Insurance Fraud NEWS
Florida man assumes ID of New Jersey doc, makes $1M of claims
July 11, 2018, Hudson County, FL
Attorney General Gurbir S. Grewal and the Office of the Insurance Fraud Prosecutor announced that a Florida man was charged today with assuming the identity of a New Jersey doctor to submit more than $1 million in fraudulent medical claims for medical services purportedly rendered at a Morris County medical center that, in reality, did not exist.
Yoandi Marrero, 33, of Hialeah, Florida, and PA Clinical Center, Inc., the registered company he allegedly used to front the phantom medical practice, were charged with insurance fraud and attempted theft by deception (2nd degree); theft by deception (3rd degree); and identity theft (4th degree) in an indictment handed up by a state Grand Jury in Trenton today. Marrero was also charged with fourth degree identity theft in the alleged scheme.
Marrero allegedly used the personal information of a Hudson County family physician to submit fraudulent insurance claims to United Healthcare Insurance Company (“United Healthcare”) for a variety of physical therapy and medical services - including x-rays, ultrasound therapy, and electrical stimulation - purportedly provided to more than a dozen patients at PA Clinical Center located in medical suite on Bloomfield Avenue in Denville.
According to prosecutors, neither the doctor, nor the patients who allegedly received the treatments had ever been to the PA Clinical Center; and they had no idea how Marrero got their personal information. In reality, the address listed for PA Clinical Center is the site of an unoccupied storage unit.
“Insurance fraud is a reprehensible crime but it’s even worse when criminals cloak themselves in the identities of unsuspecting, law-abiding citizens to commit their illegal acts, as this defendant allegedly did,” said Attorney General Grewal. “We will vigorously investigate and prosecute anyone who blatantly exploits the privacy of others in order to steal benefits from insurance providers.”
As a result of Marrero’s alleged scheme, he received more than $46,000 in payments from United Healthcare.
The scheme was uncovered when a United Healthcare member claimed a doctor had billed her insurance for services that were never rendered. A review of billing records for the doctor and PA Clinical Center led investigators to Marrero, who is listed with the NJ Department of Treasury as PA Clinical’ s registered agent.
“It’s astounding that anyone would think they could get away with this kind of wholesale corruption of the insurance system,” said Acting Insurance Fraud Prosecutor Tracy M. Thompson. “Nothing about these claims for medical services was legitimate; not the doctor who allegedly performed them; not the patients who allegedly received them, not even the facility in which they were allegedly performed. As this case demonstrates, we will vigorously investigate these phantom claims all the way back to their illegal sources to bring the perpetrators to justice.”
Second-degree crimes carry a sentence of five to ten years in state prison and a fine of up to $15,000, while third-degree crimes carry a sentence of three to five years in state prison and a fine of up to $15,000, and fourth-degree crimes carry a sentence of up to eighteen months in state prison and a criminal fine of up to $5,000. The indictment is merely an accusation and the defendant is presumed innocent until proven guilty.
Deputy Attorney General Charles Wright presented the case to the grand jury.
Detectives Justin Callahan and James Mahady coordinated the investigation.
Acting Insurance Fraud Prosecutor Thompson thanks United Healthcare for their assistance in this case.
Acting Insurance Fraud Prosecutor Thompson 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.
Source: N.J. Office of the Attorney General