NJ Attorney General: Physician indicted for defrauding medical insurance
Acting New Jersey Attorney General John Jay Hoffman, a Republican, announced on July 2, 2013 that his office’s insurance fraud prosecuting attorney was handed a state grand jury’s indictment that charges a Passaic County medical doctor with the alleged billing of a health insurance provider for procedures, treatments and other services that were never performed on patients.
Dr. Mohammad Ibrahim, 46, of Clifton, is charged with a whopping 151 counts of second-degree health care claims fraud. He is also charged with one count each of third-degree Medicaid fraud and third-degree theft by deception.
“Today’s indictment sends a clear message that we will continue to aggressively investigate and prosecute those who abuse the Medicaid program, including licensed professionals,” said Acting Attorney General Hoffman in a press statement. “We are vigorously committed to prosecuting cases of this nature because money stolen from Medicaid is money stolen from all of us,” the Gov. Chris Christie appointee added.
Deputy Attorney General Peter Sepulveda and Detective Audrey Young coordinated the investigation. Acting Insurance Fraud Prosecutor Ronald Chillemi thanked Amerigroup for referring the matter to the Medicaid Fraud Control Unit within the Office of the Insurance Fraud Prosecutor.
According to the grand jury indictment: between Aug. 1, 2008 and Dec. 31, 2009, Ibrahim, the owner of West Paterson Specialty Clinic in Woodland Park, submitted a total of 151 fraudulent claims for 40 patients for services that were never given.
The indictment alleges that Ibrahim received payment from Medicaid for examinations, evaluations, procedures or tests that had not been provided. Dr. Ibrahim’s bills were submitted to Amerigroup, a managed care organization that offers insurance coverage to Medicaid beneficiaries. As a result of the alleged fraud, Ibrahim allegedly received $43,790 to which he was not entitled.
According to ACAMS Today, “Fraud has long been a favorite of organized criminal groups in the U.S. and around the world. Fraud is a very broad topic and it is manifested in many ways.”
Some of the most applicable types of fraud related to this topic include:
- Immigration fraud
- Identify theft/fraud
- Medicare and healthcare fraud
- Intellectual property rights violations
- Trafficking in counterfeit cigarettes
- Defrauding government social programs
- False invoicing
- Credit card fraud and skimming
- Online fraud
- Mortgage fraud
- Charitable fraud
- Fraudulent insurance claims, staged crashes, etc.
“Today, Strike Force operations have charged doctors, nurses, health care executives, and others—from Los Angeles to New York and cities in between—with engaging in Medicare fraud schemes that cheat taxpayers and patients alike,” said U.S. Assistant Attorney General Lanny A. Breuer. “With this nationwide takedown and the expansion of the Strike Force to two additional cities, our message is clear: we are determined to put Medicare fraudsters out of business.”
