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For Immediate Release:  
For Further Information Contact:
April 5, 2005

Office of The Attorney General
- Peter C. Harvey, Attorney General
Division of Criminal Justice
- Vaughn L. McKoy, Director
Office of the Insurance Fraud Prosecutor
- Greta Gooden Brown, Insurance Fraud Prosecutor

 

John R. Hagerty
609-984-1936

 

Hudson County Man Sentenced to Nine Years for $300,000 Insurance Fraud and Theft

TRENTON - Attorney General Peter C. Harvey announced that a Hudson County businessman has been sentenced to nine years in State Prison for submitting more than 400 fraudulent health insurance claims totaling more than $300,000 in illegal payments.

According to Vaughn L. McKoy, Director, Division of Criminal Justice and Insurance Fraud Prosecutor Greta Gooden-Brown, James Clark, 49, Mountain Road, Union City, Hudson County, was sentenced by Essex County Superior Court Judge Michael A. Petrolle to nine years in State Prison and ordered to pay a $5,000 fine. Clark was sentenced on April 1 after being found guilty on charges of theft by deception and Health Care Claims Fraud after aFeb. 10 jury trial.

Insurance Fraud Prosecutor Gooden-Brown said that the Essex County jury found that between Dec. 1, 1996 and Sept. 11, 1998, Clark, as president of Home Health Care Center, Inc., located on First Street, Hoboken, Hudson County, misrepresented to Horizon Blue Cross/Blue Shield (which administers health care claims for the State Health Benefits Program) that Home Health Care was licensed to supply, dispense, and sell prescription medications which were delivered to patients and was entitled to payment or reimbursement from the State Health Benefits Plans for the cost of the medications. Home Health Care Center was in business to deliver prescription medications from pharmacies to person’s homes and was not licensed to dispense or otherwise sell prescription medications. Clark was neither a medical service provider nor a licensed pharmacist.

An investigation by the Office of Insurance Fraud Prosecutor determined that Clark submitted more than 400 fraudulent insurance claims for various medications -- approximately 330 of which may have been for medications that were never dispensed and never delivered to patients. The total amount of the fraudulent billings submitted by Clark to the State Health Benefits Program was in excess of $365,000, of which more than $343,000 was paid.

The investigation was conducted by the Division of Criminal Justice - Office of the Insurance Fraud Prosecutor which investigates and prosecutes civil and criminal insurance fraud cases. State Investigators David Hiestand and Natalie Brotherston and Deputy Attorneys General Steven B. Farman and Joan Burke were assigned to the investigation. The case was referred by Horizon Blue Cross/Blue Shield to the Office of the Insurance Fraud Prosecutor for investigation.

“Part of the reason health care and prescription insurance is not available to many people is because of the added expense of insurance fraud,” Fraud Prosecutor Gooden-Brown said. “In this case the amount of the fraud was shocking in that health care claims were submitted for medications not provided and for costs grossly inflated.”

www.NJInsuranceFraud.org

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