TRENTON - Attorney General
Paula T. Dow and Criminal Justice Director
Stephen J. Taylor announced that the medical
director of a defunct Mercer County mental
health clinic was sentenced today to state
prison for his role in a conspiracy to fraudulently
over-bill the Medicaid and Medicare programs
close to $50,000.
According to Acting Insurance
Fraud Prosecutor Riza Dagli, Arnold Jacques,
61, of Jackson, the former medical director
of the now-defunct Chambers Mental Health
Clinic LLC, a mental health counseling center
in Trenton, was sentenced to three years
in state prison and ordered to pay a total
of $49,941 restitution to the Medicaid and
Medicare programs by Superior Court Judge
Edward M. Neafsey in Mercer County. Jacques’
sentence was based on his Sept. 8 guilty
plea to second-degree conspiracy, second-degree
health care claims fraud, and third-degree
Medicaid fraud. The charges were contained
in a state grand jury indictment returned
on Nov. 13, 2007.
In pleading guilty, Jacques,
a medical doctor who practices as a psychiatrist,
admitted that between January 2004 and November
2005, he conspired with the two co-owners
of Chambers Mental Health Clinic to fraudulently
over-bill the Medicaid and Medicare programs.
Jacques and his co-defendants,
Pedro Acosta, 65, of Queens, N.Y., and Osvaldo
Morales Sr., 62, of Bronx, N.Y., caused
Medicaid and Medicare claims to be billed
under Jacques’ Medicaid and Medicare
provider numbers even though he did not
personally provide the counseling services
billed. In addition, among other things,
the defendants billed Medicaid and Medicare
for longer counseling sessions than those
that were actually provided, billed for
family counseling in addition to individual
sessions for the same patient in the same
day, and billed for counseling services
that were not rendered at all. Medicaid
pays a higher rate for longer counseling
sessions and for counseling services provided
by a specialist medical doctor as opposed
to counselors with lesser licenses. The
defendants thereby fraudulently billed the
Medicaid and Medicare programs for close
to $50,000 to which they were not entitled.
Acosta and Morales previously
pleaded guilty for their roles in the scheme.
Acosta pleaded guilty to second-degree health
care claims fraud and Morales pleaded guilty
to third-degree Medicaid fraud. Both defendants
are awaiting sentencing.
Detectives Joseph Jaruszewski and Kevin
Gannon and former Deputy Attorney General
Sherry L. Wilson were assigned to the investigation.
Deputy Attorney General Erik Daab represented
the Office of the Insurance Fraud Prosecutor
at the sentencing.