N.J. Neurologist Accused of Filing Fraudulent Bills to Insurers

February 9, 2016

Authorities 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.

New Jersey Acting Attorney General John Hoffman and the Office of Insurance Fraud Prosecutor made the announcement Tuesday.

Authorities said 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, 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 indictment said 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 2011 and 2013 to: 21st Century Insurance Co., Travelers Insurance Co., Encompass Insurance Co., and Metropolitan Life Insurance Co.

The theft by deception charges stem from the above claims and earlier claims submitted to: Allstate Insurance Co., Farmers Insurance Co., Progressive Insurance Co., AIG Insurance Co., and NJ Cure Insurance Co.

“The integrity of physicians is the lynchpin of the health care claims process,” said New Jersey Acting Attorney General Hoffman. “Doctors who file false claims undermine that system and drive up health care costs for honest participants.”

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.

Source: New Jersey Office of the Attorney General


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