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TRENTON
- Attorney General Anne Milgram and Criminal
Justice Director Gregory A. Paw announced
today that two owners and the medical director
of a Trenton mental health clinic were indicted
today for their roles in a conspiracy to
fraudulently over-bill the Medicaid and
Medicare programs by more than $160,000.
According
to Insurance Fraud Prosecutor Greta Gooden
Brown, a state grand jury has indicted two
owners of the now-defunct Chambers Mental
Health Clinic LLC, Pedro Acosta, 62, of
Queens, N.Y., and Osvaldo Morales Sr., 59,
of Bronx, N.Y., as well as Chambers’
former medical director, Dr. Arnold Jacques,
58, of Jackson, a medical doctor who practices
as a psychiatrist. All three men were charged
in the indictment with second-degree conspiracy,
second-degree health care claims fraud,
and third-degree Medicaid fraud.
The
indictment alleges that between January
2004 and November 2005, Acosta, Morales
and Jacques, who operated a drug and alcohol
counseling center in Trenton known as Chambers
Mental Health Clinic, fraudulently over-billed
the Medicaid and Medicare programs.
The
indictment alleges that the defendants caused
Medicaid and Medicare claims to be billed
under Dr. Jacques’ Medicaid and Medicare
provider numbers even though he did not
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 medical doctor as
opposed to counselors with lesser licenses.
It is alleged that the defendants thereby
fraudulently billed the Medicaid program
for more than $160,000 to which they were
not entitled.
As
part of the ongoing investigation, another
co-owner of the company, Bernardo Estambul,
58, of New York City, pleaded guilty on
Oct. 18 before Superior Court Judge Maryann
K. Bielamowicz to a criminal accusation
which charged him with third-degree Medicaid
Fraud.
State
Investigators Joseph Jaruszewski and Kevin
Gannon and Deputy Attorney General Sherry
L. Wilson of the Office of Insurance Fraud
Prosecutor’s Medicaid Fraud Control
Unit were assigned to the investigation.
Wilson presented the case to the grand jury.
“Abuse
of the Medicaid program and insurance fraud
by persons who hold professional licenses
are particularly disturbing crimes,”
said Insurance Fraud Prosecutor Brown. “Not
only do such Medicaid fraud schemes involve
theft of tax dollars, they also represent
a theft from a program designed to assist
persons who cannot afford health insurance
or health care services. Such cases are
a priority for the Office of Insurance Fraud
Prosecutor.”
The
indictment is merely an accusation and the
defendants are presumed innocent until proven
guilty. Under state law, crimes of the second
degree carry a maximum punishment of 10
years in state prison and a criminal fine
of $150,000, while the crime of third degree
Medicaid fraud carries a maximum punishment
of three years in state prison and a criminal
fine of $10,000.
The
Medicaid program, which is funded by the
state and federal governments, provides
health care services and prescription drugs
to persons who may not otherwise be able
to afford such services and medicines.
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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