|TRENTON – Acting Attorney General John Hoffman and the Office of Insurance Fraud Prosecutor today announced that a North Jersey doctor has been indicted for allegedly billing numerous insurance carriers for medical procedures he did not perform himself or that were not performed at all.
Gautam Sehgal, a neurologist with practices in Newark, Perth Amboy, Clifton, Elizabeth, South Orange and Paterson, was charged by a state grand jury with seven counts of health care claims fraud in the second degree for allegedly filing fraudulent bills to insurance carriers. The 52-year-old Livingston resident was also charged with one count of second-degree insurance fraud and one count of third-degree theft by deception in connection with the alleged fraudulent claims.
According to the Indictment handed up in Middlesex County Superior Court, Sehgal filed seven health care claims fraudulently stating he had performed a diagnostic procedure known as needle Electromyography (EMGs) on seven patients. In six of the cases an unlicensed technician, not Sehgal, performed the procedures. In the case of the seventh claim, no needle EMG was performed at all.
“The integrity of physicians is the lynchpin of the health care claims process,” said Acting Attorney General Hoffman. ”Doctors who file false claims undermine that system and drive up health care costs for honest participants.”
According to the indictment, Sehgal filed potentially fraudulent claims to nine carriers between July 2008 and October 2013. The health care claims indictments stem from seven claims submitted between February 2011 and October 2013 to: 21st Century Insurance Company, Travelers Insurance Company, Encompass Insurance Company, and Metropolitan Life Insurance Company. The theft by deception charges stem from the above claims and earlier claims submitted to: Allstate Insurance Company, Farmers Insurance Company, Progressive Insurance Company, AIG Insurance Company, and NJ Cure Insurance Company.
“The allegations against Dr. Sehgal, if proven, show an utter lack respect for his patients, his profession, and the law,” said Acting Insurance Fraud Prosecutor Iu. ”Our office will not tolerate any doctor who blatantly cheats the system to satisfy his own greed.”
Deputy Attorney General Dennis Kwasnik presented the case to the grand jury. Detective Amy Carson and Detective Jon Berman coordinated the investigation with assistance from National Insurance Crime Bureau, Travelers Insurance Company, 21st Century Insurance Company, Metropolitan Life Insurance Company, State Farm Insurance Company, Progressive Insurance Company, Farmers Insurance, NJCure Insurance Company, Encompass Insurance Company, and Allstate Insurance Company.
The indictment is merely an accusation and the defendants are presumed innocent until proven guilty. Second-degree crimes carry a sentence of five to 10 years in state prison and a criminal fine of up to $150,000; third-degree crimes carry a sentence of three to five years in state prison and a criminal fine of up to $15,000.
Acting Insurance Fraud Prosecutor Iu 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 at 1‑877‑55‑FRAUD, or visiting the Web site at 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.