TRENTON – Attorney General Jeffrey S. Chiesa announced that a Middlesex County woman has been indicted for allegedly stealing nearly $170,000 by falsifying invoices that she sent to an insurance company regarding out-of-pocket expenses she purportedly incurred for in-home healthcare services provided to her ailing husband.
Loreta Fontanilla, 72, of Piscataway, was charged on Friday (Dec. 14) with second-degree health care claims fraud, second-degree theft by deception, and six counts of fourth-degree falsifying records.
"This defendant is charged with lining her own pockets by padding invoices pertaining to her husband's in-home health care,” Acting Insurance Fraud Prosecutor Ronald Chillemi said. “Such callous greed steals funds meant for the care of other patients, and will not be tolerated by this office."
The state grand jury indictment alleges that between January 2005 and December 2010, Fontanilla submitted 71 falsified independent care provider monthly invoices to the MetLife Insurance Company (“MetLife”) for health care services purportedly provided to her husband. In particular, the indictment alleges that Fontanilla falsely claimed on these invoices that her husband had received between approximately 52 and 93 hours of health care services during each month and that Fontanilla paid the healthcare service providers $50 per hour.
The indictment further alleges that, by submitting these 71 falsified invoices, Fontanilla fraudulently claimed to MetLife that she incurred a total of $237,019 of reimbursable expenses paying for health care services for her husband. As a result of the submission of these allegedly-fraudulent invoices, MetLife paid Fontanilla a total of $169,000. An investigation by the Office of the Insurance Fraud Prosecutor revealed that in fact the nurses provided healthcare services to Fontanilla’s husband between 10 and 40 hours per month at a rate of $25 per hour, and that Fontanilla paid the nurses a total of approximately $27,000 during the time period that is the subject of the indictment.
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 up to $150,000 while fourth-degree crimes carry a maximum sentence of 18 months in state prison and a criminal fine of up to $10,000.
Deputy Attorney General T.J. Harker, Detective Wendy Berg and Analyst Kelly Celenza coordinated the investigation. Acting Insurance Fraud Prosecutor Chillemi thanked MetLife for referring the matter to the Office of the Insurance Fraud Prosecutor and for its assistance in the investigation.