A New Jersey woman was sentenced on May 1 for fraud involving health care claims over a two-year period. According to court documents in Freehold, the woman turned in fraudulent claims to Horizon Blue Cross and Blue Shield of New Jersey. The false claims totaled about $500,000.
The 41-year-old woman, who is a resident of Middletown, was identified as a nurse registered with the state who was able to file the claims by using a physician's name along with the doctor's tax ID and the required business information. She filed 107 claims from March 2011 to March 2013, and the claims totaled $502,740 for the two-year period. According to a representative from the New Jersey attorney general's office, the woman had about $2,600 in real medical costs and saw her doctor six times over the years noted in the court file.
The state attorney general maintained the nurse lied to Blue Cross and Blue Shield in excess of 100 times to illegally profit from the endeavor. The defendant said she was able to put $141,126 in fraudulent payments in her bank account.
The nurse pleaded guilty to the charges of fraud involving claims for health care in October 2014. She was sentenced in superior court in Freehold to three years prison time.
Submission of claims for health care that are fraudulent is illegal and punishable by penalties, including prison time. As in this case, using a physician's information to submit the claims for one's own benefit compounds the issue.
When allegations are brought against an individual for white-collar crimes such as these, it may be beneficial to speak with an attorney. The attorney might review the case to develop a defense strategy. This might include a plea deal. This agreement, if accepted, might incorporate decreased charges and reduced penalties.
Source: NJ.com, "Middletown woman sentenced to prison for $500K health insurance scam," MaryAnn Spoto, May 2, 2015