TRENTON
- Attorney General Anne Milgram and Criminal
Justice Director Deborah L. Gramiccioni announced
that a Clifton chiropractor was indicted today
for improperly billing insurance companies
more than $230,000 for tests he did not personally
perform.
According to Insurance Fraud
Prosecutor Greta Gooden Brown, Sean Nisivoccia,
38, of Clifton, was charged with attempted
theft by deception, theft by deception, and
four counts of health care claims fraud, all
second-degree offenses.
The Essex County grand jury indictment alleges
that between April 2000 and June 2004, Nisivoccia,
whose chiropractic license has been suspended,
fraudulently billed several insurance companies
more than $230,000 by creating the false impression
that he personally performed nerve conduction
studies or nerve conduction velocity (NCV)
tests on his patients and that he was qualified
to perform such tests, when, in fact, he did
not personally perform such tests, nor was
he qualified to perform them. The indictment
alleges that Nisivoccia fraudulently received
$125,000 from the insurance companies for
the NCV tests.
Nisivoccia allegedly submitted
the fraudulent claims to New Jersey Manufacturers
Insurance Company and its affiliate New Jersey
Re-Insurance Company, as well as Liberty Mutual
Insurance Company, Ohio Casualty Group, First
Trenton Insurance Company, National Continental
Insurance Company, Metropolitan Insurance
Company and Allstate New Jersey Insurance
Company.
This case was referred to
OIFP by the Special Investigative Unit of
New Jersey Re-Insurance Company, which initially
uncovered the fraud and assisted OIFP in the
investigation. Insurance Fraud Prosecutor
Brown thanked New Jersey Manufacturers and
New Jersey Re-Insurance for their assistance
in this matter.
In August 2008, the New Jersey
Board of Chiropractic Examiners suspended
Nisivoccia’s chiropractic license for
five years. The suspension was based on civil
fraud litigation by insurance carriers and
on Nisivoccia’s guilty plea to a criminal
charge in Massachusetts.
Detectives Scott M. Stevens and Abraham Aquino,
Supervising Civil Investigator Joseph Dugan,
Civil Investigator Carol Seekamp and Deputy
Attorney General Dennis Kwasnik were assigned
to the investigation. Kwasnik presented the
case to the grand jury. Special Assistant
Annie Meredith and Analysts Terri Drumm and
Terri Worthington assisted in the investigation.
“When licensed 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,” said Fraud Prosecutor Brown.
The indictment is merely an
accusation and the defendant is presumed innocent
until proven guilty. Second-degree crimes
carry a maximum sentence of 10 years in state
prison and a criminal fine of $150,000. Nisivoccia
also may face civil insurance fraud fines.
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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