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TRENTON
- Attorney General Paula T. Dow and Criminal
Justice Director Stephen J. Taylor, announced
that a Middlesex County dentist pleaded
guilty today to defrauding the Medicaid
program of almost $85,000.
According
to Acting Insurance Fraud Prosecutor Riza
Dagli, Larry Berman, 56, of Edison, a licensed
dentist employed by New Jersey Mobile Dentist
P.A. of Colts Neck, pleaded guilty to an
accusation charging him with third-degree
conspiracy to commit Medicaid fraud before
Superior Court Judge Francis J. Vernoia
in Monmouth County. The accusation was filed
by the Office of the Insurance Fraud Prosecutor=s
Medicaid Fraud Control Unit, which investigates
and prosecutes both civil and criminal Medicaid
fraud related cases.
Berman
admitted that between January 1, 2006, and
March 10, 2009, as a Medicaid provider,
he willfully received medical assistance
payments to which he was not entitled. The
payments related to fraudulent bills submitted
to Medicaid for dental services for beneficiaries
at various nursing homes and assisted living
facilities that he did not provide or that
were not medically necessary. The investigation
revealed that as a result of the alleged
fraudulent billing, Medicaid paid New Jersey
Mobile Dentist, which had used Dr. Berman=s
Medicaid provider number, over $280,000
to which it was not entitled. New Jersey
Mobile Dentist contracts with individual
dentists to provide Amobile@ dental services
in such facilities throughout New Jersey.
Under
the plea agreement, the state will recommend
that Berman be sentenced to up to 364 days
in county jail as a condition of a term
of probation. Berman must pay the state
a total of $169,164, including $84,582 in
restitution for amounts he received from
New Jersey Mobile Dentist in connection
with the fraudulent billing and an equal
civil penalty of $84,582. Those payments
will be made through the Office of the State
Comptroller, Medicaid Fraud Division, which
commenced operations in 2009 to investigate
fraud, waste and abuse in the Medicaid program.
Deputy
Attorney General Debra A. Conrad represented
the Office of Insurance Fraud Prosecutor
at the guilty plea hearing. Sgt. Kathleen
Casey, Auditor Kim Geis and Deputy Attorney
General Conrad are assigned to the ongoing
investigation.
Judge
Vernoia scheduled sentencing for Berman
for Dec. 10. This matter will be referred
to the Division of Consumer Affairs, which
may result in legal action against his professional
license.
Five
other dentists associated with New Jersey
Mobile Dentist have previously pleaded guilty
in this investigation:
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Joshua Prensky of Fair Lawn;
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Christopher Lillo of Toms River;
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Anna Pavda-German of Secaucus;
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Marc Wertheim of Moonachie; and
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Subina Anand of Plainsboro.
AThese
dentists exploited a vulnerable population,
namely elderly and disabled patients. Medical
professionals are given a tremendous amount
of trust, and we will continue to aggressively
prosecute those who take advantage of that
trust,@ said Acting Insurance Fraud Prosecutor
Dagli.
On
Aug. 25, 2009, Wertheim, 45, pleaded guilty
to third-degree Medicaid fraud. He admitted
that between January 1, 2003, and March
10, 2009, as a Medicaid provider, he willfully
received medical assistance payments to
which he was not entitled. The investigation
revealed that as a result of the allegedly
fraudulent billing, Medicaid paid New Jersey
Mobile Dentist, which had used Dr. Wertheim=s
Medicaid provider number, over $280,000
to which it was not entitled. Wertheim is
awaiting sentencing. Under the plea agreement,
the state will recommend that he be sentenced
to 364 days in county jail as a condition
of a term of probation. He must pay $225,715
to the state, representing the share of
the fraudulent Medicaid billings he received
from New Jersey Mobile Dentist plus a civil
penalty.
On
Jan. 19, 2010, Anand pleaded guilty to third-degree
Medicaid fraud. She admitted that between
January 1, 2003, and March 10, 2009, as
a Medicaid provider, she willfully received
medical assistance payments to which she
was not entitled. The investigation revealed
that as a result of the allegedly fraudulent
billing, Medicaid paid New Jersey Mobile
Dentist, which had used Dr. Anand=s Medicaid
provider number, over $850,000 to which
it was not entitled. Anand is awaiting sentencing.
Under the plea agreement, the state will
also recommend that she be sentenced to
364 days in county jail as a condition of
a term of probation. She must pay $415,201
to the state, representing the share of
the fraudulent Medicaid billings she received
from New Jersey Mobile Dentist plus a civil
penalty.
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 them. The State of New Jersey
administers the Medicaid Program through
the Division of Medical Assistance and Health
Services and through the Office of the Insurance
Fraud Prosecutor=s Medicaid Fraud Control
Unit.
Acting
Insurance Fraud Prosecutor Dagli noted that
people can report Medicaid fraud and insurance
fraud anonymously by calling the toll-free
hotline 1-877-55-FRAUD
or visiting www.NJInsurancefraud.org
. State regulations permit a reward to be
paid to an eligible person who provides
information that leads to an arrest, prosecution
and conviction for insurance fraud.
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