TRENTON - Attorney General Anne Milgram and Division of Criminal Justice Director Gregory A. Paw announced that five people, including three members of a Union County family, have been indicted for allegedly participating in a health insurance fraud conspiracy.
According to Insurance Fraud Prosecutor Greta Gooden Brown, John D. Dent, 53, of Clark; his wife, Graciela M. Dent, 33, of Clark; his brother, Steven W. Dent, 49, of Scotch Plains; and Bernard S. Francis, 40, of Eatontown were each charged in an indictment returned Friday with second-degree conspiracy, second-degree insurance fraud, third-degree theft by deception and fourth degree-falsifying records.
In addition, Olubuyiso M. Okunola, 46, of Maplewood, was charged with second-degree conspiracy, third-degree insurance fraud, fourth-degree attempted theft by deception and fourth degree falsifying records.
The Union County grand jury indictment alleges that between October 2003 and April 2005, John Dent, owner and operator of Parking Productions, located in Clark, filed an application for a small employer health benefits policy and enrolled his four co-defendants as employees. According to the indictment, Graciela Dent, Steven Dent, Francis and Okunola agreed to falsely represent that they were employees of Parking Productions when they were not employees and were not entitled to small employer group health insurance.
Small employer group health insurance is available if the employer and the employees meet certain conditions established by health insurance companies, including being bona fide employees who actually work for the employer for a set number of hours per week.
It is charged that the five defendants falsified various records, including employee applications and small employer benefits enrollment forms, and submitted them to Horizon Blue Cross/Blue Shield of New Jersey to secure health insurance coverage.
The indictment alleges that, as a result of the fraud, Horizon Blue Cross/Blue Shield paid health insurance claims for John and Graciela Dent in the approximate amount of $5,346; for Steven Dent in the approximate amount of $1,935; for Francis in the approximate amount of $1,275; and for Okunola in the approximate amount of $175.
State Investigator Thomas Ference, Civil Investigator Dana Basile and Deputy Attorney General Cheryl A. Maccaroni were assigned to the investigation. Maccaroni presented the case to the Union County grand jury.
“We frequently receive information about individuals falsifying underwriting information for small employer sponsored group health insurance,” said Insurance Fraud Prosecutor Brown. “Typically information is falsified to include persons in such insurance groups who should not be included because they don’t work for the business or have left the business. Such conduct can constitute the serious crimes of theft and insurance fraud.”
This case was referred to OIFP by Horizon Blue Cross/Blue Shield, which initially uncovered the fraud and assisted OIFP in the investigation. Insurance Fraud Prosecutor Brown thanks Horizon for its assistance in this matter.
The indictments are merely accusations and the defendants are presumed innocent until proven guilty.
Second-degree crimes carry a maximum punishment of 10 years in state prison and a fine of $150,000, while third-degree crimes carry a maximum punishment of five years in state prison and a fine of $15,000. Fourth-degree crimes carry a punishment of up to 18 months in state prison and a fine of up to $10,000. The defendants also could 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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