Man Charged with Assuming Identity of N.J. Doctor in $1M Insurance Fraud Scheme

July 13, 2018

A Florida man has been charged with assuming the identity of a New Jersey doctor to submit more than $1 million in fraudulent medical claims for services allegedly rendered at a Morris County medical center that, in reality, did not exist.

Yoandi Marrero, of Hialeah, Fla., and PA Clinical Center Inc., the registered company he is said to have used to front the phantom medical practice, were charged with insurance fraud and attempted second degree theft by deception, third degree theft by deception, and fourth degree identity theft in an indictment handed up by a state Grand Jury in Trenton, N.J. Marrero was also charged with fourth degree identity theft in the alleged scheme. The indictment is merely an accusation, and the defendant is presumed innocent until proven guilty.

“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 New Jersey Attorney General Gurbir S. Grewal in a press release issued by his office. “We will vigorously investigate and prosecute anyone who blatantly exploits the privacy of others in order to steal benefits from insurance providers.”

Marrero allegedly used the personal information of a Hudson County family physician to submit fraudulent insurance claims to United Healthcare Insurance Company 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.

According to prosecutors, neither the doctor nor the patients who were said to have 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.

As a result of Marrero’s 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 in the release. “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.”

In New Jersey, 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. Fourth-degree crimes in New Jersey carry a sentence of up to eighteen months in state prison and a criminal fine of up to $5,000.

Deputy Attorney General Charles Wright presented the case to the grand jury. Detectives Justin Callahan and James Mahady coordinated the investigation.

Source: New Jersey Office of the Attorney General

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