring to fraudulently
bill 13 insurance companies more than $470,000.
According
to Insurance Fraud Prosecutor Greta Gooden
Brown, Dr. Alan E. Ottenstein, 52, of Washington
Crossing, Pa., was ordered yesterday by
Superior Court Judge Mitchel E. Ostrer in
Mercer County to serve five years probation,
conditioned on successful completion of
an in-patient treatment in a Mentally Impaired
Chemical Abuse program. Ottenstein was also
ordered to pay $500,000 in restitution and
fines.
The
sentence was pursuant to Ottenstein’s
Feb. 11 guilty plea to conspiracy to commit
theft by deception. Ottenstein’s corporation,
Lawrenceville Neurology Associates, P.A.,
which had offices on Princeton Pike in Lawrenceville,
pleaded guilty to conspiracy. The Corporate
charter of Lawrenceville Neurology was order
dissolved as the sentence for the plea by
the corporation. The guilty pleas stem from
a state grand jury indictment obtained by
the Office of Insurance Fraud Prosecutor
in December 2005.
In
pleading guilty before Judge Ostrer, Ottenstein
admitted that he falsely billed insurance
companies in several ways. Ottenstein admitted
that he billed for certain treatments for
back injuries as surgical procedures when,
in fact, non-surgical, mechanical traction
procedures were used. In addition, he admitted
that he billed for medical supplies that
were not used, and that he wrongfully billed
for an additional “facility fee”
for epidural injections when regulations
prohibited billing such fees.
Among
the insurance companies falsely billed by
Ottenstein were Aetna, AmeriHealth, Health
Net, Horizon Blue Cross Blue Shield, MetLife,
New Jersey Manufacturers, The Oxford Plan,
State Farm and Zurich Insurance. Based on
the Office of Insurance Fraud Prosecutor’s
investigation, Ottenstein wrongfully billed
approximately $477,000 to these companies.
Ottenstein’s
former office administrator, Jean Woolman,
58, of Morrisville, Pa., also pleaded guilty
on Feb. 11 to conspiracy to commit theft
by deception. On March 10, 2008, Woolman
was admitted into the Pre trial Intervention
(PTI) Program conditioned upon her payment
of a $10,000 civil fine.
The
investigation was coordinated by the Division
of Criminal Justice - Office of Insurance
Fraud Prosecutor, which investigates and
prosecutes both civil and criminal insurance
fraud cases. State Investigators Allan Buecker
and Scott Naismyth, Civil Investigators
Donna Augustyniak and Craig Leschner, Analysts
Terri Drumm and Terri Worthington, and Deputy
Attorney General Steven Farman were assigned
to the investigation. Additional investigative
assistance was provided by New Jersey Manufacturers
Insurance Company and Special Agent John
Vella of the U.S. Department of Health and
Human Services.
“When
health care providers commit fraud, it is
particularly disturbing, because the integrity
of the health insurance claims process depends
on the trustworthiness of the licensed professionals
involved,” said Insurance Fraud Prosecutor
Brown. “I would like to thank New
Jersey Manufacturers Insurance Company for
its invaluable assistance, as well as the
other insurance companies that initiated
civil proceedings in this case and assisted
in the criminal investigation.”
Prosecutor
Brown 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 1-877-55-FRAUD or visiting the Web
site www.njinsurancefraud.org.
State regulations permit an award to be
paid to an eligible person who provides
information that leads to an arrest, prosecution
and conviction for insurance fraud.
The
Office of Insurance Fraud Prosecutor was
established by the Automobile Insurance
Cost Reduction Act of 1998. The office is
the centralized state agency that investigates
and prosecutes both civil and criminal insurance
fraud, as well as Medicaid fraud.
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