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TRENTON
- Attorney General Anne Milgram and Criminal
Justice Director Deborah L. Gramiccioni
announced that a doctor who formerly practiced
in Cliffside Park has been indicted on charges
she fraudulently billed insurance companies.
According
to Insurance Fraud Prosecutor Greta Gooden
Brown, Nina D’Lugy, 63 - a doctor
formerly licensed in New Jersey who had
a medical practice known as Renaissance
Medical Cosmetology in Cliffside Park -
was charged with second-degree health care
claims fraud, third-degree theft by deception
and fourth-degree falsifying records. The
Passaic County grand jury indictment was
handed up in Superior Court on Aug. 11.
According
to Gramiccioni, the indictment alleges that
between January 6, 2000, and October 18,
2003, D’Lugy submitted claims for
health care services to several insurance
companies in which she represented that
she provided medical services to patients
on specific dates, when in fact the specified
services were not provided or were not provided
by her or any licensed individual, as required.
The indictment alleges that the claims were
submitted to Horizon Blue Cross Blue Shield,
Health Net Insurance Company, Oxford Insurance
Company, Cigna Insurance Company, and Aetna
Insurance Company. It is alleged that by
submitting false claims, D’Lugy falsely
obtained approximately $23,858. D’Lugy
failed to renew her medical license in New
Jersey in 2005.
Second-degree
crimes carry a maximum sentence of 10 years
in state prison and a criminal fine of $150,000,
while third-degree crimes carry a maximum
sentence of five years in prison and a fine
of $15,000. Fourth-degree crimes carry a
maximum sentence of 18 months in prison
and a fine of $10,000. D’Lugy may
also face civil insurance fraud fines.
The
indictment is merely an accusation and the
defendant is presumed innocent until proven
guilty.
D’Lugy
will be ordered to appear in Superior Court
in Passaic County at a later date to answer
the charges.
Detective
Janessa Jones, Civil Investigator Martin
Arasin and Deputy Attorney General Michael
V. Troso were assigned to the investigation
in this case. Troso presented the case to
the Passaic County grand jury.
The
Enforcement Bureau of the Professional Licensing
Boards routinely provides assistance to
the Office of the Insurance Fraud Prosecutor
in investigations involving professional
licensees.
“This
indictment demonstrates our resolve to prosecute
health care providers who think it’s
acceptable to cheat the system for their
own personal gain,” said Insurance
Fraud Prosecutor Greta Gooden Brown.
Prosecutor
Brown thanked Horizon Blue Cross Blue Shield,
Health Net Insurance Company, Oxford Insurance
Company, Cigna Insurance Company, and Aetna
Insurance Company for their assistance in
this matter.
Prosecutor
Brown noted that some important cases have
started with anonymous tips. People who
are concerned about insurance cheating and
have information about 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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