A New Jersey neurologist has been charged with allegedly paying a “runner” to bring him patients and then falsifying the treatment provided to the patients on claims to the insurance company, New Jersey Acting Attorney General John J. Hoffman and the Office of the Insurance Fraud Prosecutor (OIFP) announced.
Authorities said Dr. Dan Dumitru was arrested on Oct. 23, one day after a state grand jury charged him with two counts of health care claims fraud (second degree), two counts of criminal use of runners (third degree), two counts of falsification of medical records (fourth degree), and one count each of conspiracy to use a runner (third degree) in an alleged scam exposed by undercover OIFP detectives.
As charged in the indictment, Dumitru allegedly paid a runner to recruit patients to his Big Apple Neurology office in Jersey City, New Jersey.
Authorities said that unbeknownst to Dumitru, the “patients” delivered by the runner were actually undercover detectives for the OIFP. Dumitru treated two undercover officers then overbilled their insurance company for the care he provided.
Dumitru allegedly provided two undercover detectives with medical treatment in the spring of 2015. Both detectives complained of nerve trouble in their hands and both times Dumitru performed non-needle nerve testing on the patients, as charged in the indictment. But when Dumitru submitted the invoices to Horizon Blue Cross/Blue Shield he falsely claimed to have performed more costly needle testing, the indictment charges.
“It’s fraud like this that corrupts the insurance system and causes New Jersey’s consumers to suffer increased insurance rates,” said New Jersey Acting Attorney General Hoffman. “The fact that a member of the medical profession allegedly chose to enrich himself with undeserved insurance payments instead of providing proper care to his patients is especially disturbing.”
Dumitru was also charged with violating New Jersey’s “anti-running statute,” which imposes criminal penalties for acting as a runner or using, directing, or employing a runner.
The statute defines a runner as a person who attempts to procure a patient at the direction of, request of or in cooperation with a health care professional in exchange for a pecuniary benefit, when the health care professional intends to assert a claim against an insured person or an insurance carrier for providing services to the patient.
The anti-running statute carries a presumptive sentence of three to five years in state prison, as well as other penalties.
Dumitru met with the runner, who is an unindicted co-conspirator in the case, on several occasions and agreed to pay $100 for each patient, even though the doctor appeared to be aware that his actions were against the law, as charged in the indictment.
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, while fourth-degree crimes carry a maximum sentence of 18 months in prison and a $10,000 fine.
Source: New Jersey Office of the Attorney General, New Jersey Office of the Insurance Fraud Prosecutor
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