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TRENTON
- Attorney General Anne Milgram and Acting
Criminal Justice Director Deborah Gramiccioni
announced that a co-owner of a defunct Mercer
County mental health clinic was sentenced
today for his role in a conspiracy to fraudulently
bill the Medicaid program $160,000.
According
to Insurance Fraud Prosecutor Greta Gooden
Brown, Bernardo Estambul, 58, of New York,
N.Y., was ordered by Superior Court Judge
Darlene Pereksta in Mercer County to serve
three years probation and to pay $10,044
in fines and restitution. Estambul was also
debarred from participation in the Medicaid
program for five years. Estambul was sentenced
pursuant to his Oct. 18, 2007 guilty plea
to a criminal accusation which charged him
with third-degree Medicaid fraud.
At
his guilty plea hearing before Superior
Court Judge Maryann K. Bielamowicz in Mercer
County, Estambul, part-owner of Chambers
Mental Health Clinic, LLC, admitted that
between January and September 2004, he,
along with his co-defendants – Pedro
Acosta, of Queens, N.Y., and Osvaldo Morales,
Sr., 59, of Bronx, N.Y. – submitted
fraudulent claims to Medicaid using the
provider number of the clinic’s doctor,
Arnold Jaques, 58, of Jackson, knowing that
the doctor did not provide the counseling
services.
Estambul
admitted that he knew that clinic counselors
were providing the services, but submitted
claims to Medicaid as if the doctor was
performing the services, knowing that Medicaid
would pay a higher rate for the doctor’s
services than for the counselors’
services. Estambul also admitted that he
and his co-owners submitted claims to Medicaid
for counseling sessions, knowing that they
did not provide counseling for the minimum
amount of time required by the Medicaid
regulations.
As
part of the investigation, Acosta, Morales
and Jacques were indicted on Nov. 13 for
their roles in the alleged fraud. Acosta
pleaded guilty on May 2 before Judge Pereksta
to second-degree health care claims fraud.
Morales and Jacques’ cases are all
still pending. The charges against them
are merely accusations and they are presumed
innocent until proven guilty.
Detectives
Joseph Jaruszewski and Kevin Gannon, and
Deputy Attorney General Sherry L. Wilson
coordinated the investigation. Wilson represented
the state at the sentencing.
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